{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T06:09:58Z","timestamp":1775628598096,"version":"3.50.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sichuan Medical Association Special Project Fund for Analgesia and Sedation","award":["2024RF08"],"award-info":[{"award-number":["2024RF08"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n \n Alfentanil is a short-acting\n \u03bc<\/jats:italic>\n -opioid receptor agonist that can be used synergistically with other sedatives. This study aimed to investigate the clinical efficacy of an alfentanil-remimazolam combination for first-trimester surgical abortion (vacuum aspiration) under intravenous anesthesia.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A total of 120 patients undergoing first-trimester surgical abortion under intravenous anesthesia at our hospital were recruited between January 1, 2025 and June 30, 2025, and were randomly assigned to two groups: the alfentanil-remimazolam group (AF-RMZ,\n n<\/jats:italic>\n \u202f=\u202f60) and the fentanyl-remimazolam group (F-RMZ,\n n<\/jats:italic>\n \u202f=\u202f60). The AF-RMZ group received alfentanil (10\u202f\u03bcg\u202fkg\n \u22121<\/jats:sup>\n ) combined with remimazolam (0.3\u202fmg\u202fkg\n \u22121<\/jats:sup>\n ), while the F-RMZ group received fentanyl (1\u202f\u03bcg\u202fkg\n \u22121<\/jats:sup>\n ) combined with remimazolam (0.3\u202fmg\u202fkg\n \u22121<\/jats:sup>\n ). The primary outcome was emergence time from anesthesia. Secondary outcomes included intravenous anesthesia induction time, total remimazolam dose, Visual Analog Scale (VAS) score at 30\u202fmin after awakening, and adverse events, including low pulse oximetry (SpO\u2082), bradycardia, hypotension, somatomotor response, and postoperative nausea and vomiting (PONV).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The AF-RMZ and F-RMZ groups had comparable demographic characteristics. AF-RMZ showed shorter induction (37.97\u202f\u00b1\u202f4.38\u202fs) and emergence times (68.40\u202f\u00b1\u202f47.01\u202fs) and reduced discharge time (36.38\u202f\u00b1\u202f5.31\u202fmin) compared with F-RMZ, while total remimazolam use and postoperative 30-min VAS scores were similar. Heart rate and respiratory rate exhibited significant group-time interactions, whereas mean arterial pressure remained comparable. Peripheral oxygen saturation was transiently higher in the F-RMZ at early time points. All SpO\u2082 values remained clinically acceptable, supporting monitored respiratory safety. Adverse events were mild, with a lower incidence of somatomotor response in AF-RMZ (8.3% vs. 21.7%,\n p<\/jats:italic>\n \u202f=\u202f0.036).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Alfentanil combined with remimazolam showed a slight advantage in anesthesia induction and emergence times, with comparable postoperative recovery, clinically stable hemodynamics, and safety profiles compared with fentanyl\u2013remimazolam in outpatient gynecological procedures; however, the clinical impact of these differences may be limited.<\/jats:p>\n <\/jats:sec>\n \n Clinical trial registration<\/jats:title>\n \n https:\/\/www.chictr.org.cn<\/jats:ext-link>\n , identifier ChiCTR2400094571.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1796064","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T05:32:55Z","timestamp":1775626375000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative effects of alfentanil-remimazolam versus fentanyl-remimazolam on anesthesia onset, emergence, and safety in first-trimester surgical abortion under intravenous anesthesia: a randomized controlled trial"],"prefix":"10.3389","volume":"13","author":[{"given":"Weijie","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Mianyang 404 Hospital","place":["Mianyang, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Mianyang 404 Hospital","place":["Mianyang, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kangning","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Mianyang 404 Hospital","place":["Mianyang, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyi","family":"Pang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Mianyang 404 Hospital","place":["Mianyang, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5281\/zenodo.10278156","article-title":"Association between induced abortion and depression: a systematic review and meta-analysis","volume":"62","author":"Montoya-Gambini","year":"2024","journal-title":"Rev Med Inst Mex Seguro Soc"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"690875","DOI":"10.3389\/fphar.2021.690875","article-title":"Remimazolam: non-clinical and clinical profile of a new sedative\/anesthetic agent","volume":"12","author":"Kilpatrick","year":"2021","journal-title":"Front Pharmacol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"275","DOI":"10.2165\/00003088-199631040-00004","article-title":"Clinical pharmacokinetics of alfentanil, fentanyl and sufentanil. An update","volume":"31","author":"Scholz","year":"1996","journal-title":"Clin Pharmacokinet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1036840","DOI":"10.3389\/fphar.2022.1036840","article-title":"The safety and efficacy of alfentanil combined with midazolam in fiberoptic bronchoscopy sedation: a randomized, double-blind, controlled trial","volume":"13","author":"Wang","year":"2022","journal-title":"Front Pharmacol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"5653","DOI":"10.2147\/DDDT.S508941","article-title":"Alfentanil enhanced the sedation of remimazolam during anaesthesia induction in patients undergoing urological day surgery: a randomised controlled trial","volume":"19","author":"Lin","year":"2025","journal-title":"Drug Des Devel Ther"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e079095","DOI":"10.1136\/bmjopen-2023-079095","article-title":"Safety and efficacy of remimazolam tosilate combined with low-dose fentanyl for procedural sedation in obese patients undergoing gastroscopy: study protocol for a single-centre, double-blind, randomised controlled trial","volume":"13","author":"Yan","year":"2023","journal-title":"BMJ Open"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1111\/j.1399-6576.1990.tb03036.x","article-title":"Analgesia for appendectomy: comparison of fentanyl and alfentanil in children","volume":"34","author":"Sfez","year":"1990","journal-title":"Acta Anaesthesiol Scand"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"7102293","DOI":"10.1155\/2022\/7102293","article-title":"Efficacy and safety of remimazolam besylate combined with alfentanil in painless gastroscopy: a randomized, single-blind, parallel controlled study","volume":"2022","author":"Xu","year":"2022","journal-title":"Contrast Media Mol Imaging"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1186\/s12871-022-01805-3","article-title":"Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial","volume":"22","author":"Xin","year":"2022","journal-title":"BMC Anesthesiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.bpobgyn.2019.11.008","article-title":"Modern methods to induce abortion: safety, efficacy and choice","volume":"63","author":"Kapp","year":"2020","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"126","DOI":"10.26355\/eurrev_202401_34898","article-title":"Comparison of different dosages of propofol combined with its equivalent alfentanil in outpatient abortion: a prospective, double-blinded, randomized trial","volume":"28","author":"Jin","year":"2024","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"ref12","first-page":"581","article-title":"Clinical uses of fentanyl, sufentanil, and alfentanil","volume":"10","author":"Clotz","year":"1991","journal-title":"Clin Pharm"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1097\/01.anes.0000267503.85085.c0","article-title":"CNS 7056: a novel ultra-short-acting benzodiazepine","volume":"107","author":"Kilpatrick","year":"2007","journal-title":"Anesthesiology"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1097\/ALN.0000000000003103","article-title":"Pharmacokinetics and pharmacodynamics of remimazolam (CNS 7056) after continuous infusion in healthy male volunteers: part I","volume":"132","author":"Sch\u00fcttler","year":"2020","journal-title":"Pharmacokinet Clin Pharmacodyn Anesthesiol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1186\/s12871-024-02746-9","article-title":"Comparison of hypotension between propofol and remimazolam-propofol combinations sedation for day-surgery hysteroscopy: a prospective, randomized, controlled trial","volume":"24","author":"Tan","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1607279","DOI":"10.3389\/fped.2025.1607279","article-title":"The effects of alfentanil on emergence agitation in children under general anesthesia: a meta-analysis of randomized controlled trials","volume":"13","author":"Xu","year":"2025","journal-title":"Front Pediatr"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1653593","DOI":"10.3389\/fphar.2025.1653593","article-title":"Combination of remazolam and alfentanil on hemodynamics, postoperative cognitive function, and adverse cardiovascular events in elderly patients undergoing laparoscopic cholecystectomy: a randomized controlled trial","volume":"16","author":"Liu","year":"2025","journal-title":"Front Pharmacol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1186\/s12871-025-03217-5","article-title":"The median effective dose (ED50) and the 95% effective dose (ED95) of alfentanil in inhibiting responses to cervical dilation when combined with ciprofol during hysteroscopic procedure: a prospective, double-blind, dose-finding clinical study","volume":"25","author":"Gao","year":"2025","journal-title":"BMC Anesthesiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e37627","DOI":"10.1097\/MD.0000000000037627","article-title":"Effectiveness and safety of remimazolam combined with alfentanil in hysteroscopic examination: a prospective, randomized, single-blind trial","volume":"103","author":"Huang","year":"2024","journal-title":"Medicine"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"111077","DOI":"10.1016\/j.jclinane.2023.111077","article-title":"A randomized, controlled clinical trial comparing remimazolam to propofol when combined with alfentanil for sedation during ERCP procedures","volume":"86","author":"Dong","year":"2023","journal-title":"J Clin 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combined with alfentanil for plastic surgery anesthesia cases: a clinical trial","volume":"90","author":"Xu","year":"2023","journal-title":"Ann Plast Surg"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"950564","DOI":"10.3389\/fmed.2022.950564","article-title":"Moderate sedation by total intravenous remimazolam-alfentanil vs. propofol-alfentanil for third molar extraction: a prospective randomized controlled trial","volume":"9","author":"Zhao","year":"2022","journal-title":"Front Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1016\/j.clinthera.2022.09.014","article-title":"Efficacy and safety of the remimazolam-alfentanil combination for sedation during gastroscopy: a randomized, double-blind, single-center controlled trial","volume":"44","author":"Shi","year":"2022","journal-title":"Clin Ther"}],"container-title":["Frontiers in 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