{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T06:35:02Z","timestamp":1763966102917,"version":"3.45.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014718","name":"Innovative Research Group Project of the National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81860218"],"award-info":[{"award-number":["81860218"]}],"id":[{"id":"10.13039\/100014718","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008871","name":"Yunnan Provincial Science and Technology Department","doi-asserted-by":"publisher","award":["202502AS080002","202301AY070001-056","202501AY070001-219","202102AA310068","2023YJZX-GK03","2023YJZX-GK10"],"award-info":[{"award-number":["202502AS080002","202301AY070001-056","202501AY070001-219","202102AA310068","2023YJZX-GK03","2023YJZX-GK10"]}],"id":[{"id":"10.13039\/501100008871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007301","name":"Kunming University of Science and Technology","doi-asserted-by":"publisher","award":["KUST-KH2023026Y"],"award-info":[{"award-number":["KUST-KH2023026Y"]}],"id":[{"id":"10.13039\/501100007301","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Remimazolam is a fast-acting benzodiazepine used for anesthesia and sedation, notable for its quick onset and reversible effects. Its role in wake-up testing during spinal deformity surgery is uncertain. This study assessed the effectiveness and safety of combining remimazolam with propofol during wake-up tests in scoliosis correction surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this randomized trial, 54 scoliosis surgery patients were assigned to receive either propofol alone (Group P), propofol with dexmedetomidine (Group D), or propofol with remimazolam (Group R). Primary outcomes were wake-up time and quality; secondary outcomes included spinal monitoring, cerebral indices, hemodynamic stability, surgery duration, Visual Analog Scale and Behavioral Comfort Scale scores, satisfaction, and postoperative adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean wake-up times varied significantly across groups: 10.58 \u00b1 1.60\u00a0min (Group P), 16.14 \u00b1 2.64\u00a0min (Group D), and 6.69 \u00b1 3.85\u00a0min (Group R) (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001). Post-hoc analysis revealed Group R had significantly shorter wake-up times than Group P (mean difference, 3.9\u00a0min;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0005) and Group D (mean difference, 9.4\u00a0min;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0001). Excellent wake-up quality was reported in 50% of Group P, 100% of Group D, and 94.4% of Group R (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0002). Group R also had a shorter mean operative duration (256.3 \u00b1 74.4\u00a0min) compared to Group P (264.4 \u00b1 60.4\u00a0min) and Group D (310.9 \u00b1 57.9\u00a0min) (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.03). Additionally, Group R showed significantly higher amnesia indices at multiple time points compared to Groups P and D (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05). Hemodynamic assessments revealed that Group D had significantly lower heart rates at T2, T3, and T4 than Groups P and R (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05). Group R also had a higher mean arterial pressure than Group P at T2 (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05). Surgeon satisfaction scores were significantly higher in Group R than in Groups P and D (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0001), and patient satisfaction scores in Group R were higher than in Group P (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0001). No significant differences were observed in other secondary outcomes (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;gt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The remimazolam-propofol combo for intraoperative wake-up testing in scoliosis correction surgery shows superior efficacy with quicker wake-up times, better wakefulness quality, and higher satisfaction, without affecting spinal neurophysiological monitoring. This suggests it as a promising sedative option for spinal deformity surgeries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.chictr.org.cn\/bin\/project\/edit?pid=203900<\/jats:ext-link>\n                      as ChiCTR2300076802.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2025.1685683","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T06:30:07Z","timestamp":1763965807000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Remimazolam combined with propofol for intraoperative wake-up testing in scoliosis correction surgery: a prospective, blind, randomized controlled trial"],"prefix":"10.3389","volume":"16","author":[{"given":"Jing","family":"Luo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Da-Lin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zong-Long","family":"Lv","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong-Hui","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Jin","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin-Nan","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing-Ce","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Bao","family":"Shi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun","family":"Bo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rong-Qian","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"You-Zhi","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheng","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Sen","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hua","family":"Jin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"8","DOI":"10.3389\/fsurg.2017.00008","article-title":"Transcranial motor evoked potentials during spinal deformity corrections-safety, efficacy, limitations, and the role of a checklist","volume":"4","author":"Acharya","year":"2017","journal-title":"Front. Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1097\/ANA.0000000000001009","article-title":"Time to wake up to remimazolam's potential","volume":"37","author":"Allen","year":"2025","journal-title":"J. Neurosurg. Anesthesiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"3072","DOI":"10.1007\/s00586-023-07837-8","article-title":"Intraoperative neurophysiological monitoring in scoliosis surgery: literature review of the last 10 years","volume":"32","author":"Angelliaume","year":"2023","journal-title":"Eur. Spine J."},{"key":"B4","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1016\/j.bjane.2013.10.003","article-title":"Comparison of propofol and midazolam on patients undergoing spinal surgery with intraoperative wake-up test: randomized clinical trial","volume":"65","author":"Canbay","year":"2015","journal-title":"Braz J. Anesthesiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1016\/j.jopan.2016.07.009","article-title":"Impact of dexmedetomidine on intraoperative Wake-Up tests in patients undergoing spinal surgery","volume":"33","author":"Chen","year":"2018","journal-title":"J. Perianesth Nurs."},{"key":"B6","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1111\/pan.14390","article-title":"Recovery characteristics and parental satisfaction in pediatric procedural sedation","volume":"32","author":"Cortellazzo Wiel","year":"2022","journal-title":"Paediatr. Anaesth."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1097\/BRS.0000000000002575","article-title":"Intraoperative neurophysiological monitoring in spine surgery: a systematic review and meta-analysis","volume":"43","author":"Daniel","year":"2018","journal-title":"Spine (Phila Pa 1976)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.rehab.2012.01.003","article-title":"Pathogenesis of idiopathic scoliosis: a review","volume":"55","author":"de Seze","year":"2012","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1007\/s00402-004-0763-5","article-title":"Iatrogenic paraplegia in spinal surgery","volume":"125","author":"Delank","year":"2005","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1097\/00000542-200008000-00016","article-title":"The effects of increasing plasma concentrations of dexmedetomidine in humans","volume":"93","author":"Ebert","year":"2000","journal-title":"Anesthesiology"},{"key":"B11","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1051\/sicotj\/2017057","article-title":"Posterior-only surgical correction of adolescent idiopathic scoliosis: an Egyptian experience","volume":"3","author":"Elnady","year":"2017","journal-title":"SICOT J."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1218","DOI":"10.1097\/BRS.0b013e3181ec5fd9","article-title":"Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: a report of the scoliosis research society morbidity and mortality committee","volume":"36","author":"Hamilton","year":"2011","journal-title":"Spine (Phila Pa 1976)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1007\/s11325-020-02180-4","article-title":"Depth of sedation during drug induced sedation endoscopy monitored by BiSpectral Index(R) and cerebral state Index(R)","volume":"25","author":"Herzog","year":"2021","journal-title":"Sleep. Breath."},{"key":"B14","doi-asserted-by":"publisher","first-page":"3957","DOI":"10.2147\/DDDT.S384155","article-title":"Remimazolam: an updated review of a new sedative and anaesthetic","volume":"16","author":"Hu","year":"2022","journal-title":"Drug Des. Devel Ther."},{"key":"B15","doi-asserted-by":"crossref","first-page":"21","DOI":"10.36076\/ppj.2023.26.21","article-title":"Ultrasound-guided transversus abdominis plane block in treating abdominal skin tension pain after kyphosis surgery: a pilot study in enhanced recovery after surgery setting","volume":"26","author":"Huang","year":"2023","journal-title":"Pain Physician"},{"key":"B16","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1093\/bja\/ael075","article-title":"Propofol-alfentanil vs propofol-remifentanil for posterior spinal fusion including wake-up test","volume":"96","author":"Imani","year":"2006","journal-title":"Br. J. Anaesth."},{"key":"B17","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1016\/j.ajem.2018.01.008","article-title":"A systematic review of the pain scales in adults: which to use?","volume":"36","author":"Karcioglu","year":"2018","journal-title":"Am. J. Emerg. Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1186\/s40981-020-00401-z","article-title":"Intraoperative responses of motor evoked potentials to the novel intravenous anesthetic remimazolam during spine surgery: a report of two cases","volume":"6","author":"Kondo","year":"2020","journal-title":"JA Clin. Rep."},{"key":"B19","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/j.jor.2018.02.003","article-title":"Children's and parents' perspectives of health-related quality of life in newly diagnosed adolescent idiopathic scoliosis","volume":"15","author":"Kontodimopoulos","year":"2018","journal-title":"J. Orthop."},{"key":"B20","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1055\/s-0043-1772168","article-title":"Scoliosis","volume":"27","author":"Lacroix","year":"2023","journal-title":"Semin. Musculoskelet. Radiol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1916","DOI":"10.1097\/01.brs.0000228724.01795.a2","article-title":"Characterization of neurophysiologic alerts during anterior cervical spine surgery","volume":"31","author":"Lee","year":"2006","journal-title":"Spine (Phila Pa 1976)"},{"key":"B22","volume-title":"Effects of ciprofol and propofol on electroencephalographic state index of patients during anesthesia induction [Master\u2019s thesis]","author":"Liu","year":"2024"},{"key":"B23","first-page":"113","article-title":"Clinical application of precise anesthesia implemented by linkage of sedation index and analgesia index","volume":"7","author":"Liu","year":"2017","journal-title":"China Med. Sci."},{"key":"B24","doi-asserted-by":"publisher","first-page":"24514","DOI":"10.52965\/001c.24514","article-title":"A comprehensive review of remimazolam for sedation","volume":"9","author":"Noor","year":"2021","journal-title":"Health Psychol. Res."},{"key":"B25","doi-asserted-by":"publisher","first-page":"e44046","DOI":"10.7759\/cureus.44046","article-title":"Neuromuscular monitoring and Wake-Up test during scoliosis surgery","volume":"15","author":"Paunikar","year":"2023","journal-title":"Cureus"},{"key":"B26","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1097\/CM9.0000000000000652","article-title":"Research progress on the etiology and pathogenesis of adolescent idiopathic scoliosis","volume":"133","author":"Peng","year":"2020","journal-title":"Chin. Med. J. Engl."},{"key":"B27","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1007\/s00132-016-3313-2","article-title":"Surgical treatment of de-novo scoliosis","volume":"45","author":"Putzier","year":"2016","journal-title":"Orthopade"},{"key":"B28","first-page":"855","article-title":"Impact of dexmedetomidine-sevoflurane anesthesia on intraoperative wake-up test in children patients undergoing scoliosis surgery","volume":"48","author":"Quan","year":"2016","journal-title":"Beijing Da Xue Xue Bao Yi Xue Ban."},{"key":"B29","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.ijscr.2016.09.032","article-title":"Pedicle screw position changing policy for nerve injury problems during screw insertion on thoracolumbar compression fractures","volume":"28","author":"Rahyussalim","year":"2016","journal-title":"Int. J. Surg. Case Rep."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1007\/s40262-018-0672-3","article-title":"Clinical pharmacokinetics and pharmacodynamics of propofol","volume":"57","author":"Sahinovic","year":"2018","journal-title":"Clin. Pharmacokinet."},{"key":"B31","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1007\/s00540-021-03021-8","article-title":"Comparison of remimazolam and propofol in anesthetic management for awake craniotomy: a retrospective study","volume":"36","author":"Sato","year":"2022","journal-title":"J. Anesth."},{"key":"B32","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1186\/s40981-020-00398-5","article-title":"Novel anesthetic agent remimazolam as an alternative for the asleep-awake-asleep technique of awake craniotomy","volume":"6","author":"Sato","year":"2020","journal-title":"JA Clin. Rep."},{"key":"B33","doi-asserted-by":"publisher","first-page":"726","DOI":"10.7326\/0003-4819-152-11-201006010-00232","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials","volume":"152","author":"Schulz","year":"2010","journal-title":"Ann. Intern Med."},{"key":"B34","doi-asserted-by":"publisher","first-page":"836","DOI":"10.1007\/s00132-015-3165-1","article-title":"Adolescent scoliosis: from deformity to treatment","volume":"44","author":"Schulze","year":"2015","journal-title":"Orthopade"},{"key":"B35","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1016\/j.spinee.2017.07.005","article-title":"Perils of intraoperative neurophysiological monitoring: analysis of false-negative results in spine surgeries","volume":"18","author":"Tamkus","year":"2018","journal-title":"Spine J."},{"key":"B36","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1097\/00003086-197306000-00017","article-title":"Functional monitoring of spinal cord activity during spinal surgery","volume":"93","author":"Vauzelle","year":"1973","journal-title":"Clin. Orthop. Relat. Res."},{"key":"B37","doi-asserted-by":"publisher","first-page":"107623","DOI":"10.1016\/j.clineuro.2023.107623","article-title":"Comparison of dexmedetomidine and propofol for sedation in awake craniotomy: a meta-analysis","volume":"226","author":"Viderman","year":"2023","journal-title":"Clin. Neurol. Neurosurg."},{"key":"B38","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1097\/00003086-197607000-00018","article-title":"The clinical biomechanics of scoliosis","volume":"118","author":"White","year":"1976","journal-title":"Clin. Orthop. Relat. Res."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1685","DOI":"10.1097\/00007632-199908150-00010","article-title":"Efficacy of intraoperative monitoring for pediatric patients with spinal cord pathology undergoing spinal deformity surgery","volume":"24","author":"Wilson-Holden","year":"1999","journal-title":"Spine (Phila Pa 1976)"},{"key":"B40","doi-asserted-by":"publisher","first-page":"3245","DOI":"10.2147\/JPR.S231596","article-title":"Prediction of hemodynamic reactivity by electroencephalographically derived pain threshold index in children undergoing general anesthesia: a prospective observational study","volume":"12","author":"Wu","year":"2019","journal-title":"J. Pain Res."},{"key":"B41","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.jopan.2024.04.006","article-title":"The study of remazolam combined with propofol on painless gastroscopy: a randomized controlled trial","volume":"40","author":"Wu","year":"2025","journal-title":"J. Perianesth Nurs."},{"key":"B42","doi-asserted-by":"publisher","first-page":"e28993","DOI":"10.1097\/MD.0000000000028993","article-title":"Dexmedetomidine dosage in critically ill patients undergoing intraoperative wake-up test: a randomized controlled trial","volume":"101","author":"Yang","year":"2022","journal-title":"Med. Baltim."},{"key":"B43","doi-asserted-by":"publisher","first-page":"e944632","DOI":"10.12659\/MSM.944632","article-title":"Comparison of remimazolam and dexmedetomidine for sedation in awake endotracheal intubation in scoliosis surgery: a retrospective analysis","volume":"30","author":"Zhou","year":"2024","journal-title":"Med. Sci. Monit."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2025.1685683\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T06:30:08Z","timestamp":1763965808000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2025.1685683\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,24]]},"references-count":43,"alternative-id":["10.3389\/fphar.2025.1685683"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2025.1685683","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,24]]},"article-number":"1685683"}}