Purpose <p>The anesthetic management combining remimazolam and neuromuscular blocking agents with sugammadex is expected to enhance the speed and safety of recovery from anesthesia. However, the effect of remimazolam on reversal of neuromuscular blockade with sugammadex remains unclear. We hypothesized that sugammadex could reverse rocuronium-induced neuromuscular blockade even under remimazolam anesthesia, although the recovery might be delayed. In the present study, the recovery time from rocuronium-induced neuromuscular blockade after administration of sugammadex under remimazolam anesthesia was compared with that under propofol anesthesia.</p> Methods <p>Twenty-six patients over 18&#xa0;years old scheduled for elective gynecological laparotomy under general anesthesia combined with epidural anesthesia were prospectively randomly assigned to remimazolam and propofol groups. After induction of general anesthesia with remifentanil and remimazolam or remifentanil and propofol, followed by their continuous infusion for anesthesia maintenance, train-of-four (TOF) responses were monitored following 0.9&#xa0;mg/kg rocuronium administration. During surgery, rocuronium was infused continuously to maintain a TOF count of 1. At the end of surgery, when TOF counts of 2 were confirmed, sugammadex 2&#xa0;mg/kg was administered and time to recovery of the TOF ratio to ≥ 90% of the baseline TOF ratio was compared between the two groups.</p> Results <p>Median (interquartile range) recovery times in the remimazolam and propofol groups were 3.0 (2.3 to 3.8) and 2.5 (2.0 to 3.3) min, respectively (P = 0.62).</p> Conclusion <p>Remimazolam anesthesia may not delay the efficacy of sugammadex in reversing rocuronium-induced neuromuscular blockade compared with propofol anesthesia.</p> Clinical trial number and registry URL <p>The Japan Registry of Clinical trials (jRCT1071230073). URL: <a href="https://jrct.niph.go.jp/latest-detail/jRCT1071230073">https://jrct.niph.go.jp/latest-detail/jRCT1071230073</a>.</p>