Effects of remimazolam and sevoflurane on postoperative delirium and early cognitive impairment in elderly patients after laparoscopic-assisted gastrointestinal surgery: a randomized clinical trial.

BACKGROUND

Postoperative delirium (POD) is a prevalent complication after surgery and anesthesia in elderly patients. Remimazolam and sevoflurane are two commonly used general anesthetics. This study aimed to evaluate the effects of remimazolam and sevoflurane on POD and early postoperative cognitive function in elderly patients.

METHODS

A total of 90 patients scheduled for laparoscopic-assisted gastrointestinal surgery under general anesthesia were recruited, and randomly assigned into three groups (n = 30 for each group): remimazolam (R), sevoflurane (S), and remimazolam combined with sevoflurane (RS) groups. After surgery, the incidence of POD and early postoperative cognitive impairment, postoperative pain score, recovery quality score, intraoperative drug dosage, and the incidence of intraoperative adverse reactions were assessed.

RESULTS

No significant differences were observed in the POD incidence (p = 0.654), occurrence time (p = 0.985), duration (p = 0.355), and classification (p = 1.000) among the R, S, and RS groups. The incidence of delayed recovery of post-operative cognitive function also did not differ significantly among the three groups (p = 0.616). Additionally, the incidence of intraoperative hypotension was lower, and the use of vasoactive drugs was reduced in the R group (p < 0.05). When combined with sevoflurane, the induction and maintenance doses of remimazolam were reduced, and the time to loss of consciousness was shortened (p < 0.05)..

CONCLUSION

Remimazolam was not associated with an increased incidence of POD or delayed recovery of early cognitive function in elderly patients. Moreover, it had a less pronounced impact on circulation compared to sevoflurane.

CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn/showproj.html?proj=174731, identifier ChiCRT2200064984.