TL;DR
Remimazolam did not appear to increase POD over the first 7 postoperative days compared with saline, although the study was not powered to detect modest differences.
Objectives: The objective of the study was to assess the effectiveness and safety of dexmedetomidine versus midazolam for sedation during regional anesthesia surgery. Methods: This prospective randomized comparative interventional study was conducted in the Department of Anesthesiology at a tertiary care hospital from January 2025 to January 2026. 100 adult patients undergoing elective surgeries under regional anesthesia were randomly divided into two groups: Group D (dexmedetomidine, n=50) and Group M (midazolam, n=50). Richmond agitation sedation scale (RASS) was used to evaluate sedation. Intraoperative monitoring of hemodynamic parameters, such as mean arterial pressure and heart rate, was performed. Recovery characteristics, patient satisfaction, requirement for rescue sedation and adverse effects were also assessed. Results: The mean intraoperative RASS score was significantly lower in the Group D than in the Group M (−2.8±0.5 vs. −2.5±0.7; p=0.02). The time required to reach the target sedation level was significantly greater in Group D (9.4±2.6 min vs. 7.8±2.4 min; p=0.003). The scores of patient satisfaction with dexmedetomidine use were significantly greater than with midazolam use (8.5±1.0 vs. 7.9±1.2; p=0.01). Dexmedetomidine was associated with more adverse effects of bradycardia (p=0.08) and hypotension (p=0.46), whereas midazolam was associated with more adverse effects of excessive sedation (p=0.14) and restlessness (p=0.09). Conclusion: Dexmedetomidine and midazolam were both found to be effective sedatives for patients undergoing regional anesthetic. Dexmedetomidine was found to be a more effective sedative, well tolerated, more patient-satisfying and more stable for intraoperative hemodynamic despite its comparatively slower onset of sedation than midazolam.
Importance Postoperative delirium is a common and serious neurocognitive complication in elderly arthroplasty patients, with preoperative poor sleep as a key risk factor. Effective preoperative prevention strategies remain an urgent clinical need. Objective To assess preoperative intranasal dexmedetomidine for preventing postoperative delirium in older adults undergoing hip or knee arthroplasty. Design This trial was conducted at a single tertiary academic hospital in China from January 10, 2025 to June 10, 2025, with follow-up assessments performed from admission to 7 days after surgery. Setting This was a single-center, double-blind, placebo-controlled randomized trial. Participants 232 elderly patients aged 60 years or older, with American Society of Anesthesiologists (ASA) status 1 to 3, scheduled for total hip or knee arthroplasty under general anesthesia were enrolled and randomized 1:1 after eligibility screening. Interventions Intranasal dexmedetomidine(100 μg total dose) or normal saline, administered at 21:00 on the night before surgery. Main Outcomes and Measures The primary outcome was the incidence of postoperative delirium within 3 postoperative days, evaluated by the Confusion Assessment Method. Secondary outcomes included postoperative delirium incidence within 7 days, duration, severity, subtype, perioperative sleep quality, pain, anxiety, quality of recovery, time to ambulation, and adverse events. Results In the intention-to-treat analysis, the postoperative delirium incidence within 3 days was 10.3% in the dexmedetomidine group and 20.7% in the placebo group [relative risk=0.50; 95% confidence interval (CI)=0.26–0.95; P=0.030]. Intranasal dexmedetomidine could improve sleep quality and reduce preoperative and postoperative anxiety and pain. No severe adverse events or nasal mucosal injuries were observed in either group. Conclusion Intranasal dexmedetomidine on the night before surgery could reduce the incidence of postoperative delirium and improve perioperative sleep quality in older patients undergoing joint arthroplasty. Sleep improvement may partly explain this association, suggesting a potential supportive strategy for delirium prevention. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2500095414.
INTRODUCTION Remimazolam tosylate is an ultra-short-acting benzodiazepine sedative and anaesthetic. The related drug, midazolam, is associated with delirium but it remains unclear whether remimazolam also promotes delirium. We tested the primary hypothesis that remimazolam is non-inferior to propofol for delirium in patients during the initial 3 days after lung resection surgery. Secondary outcomes were the proportion of delirium-positive assessments; duration of stay in the post-anaesthesia care unit; and hospital and Mini-mental State Examination scores at 30 days. METHODS We randomly allocated patients aged ≥ 65 y to remimazolam or propofol anaesthesia for lung resection surgery. Delirium was assessed by trained assessors blinded to trial treatment using the Confusion Assessment Method in the post-anaesthesia care unit and twice daily for 3 postoperative days. Our non-inferiority margin was a 10% absolute difference in the incidence of postoperative delirium. RESULTS The modified intent-to-treat population included 455 patients. Delirium occurred in 108/227 (48%) patients allocated to the remimazolam group and 71/228 (31%) in those allocated to the propofol group (risk ratio 1.53, 95%CI 1.21-1.94). The absolute risk difference was 16.5% (95%CI 7.7-25.3%) which considerably exceeded our non-inferiority margin; therefore, non-inferiority was not established. Emergence delirium was more frequent in patients allocated to remimazolam (105/227 (46%) vs. 64/228 (28%); risk ratio 1.65, 95%CI 1.28-2.12), whereas delirium after post-anaesthesia care unit discharge was uncommon and similar between groups (9/227 (4%) vs. 12/228 (5%); risk ratio 0.75, 95%CI 0.32-1.75). Delirium-positive assessments occurred in 129/1377 (9%) patients allocated to the remimazolam group and 102/1440 (7%) in those allocated to the propofol group (risk ratio 1.36, 95%CI 0.96-1.91). DISCUSSION Remimazolam was not non-inferior to propofol for postoperative delirium in older patients having lung resection surgery and provoked more emergence delirium.
BACKGROUND Elderly patients undergoing laparoscopic cholecystectomy (LC) are more vulnerable to hemodynamic instability and anesthesia-related adverse events. Remimazolam benzenesulfonate may be a useful alternative to propofol, but comparative evidence remains limited. AIM To compare the efficacy and safety of remimazolam benzenesulfonate and propofol in elderly patients undergoing LC. METHODS A total of 120 elderly patients scheduled for LC were randomized based on random number table and opaque sealed envelopes into 2 groups (n = 60 each): A propofol control group (CG) and a remimazolam benzenesulfonate observation group (OG). Anesthesia induction was intravenous propofol (1.5 mg/kg) or remimazolam benzenesulfonate (0.2 mg/kg), and rocuronium bromide (0.6 mg/kg) and sufentanil (0.4 ug/kg) in both groups. Anesthesia maintenance included targeted intravenous infusion of the assigned sedatives with remifentanil; intermittent rocuronium was used to keep a train-of-four ratio of ≤ 0.2. The primary outcome was mean arterial pressure (MAP). Secondary outcomes: Oxygen saturation, heart rate (HR), Bispectral index (BIS), perioperative use of vasoactive drugs, Riker Sedation-Agitation Scale (RSAS), Visual Analogue Scale (VAS), Mini Mental State Examination (MMSE), and incidence of adverse reactions. RESULTS After applying the predefined inclusion and exclusion criteria, 59 patients in both groups completed the trial. Relative to the CG, the OG had a longer induction time and delayed attainment of BIS < 60 (P < 0.05). However, the OG was found to have more stable MAP and HR throughout the perioperative period, lower consumption of vasoactive agents, and fewer adverse events (P < 0.05). Post-extubation RSAS scores were also lower in the OG (P < 0.05). Postoperatively, the OG had greater MMSE scores at 6 hours and lower VAS pain scores at 1 hour and 6 hours (P < 0.05). No significant variances between groups were revealed at other time points. CONCLUSION Relative to propofol, remimazolam benzenesulfonate has more stable hemodynamics and a lower incidence of adverse reactions during total intravenous anesthesia in elderly patients undergoing LC. While remimazolam showed benefits in early postoperative recovery, cognitive function, and pain control, these benefits were lost over time.
In this selected population of older patients undergoing ERCP, the remimazolam-esketamine regimen was associated with fewer composite SRAEs than propofol-fentanyl while achieving a similar anesthetic regimen success rate.
Remimazolam significantly shortened recovery time and reduced flumazenil use in elderly patients, which may reduce staff workload after ERCP; larger studies are needed to establish comparative safety.
We use cookies to run the site and, with your consent, for analytics and to show ads. See our Cookie Policy.
