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Age-Related Response to Remimazolam among Older Patients Undergoing Orthopedic Surgery: A Single-Center Prospective
Min Suk Chae1, Nuri Lee1, Hyun Jung Koh1
1Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Abstract:
Background and Objectives: Remimazolam, an ultra-short-acting benzodiazepine, is increasingly used in procedural sedation and general anesthesia. It is characterized by rapid onset of action, inactive metabolites, no delay in recovery, and few adverse events. Its hemodynamic and respiratory stability are comparable to other anesthetics, and it is safe in high-risk and geriatric patients. Materials and Methods: This prospective, observational study enrolled 110 geriatric patients (aged 65 to 85 years) scheduled for primary total knee arthroplasty (TKA). The patients were divided into the old (65 to <75 years; n = 52) and the elderly (75 to 85 years; n = 47) geriatric groups. All surgical and anesthetic methods were applied in the same manner, and TKA was performed by one surgeon. Remimazolam was infused at 6 mg/kg/h for 3 min and then at 1 mg/kg/h until the end of surgery The primary study endpoint was the requirement for flumazenil; secondary endpoints were the times to reach a bispectral index (BIS) < 60 and >80, as well as the rate of apnea occurrence. Results: Flumazenil administration was similar in both groups. There were no differences in the time to reach BIS < 60 or the rate of apnea occurrence. Recovery characteristics, including the time to reach BIS > 80 and the achievement of full consciousness, were also comparable between the groups. Conclusions: Remimazolam is well-tolerated in geriatric patients undergoing orthopedic surgery, with minimal age-related differences in response. These results suggest that remimazolam is an appropriate anesthetic for geriatric patients, even with similar dosing strategies. It provides effective anesthetic depth with no significant increases in adverse outcomes during orthopedic surgery.
Insights
Remimazolam is a safe and effective anesthetic for geriatric patients undergoing orthopedic surgery, with no significant age-related differences in response or adverse events. This ultra-short-acting benzodiazepine ensures stable hemodynamics and rapid recovery.
Area of Science:
- Anesthesiology
- Geriatric Medicine
- Pharmacology
Background:
- Remimazolam is an ultra-short-acting benzodiazepine used for procedural sedation and general anesthesia.
- It offers rapid onset, inactive metabolites, quick recovery, and a favorable safety profile, even in high-risk and elderly patients.
- Its hemodynamic and respiratory stability are comparable to existing anesthetics.
Purpose of the Study:
- To evaluate the safety and efficacy of remimazolam in geriatric patients undergoing total knee arthroplasty (TKA).
- To compare the anesthetic response and recovery characteristics between younger (65-74 years) and older (75-85 years) geriatric groups.
- To assess the need for flumazenil, time to achieve specific Bispectral Index (BIS) levels, and apnea rates.
Main Methods:
- A prospective, observational study involving 110 geriatric patients scheduled for primary TKA.
- Patients were divided into two groups: 65 to <75 years (n=52) and 75 to 85 years (n=47).
- Remimazolam infusion protocol: 6 mg/kg/h for 3 min, then 1 mg/kg/h. Standardized surgical and anesthetic procedures were used.
Main Results:
- Flumazenil administration was similar between the age groups.
- No significant differences were observed in the time to reach BIS < 60 or the incidence of apnea.
- Recovery metrics, including time to BIS > 80 and full consciousness, were comparable across both geriatric groups.
Conclusions:
- Remimazolam is well-tolerated in geriatric patients undergoing orthopedic surgery, with minimal age-related variations in response.
- The anesthetic provides effective depth without significant adverse outcomes, supporting its use in this population.
- Similar dosing strategies appear appropriate for both younger and older geriatric patients.
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