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Postoperative delirium under general anaesthesia by remimazolam versus propofol: A systematic review and
Masafumi Suga1, Jun Yasuhara2, Atsuyuki Watanabe3
1Department of Intensive Care, Monash Medical Centre, Melbourne, Australia; Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Centre, Hyogo, Japan.
Background:
Remimazolam, an ultra-short-acting benzodiazepine, has similar clinical effects to propofol for sedation in general anaesthesia. However, it remains uncertain whether remimazolam could increase postoperative delirium (POD) compared with propofol.
Objectives:
The purpose of our study was to compare the incidence of POD between remimazolam and propofol as sedative agents in general anaesthesia.
Study Design:
Systematic review and meta-analysis of randomised controlled trials (RCTs).
Methods:
PubMed, Embase, Cochrane Library, and Web of Science databases were searched for prospective RCTs published through September 16, 2024. RCTs reporting the incidence of POD and comparing remimazolam with propofol for general anaesthesia were included. Odds ratio (ORs) were calculated using a random-effects model. The primary outcome was the incidence of POD. The secondary outcomes included time to extubation, awakening time, and adverse events such as intraoperative hypotension.
Results:
A total of six RCTs involving 1107 patients were included in this meta-analysis. For the primary outcome, the incidence of POD did not differ between the remimazolam and propofol groups (OR, 0.92; 95 % confidence interval [CI], 0.58-1.44). Regarding the secondary outcomes, remimazolam was associated with a lower incidence of intraoperative hypotension compared with propofol (OR, 0.31; 95 % CI, 0.21-0.46). There were no significant differences in other secondary outcomes. In the sensitivity analysis on three RCTs including only older patients (≥60 years old), there was no significant difference in the incidence of POD (OR, 1.00; 95 % CI, 0.52-1.93).
Conclusion:
Perioperative remimazolam administration did not increase POD and reduced the risk of intraoperative hypotension compared to propofol. Further large-scale RCTs are warranted to explore the association of remimazolam and POD. Systematic review protocol: PROSPERO CRD42024544122.
Insights
Remimazolam, an ultra-short-acting sedative, does not increase the risk of postoperative delirium (POD) compared to propofol. This meta-analysis found remimazolam also reduced intraoperative hypotension, suggesting a favorable safety profile.
Area of Science:
- Anesthesiology and critical care medicine
- Pharmacology
- Clinical research
Background:
- Remimazolam is an ultra-short-acting benzodiazepine offering similar sedation to propofol in general anesthesia.
- The comparative effect of remimazolam versus propofol on postoperative delirium (POD) requires clarification.
Purpose of the Study:
- To compare the incidence of POD between remimazolam and propofol when used as sedative agents during general anesthesia.
- To evaluate secondary outcomes including recovery times and adverse events.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
- Searched major databases (PubMed, Embase, Cochrane, Web of Science) for relevant RCTs up to September 16, 2024.
- Calculated pooled odds ratios using a random-effects model for primary and secondary outcomes.
Main Results:
- Six RCTs with 1107 patients were analyzed.
- No significant difference in POD incidence was observed between remimazolam and propofol groups (OR, 0.92; 95% CI, 0.58-1.44).
- Remimazolam was associated with significantly lower intraoperative hypotension (OR, 0.31; 95% CI, 0.21-0.46).
Conclusions:
- Perioperative remimazolam administration does not increase POD and offers a reduced risk of intraoperative hypotension compared to propofol.
- Further large-scale RCTs are recommended to fully elucidate the association between remimazolam and POD.
- The study protocol was registered with PROSPERO (CRD42024544122).
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