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The impact of remimazolam compared to propofol on postoperative delirium: a systematic review and meta-analysis

Xiaoming Xue1, Xiangzheng Ma1, Bing Zhao1

  • 1Department of Anesthesiology, Third Hospital of Hebei Medical University, Shijiazhuang, China.

Minerva Anestesiologica
|January 23, 2025
PubMed
Abstract

Insights

Remimazolam does not increase the risk of postoperative delirium (POD) compared to propofol. This anesthetic agent showed fewer side effects like hypotension and bradycardia, offering a potentially safer option for surgical patients.

Area of Science:

  • Anesthesiology
  • Critical Care Medicine
  • Geriatric Medicine

Background:

  • Benzodiazepines are associated with postoperative delirium (POD).
  • Remimazolam is a newer anesthetic agent with a different pharmacokinetic profile.
  • The role of remimazolam in POD remains controversial.

Purpose of the Study:

  • To systematically review and meta-analyze randomized controlled trials (RCTs) comparing remimazolam to propofol regarding POD.
  • To evaluate the safety and efficacy of remimazolam in preventing POD.

Main Methods:

  • Systematic review and meta-analysis of 11 RCTs involving 1682 patients.
  • Searched major databases (PubMed, EMBASE, Cochrane, Web of Science, Wanfang, ZhiWang) up to April 2024.
  • Used fixed-effects and random-effects models, with trial sequential analysis for sensitivity.

Main Results:

  • No significant difference in POD incidence between remimazolam and propofol (RR 0.82; 95% CI 0.53-1.26).
  • Remimazolam showed lower rates of hypotension and bradycardia.
  • No differences in nausea, vomiting, hypoxemia, or length of stay were observed.

Conclusions:

  • Perioperative remimazolam administration is not associated with an increased incidence of POD.
  • Remimazolam may offer a favorable safety profile regarding hemodynamic stability compared to propofol.

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