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The impact of remimazolam sedation during neuraxial anesthesia on perioperative cognitive function in elderly
Dan Qiao1, Jia-Min Kang1, Rui Zhang1
1Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin Research Institute of Anesthesiology, Tianjin, China.
Background:
Remimazolam, a novel ultra-short-acting benzodiazepine, is a potential sedative for non-general anesthesia surgery in the elderly. This study aimed to investigate the appropriate sedative dosage of remimazolam and its effects on perioperative cognitive function in elderly patients undergoing non-general anesthesia surgery.
Methods:
This multicenter, placebo-controlled trial enrolled 330 elderly patients undergoing non-general anesthesia procedures at eight centers in China from July 2021 to February 2022, with 238 ultimately completing the study. The primary endpoints were the dose of successful sedation with remimazolam and the changes in perioperative cognitive function. Adverse events were recorded to assess drug safety.
Results:
The induction dose of remimazolam for sedation in spinal anesthesia in elderly patients was 5.38 mg (95% confidence interval [CI], 5.20-5.56), maintained at a rate of 0.223 mg·kg-1·h-1 (95% CI, 0.201-0.237) with no serious adverse effects. Compared with the standard saline group, there was no statistical difference in the MMSE scores on Day 2 morning (P = 0.886), Day 2 afternoon (P = 0.864), and Day 7 (P = 0.613), and no statistical difference in the MoCA scores on Day 2 morning (P = 0.687), Day 2 afternoon (P = 0.827), and Day 7 (P = 0.483) in remimazolam group.
Conclusion:
Remimazolam besylate is an effective sedative for elderly patients undergoing neuraxial anesthesia. It was successfully induced at a dose of 5.38 mg and maintained at 0.223 mg·kg-1·h-1, demonstrating a good safety profile without affecting short-term postoperative cognitive function.
Clinical Trial Registration:
http://www.chictr.org.cn (ChiCTR2100048744).
Insights
Remimazolam, an ultra-short-acting sedative, is safe for elderly patients undergoing non-general anesthesia. This study found appropriate dosages and confirmed it does not impair short-term cognitive function post-surgery.
Area of Science:
- Anesthesiology
- Pharmacology
- Geriatrics
Background:
- Remimazolam is a novel ultra-short-acting benzodiazepine with potential as a sedative for non-general anesthesia in elderly patients.
- Elderly patients undergoing non-general anesthesia surgery require careful consideration of sedative agents due to potential risks.
Purpose of the Study:
- To determine the appropriate sedative dosage of remimazolam for elderly patients undergoing non-general anesthesia surgery.
- To evaluate the effects of remimazolam sedation on perioperative cognitive function in this patient population.
Main Methods:
- A multicenter, placebo-controlled trial involving 330 elderly patients undergoing non-general anesthesia procedures.
- Primary endpoints included successful sedation dose and changes in perioperative cognitive function (MMSE, MoCA).
- Adverse events were monitored to assess the safety profile of remimazolam.
Main Results:
- The effective induction dose of remimazolam was 5.38 mg, with a maintenance rate of 0.223 mg·kg⁻¹·h⁻¹.
- No serious adverse effects were observed during the study.
- Remimazolam did not result in statistically significant differences in MMSE or MoCA scores compared to placebo on postoperative days 2 and 7.
Conclusions:
- Remimazolam besylate is an effective and safe sedative for elderly patients undergoing neuraxial anesthesia.
- The determined dosage regimen ensures successful sedation without compromising short-term postoperative cognitive function.
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