Remimazolam versus propofol for postoperative delirium prevention in geriatric surgery: A systematic review and
Rui-Jun Tong1, Yue-Zhong Lv2, Ya-Fen Shi2
1Department of Anesthesiology, The First People's Hospital of Jiashan, Jiashan Hospital Afliated of Jiaxing University, Jiaxing, Zhejiang, China.
Background:
As a novel ultra-short-acting benzodiazepine derivative, remimazolam's impact on postoperative neurocognitive recovery remains poorly characterized. Our research specifically evaluated its influence on postoperative delirium (POD) incidence compared with propofol in the geriatric surgical population.
Methods:
A comprehensive literature search was performed across four electronic databases, including the Cochrane Library, PubMed, Embase, and Web of Science, to identify eligible randomized controlled trials (RCTs). The methodological quality of the included studies was assessed using the Cochrane Collaboration's risk of bias tool. Statistical analyses were performed using Review Manager 5.3 software; effect estimates were expressed as risk ratios (RR), standardized mean differences (SMD), and 95% confidence intervals (CI). The overall quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
Results:
The meta-analysis incorporated five RCTs encompassing 1,368 patients. Pooled analysis revealed no statistically significant difference in POD incidence between the remimazolam and propofol groups (RR = 0.88, 95% CI: 0.58-1.33; P = 0.53). However, remimazolam administration was associated with a significant reduction in hypotensive events (RR = 0.55, 95% CI: 0.34-0.90; P < 0.05). No between-group differences were detected in postoperative nausea and vomiting incidence.
Conclusion:
The current meta-analysis provided evidence that perioperative remimazolam administration did not significantly increase the risk of POD in elderly surgical patients, while demonstrating clinically significant benefits in hemodynamic stability.
More Related Videos
08:49Assessing Changes in Volatile General Anesthetic Sensitivity of Mice after Local or Systemic Pharmacological Intervention
Published on: October 16, 2013
08:16Optogenetic Activation of Afferent Pathways in Brain Slices and Modulation of Responses by Volatile Anesthetics
Published on: July 23, 2020
Related Concept Videos
01:24Parenteral Anesthetics: Overview
01:17Sedatives and Hypnotics Drugs: Miscellaneous Agents
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
01:24General Anesthesia: Overview
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
01:22Stages of General Anesthesia
01:23Sedatives and Hypnotics: Overview
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
01:09Peripherally and Centrally Acting Muscle Relaxants: A Comparison
Centrally acting muscle relaxants can be further divided into spasmolytic and antispasmodic drugs. Spasmolytic...