Remimazolam in elderly patients undergoing EBUS-TBNA: protocol for a randomized clinical trial

Area of Science:

• Anesthesiology
• Geriatric Medicine
• Pulmonology

Background:

• Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard for mediastinal staging.
• Geriatric patients undergoing EBUS-TBNA face increased anesthetic risks due to altered pharmacokinetics and comorbidities.
• Optimized anesthetic strategies are crucial for safe and effective EBUS-TBNA in the elderly.

Purpose of the Study:

• To compare the efficacy and safety of remimazolam versus propofol for general anesthesia during EBUS-TBNA in patients aged 70 years and older.
• To evaluate anesthesia emergence quality, hemodynamic stability, and recovery metrics.
• To assess perioperative complications in geriatric patients receiving either anesthetic agent.

Main Methods:

• A prospective, double-blinded, randomized controlled trial was conducted with 60 eligible patients over 70 years old.
• Participants were randomized to receive either propofol (Group P, n=30) or remimazolam besylate (Group R, n=30).
• Outcomes included anesthesia emergence quality, serial hemodynamics, recovery metrics, and perioperative complications.

Main Results:

• Remimazolam demonstrated accelerated recovery (Steward score) and enhanced hemodynamic stability compared to propofol.
• Propofol use was associated with risks of hypotension and potential adipose tissue deposition.
• No significant differences in 24-hour QoR-40 scores or major perioperative complications were detailed.

Conclusions:

• Remimazolam offers a promising alternative to propofol for EBUS-TBNA anesthesia in elderly patients, providing better recovery and hemodynamic control.
• Anesthetic protocols should be tailored for geriatric patients undergoing EBUS-TBNA, considering the pharmacodynamic differences between agents.
• Further multicenter validation of age-adjusted protocols is recommended to confirm these findings.