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Effects of Remimazolam on Perioperative Inflammatory Response and Neurocognitive Disorders in Elderly Patients
Juan Hu1, Yu Huang1, Junjie Li1
1Department of Anesthesiology, Chongqing University Three Gorges Hospital, Chongqing, Wanzhou, People's Republic of China.
Purpose:
The systemic inflammatory response triggered by video-assisted thoracic surgery (VATS) is associated with the risk of perioperative neurocognitive disorders (PND). Remimazolam, a newer benzodiazepine anesthetic, has unknown anti-inflammatory properties and uncertain effects on elderly patients. This study investigated the effects of remimazolam on postoperative inflammation and neurocognitive disorders in elderly patients undergoing VATS.
Patients And Methods:
Ninety-two patients aged 60 years or older scheduled for VATS were randomized to receive either remimazolam (induction: 0.25 mg/kg; maintenance: 0.5-1.5 mg/kg/h) or propofol (induction: 2 mg/kg; maintenance: 4-6 mg/kg/h). The primary outcome was the serum C-reactive protein concentration at 24 h postoperatively. Secondary outcomes included the incidence of PND, assessed using the 3-Minute Diagnostic Confusion Assessment Method and the Mini-Mental State Examination on postoperative days 1, 3, 5, and 7. Exploratory outcomes included inflammatory cells (leucocytes and neutrophil counts), cytokines (IL-6, TNF-α, S100β), stress markers, and the systemic inflammatory response index. Other measures comprised hemodynamic parameters, anesthesia parameters, and potential adverse events.
Results:
All 92 patients completed the intention-to-treat analysis. At 24h postoperation, the remimazolam group showed significantly higher CRP, IL-6, leukocyte counts, neutrophil counts, and systemic inflammatory response index than the propofol group. No differences were found in TNF-α, S100β, or PND incidence (8.7% vs 6.5%). Stress marker levels were comparable between groups at all time points. Additionally, the remimazolam group demonstrated shorter anesthesia awakening time (P<0.001), with reduced incidence of hypotension (P <0.001) and injection pain (P = 0.015).
Conclusion:
Although remimazolam is less effective than propofol in suppressing the early postoperative inflammatory response in elderly patients undergoing VATS, it did not increase the risk of PND or infection. It has significant advantages in hemodynamic stability, facilitates faster recovery, and reduces injection pain, establishing it as a preferred anesthetic option for geriatric VATS, though its inflammatory mechanisms require clarification.
Insights
Remimazolam showed increased postoperative inflammation but did not raise neurocognitive disorder risk in elderly VATS patients. It offers faster recovery and hemodynamic stability, making it a promising anesthetic option.
Area of Science:
- Anesthesiology
- Immunology
- Geriatric Medicine
Background:
- Video-assisted thoracic surgery (VATS) can trigger systemic inflammation, increasing the risk of perioperative neurocognitive disorders (PND).
- Remimazolam, a novel benzodiazepine anesthetic, has unclear anti-inflammatory effects and impacts on elderly patients undergoing VATS.
- Understanding remimazolam's influence on inflammation and PND in this demographic is crucial.
Purpose of the Study:
- To investigate the effects of remimazolam versus propofol on postoperative inflammation.
- To assess the impact of remimazolam on neurocognitive function in elderly patients undergoing VATS.
- To compare inflammatory markers, PND incidence, and hemodynamic stability between remimazolam and propofol anesthesia.
Main Methods:
- A randomized controlled trial involving 92 elderly patients (≥60 years) undergoing VATS.
- Patients received either remimazolam or propofol for anesthesia.
- Primary outcome: C-reactive protein (CRP) at 24h postoperation; Secondary outcomes: PND incidence, inflammatory markers, and hemodynamic parameters.
Main Results:
- The remimazolam group exhibited higher postoperative CRP, IL-6, and leukocyte counts compared to propofol.
- No significant difference in PND incidence was observed between the remimazolam and propofol groups (8.7% vs 6.5%).
- Remimazolam was associated with faster awakening, reduced hypotension, and less injection pain.
Conclusions:
- Remimazolam is less effective than propofol in suppressing early postoperative inflammation after VATS in the elderly.
- Remimazolam does not increase the risk of PND or infection in this patient population.
- Its benefits in faster recovery and hemodynamic stability suggest it as a viable anesthetic choice for geriatric VATS, warranting further research into its inflammatory mechanisms.
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