Association between remimazolam and postoperative delirium in older adults undergoing elective cardiovascular surgery: a prospective cohort study

Aoki, Yoshitaka; Kurita, Tadayoshi; Nakajima, Mikio; Imai, Ryo; Suzuki, Yuji; Makino, Hiroshi; Kinoshita, Hiroyuki; Doi, Matsuyuki; Nakajima, Yoshiki

doi:10.1007/s00540-022-03119-7

Cited by 36 publications

(21 citation statements)

References 33 publications

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“…Notably, a newly prospective observational study using propensity score matching also demonstrated no difference of incidence of POD in older adults undergoing elective cardiovascular surgery using remimazolam or not, which is consistent with our results. 18 Another newly published study with 98 cases from Kaneko, Shohei et al 19 showed a lower incidence of POD with remimazolam (with the antagonist flumazenil at the end of surgery) than propofol (without flumazenil) for patients undergoing transfemoral transcatheter aortic valve implantation under general anesthesia, However, this is a retrospective study with small sample size. Previous studies on benzodiazepines and delirium except for the comparison with other sedative drugs in ICU, were mostly observational.…”

Section: Discussionmentioning

confidence: 90%

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Effect of Remimazolam on Postoperative Delirium in Older Adult Patients Undergoing Orthopedic Surgery: A Prospective Randomized Controlled Clinical Trial

Yang¹,

Lei²,

Qiu³

et al. 2023

DDDT

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Background: Postoperative delirium is common in older adult patients and associated with a poor prognosis. The use of benzodiazepine was identified as an independent risk factor for delirium, but there is no randomized controlled trial regarding the relationship between remimazolam, a new ultra-short acting benzodiazepine, and postoperative delirium. We designed a randomized controlled trial to evaluate if remimazolam increases the incidence of postoperative delirium compared with propofol in older adult patients undergoing orthopedic surgery with general anesthesia. Patients and Methods: We enrolled 320 patients aged more than 60 with American Society of Anesthesiologists physical status I-III who underwent orthopedic surgery. Patients were randomized to two groups to receive intraoperative remimazolam or propofol, respectively. Our primary outcome was the incidence of delirium within 3 days after surgery. Secondary outcome was emergence quality including the incidence of emergence agitation, extubation time, and length of post-anesthesia care unit (PACU) stay. Adverse events were also recorded. Results:The incidence of postoperative delirium was 15.6% in the remimazolam group and 12.4% in the propofol group (Risk ratio, 1.26; 95% CI, 0.72 to 2.21; Risk difference, 3.2%; 95% CI, −4.7% to 11.2%; P = 0.42). No significant differences were observed for time of delirium onset, duration of delirium, and delirium subtype between the two groups. Patients in remimazolam group had a lower incidence of hypotension after induction and consumed less vasoactive drugs intraoperatively, but had a longer postoperative extubation time and PACU stay. Conclusion: General anesthesia with remimazolam was not associated with an increased incidence of postoperative delirium compared with propofol in older adult patients undergoing orthopedic surgery.

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Section: Discussionmentioning

confidence: 90%

“…As a new benzodiazepine, there are only two newly published observational studies regarding the association of remimazolam with POD. 18,19 Therefore, whether remimazolam could increase the incidence of POD in older adult patients remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Effect of Remimazolam on Postoperative Delirium in Older Adult Patients Undergoing Orthopedic Surgery: A Prospective Randomized Controlled Clinical Trial

Yang¹,

Lei²,

Qiu³

et al. 2023

DDDT

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“…

We read with great interest and enthusiasm Aoki et al's paper on the relationship between elderly patients undergoing cardiovascular surgery and post-operative delirium (POD) [1]. This study provides relevant clinical evidence of the cognitive impact of remimazolam, and lays a foundation for further in-depth research.At present, in the field of post-operative cognitive dysfunction (POCD) research, for 65 year old people, the use of any anesthetic may increase the risk of POD [2].

…”

mentioning

confidence: 89%

“…We read with great interest and enthusiasm Aoki et al's paper on the relationship between elderly patients undergoing cardiovascular surgery and post-operative delirium (POD) [1]. This study provides relevant clinical evidence of the cognitive impact of remimazolam, and lays a foundation for further in-depth research.…”

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confidence: 89%

Letter to the editor on “association between remimazolam and post-operative delirium in older adults undergoing elective cardiovascular surgery: a prospective cohort study”

Jia

Teng

2022

J Anesth

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We read with great interest and enthusiasm Aoki et al.'s paper on the relationship between elderly patients undergoing cardiovascular surgery and post-operative delirium (POD) [1]. This study provides relevant clinical evidence of the cognitive impact of remimazolam, and lays a foundation for further in-depth research.At present, in the field of post-operative cognitive dysfunction (POCD) research, for 65 year old people, the use of any anesthetic may increase the risk of POD [2]. Remimazolam is a newly approved anesthetic sedative. The existing research results are still based on animal experiments [3,5], and a large number of related clinical trials are needed to explore the applicability of remimazolam in the clinical research of cognitive function. In addition, previous studies have shown that [4], the most common complication after cardiac surgery is early post-operative POD, and this study is biased.To sum up, remimazolam is a new drug, and its impact on cognitive function has not been determined yet, which needs a lot of research to confirm.

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“…In the periprocedural period and in critically ill patients, older generation benzodiazepines in general have been associated with an increased risk for postoperative delirium 40 . Aoki et al 41 prospectively followed (for 5 days) 78 patients ≥65 years of age who received remimazolam during cardiac surgery and compared the rates of postoperative delirium to a similar cohort of patients who did not receive remimazolam intraoperatively as part of a balanced anesthetic. Rates of postoperative delirium within 5 days of surgery were similar between groups; 30.3% and 26.6% in the remimazolam and control groups, respectively ( P =0.63%).…”

Section: Effect Of Remimazolam On Cognitive Changes Associated With A...mentioning

confidence: 99%

The Role of Remimazolam in Neurosurgery and in Patients With Neurological Diseases: A Narrative Review

Teixeira¹,

Brinkman

Pasternak³

et al. 2023

Journal of Neurosurgical Anesthesiology

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Remimazolam is a novel ultrashort-acting benzodiazepine that produces sedation by acting as a positive allosteric modulator of the gamma-amino butyric acid-A receptor. Its high water solubility and metabolism via tissue esterases allow for a rapid onset of sedation/anesthesia and prompt arousal despite prolonged use. In addition, the effects of remimazolam can be reversed with flumazenil. This narrative review discusses the role of remimazolam in patients undergoing neurosurgical and neuroradiological procedures, specifically its role during awake craniotomies and compatibility with neuromonitoring. Considerations for remimazolam use in patients with neurological diseases are also highlighted. In addition, the impact of remimazolam on postoperative excitation, risk for postoperative delirium, and delayed neurocognitive recovery are discussed. Although there seems to be a clinical promise for remimazolam based on limited case studies and our own institutional experience of its use, further clinical investigation is warranted to understand the potential impact of remimazolam on surgical and neurological outcomes.

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Association between remimazolam and postoperative delirium in older adults undergoing elective cardiovascular surgery: a prospective cohort study

Cited by 36 publications

References 33 publications

Effect of Remimazolam on Postoperative Delirium in Older Adult Patients Undergoing Orthopedic Surgery: A Prospective Randomized Controlled Clinical Trial

Effect of Remimazolam on Postoperative Delirium in Older Adult Patients Undergoing Orthopedic Surgery: A Prospective Randomized Controlled Clinical Trial

Letter to the editor on “association between remimazolam and post-operative delirium in older adults undergoing elective cardiovascular surgery: a prospective cohort study”

The Role of Remimazolam in Neurosurgery and in Patients With Neurological Diseases: A Narrative Review

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