Effect of perioperative benzodiazepine use on intraoperative awareness and postoperative delirium: a systematic review and meta-analysis of randomised controlled trials and observational studies

Wang, Eugene; Belley‐Côté, Emilie P.; Young, Jack; He, Henry; Saud, Haris; D’Aragon, Frédérick; Um, Kevin J.; Alhazzani, Waleed; Piticaru, Joshua; Hedden, Matthew; Whitlock, Richard; Mazer, C. David; Kashani, Hessam H; Zhang, Sarah Yang; Lucas, Amanda; Timmerman, Nicholas; Nishi, Cameron; Jain, Davinder; Kugler, Aaron; Beaver, Chris; Kloppenburg, Shelley; Schulman, Sam; Borges, Flávia Kessler; Kavosh, Morvarid; Wada, Chihiro; Lin, Sabrina H.; Sibilio, Serena; Lauw, Mandy N.; Benz, Alexander P; Szczeklik, Wojciech; Mokhtari, Arastoo; Jacobsohn, Eric; Spence, Jessica

doi:10.1016/j.bja.2022.12.001

Cited by 19 publications

(6 citation statements)

References 47 publications

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“…Therefore, we investigated the effect of a new benzodiazepine drug remimazolam on postoperative delirium in elderly patients undergoing laparoscopic radical resection of colon cancer. Our results suggested that anesthesia induction and maintenance of remimazolam did not increase the incidence and cumulative duration of postoperative delirium, compared with propofol; the result was consistent with that of the previous study [ 32 ]. The reason may be that, compared with other benzodiazepines, remimazolam does not undergo liver and kidney metabolism, the metabolites have no pharmacological activity, and there is no accumulation after long-term infusion.…”

Section: Discussionsupporting

confidence: 92%

“…Marcantonio et al found that long-acting benzodiazepines are more likely to cause postoperative delirium than are short-acting benzodiazepines [ 31 ]. However, a recent review noted that benzodiazepines did not increase the risk of postoperative delirium [ 32 ]. Therefore, we investigated the effect of a new benzodiazepine drug remimazolam on postoperative delirium in elderly patients undergoing laparoscopic radical resection of colon cancer.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Remimazolam and Propofol on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer: A Single-Center Prospective Randomized Controlled Study

Liu,

Zhao,

Zhao

et al. 2024

Med Sci Monit

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Background We compared the effect of remimazolam and propofol intravenous anesthesia on postoperative delirium in elderly patients undergoing laparoscopic radical resection of colon cancer. Material/Methods One hundred patients undergoing elective radical operation of colon cancer under general anesthesia were divided into a remimazolam group (group R) and propofol group (group P) by a random number table method. During anesthesia induction and maintenance, group R was intravenously injected with remimazolam to exert sedation; however, in group P, propofol was injected instead of remimazolam. The occurrence of postoperative delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit scale and postoperative pain was assessed with the visual analogue score (VAS). The primary outcome measures were the incidence and duration of delirium within 7 days following surgery. Secondary outcome measures included postoperative VAS scores, intraoperative anesthetic drug dosage, and adverse reactions, including nausea and vomiting, hypoxemia, and respiratory depression. Results There was no significant difference in baseline data between the 2 groups ( P >0.05). There was no statistically significant difference in the incidence and duration of postoperative delirium between the 2 groups ( P >0.05). There were no significant differences in VAS scores, remifentanil consumption, and adverse reactions, including nausea and vomiting, hypoxemia, and respiratory depression between the 2 groups ( P >0.05). Conclusions In elderly patients undergoing radical colon cancer surgery, remimazolam administration did not improve or aggravate the incidence and duration of delirium, compared with propofol.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Comparison of Remimazolam and Propofol on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer: A Single-Center Prospective Randomized Controlled Study

Liu,

Zhao,

Zhao

et al. 2024

Med Sci Monit

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“…[17] Moreover, the risk of intraoperative awareness can be reduced with the administration of benzodiazepines. [18] Table 2 Incidence of intraoperative hypotension. The recovery profile was similar in patients in both groups.…”

Section: Discussionmentioning

confidence: 99%

“…[ 17 ] Moreover, the risk of intraoperative awareness can be reduced with the administration of benzodiazepines. [ 18 ]…”

Section: Discussionmentioning

confidence: 99%

Incidence of intraoperative hypotension in older patients undergoing total intravenous anesthesia by remimazolam versus propofol: A randomized controlled trial

Jeon,

Kim,

Park

et al. 2023

Medicine

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Background: An increase in the frequency of surgeries among older individuals is observed in some countries. Hypotension is common and exaggerated in older patients and can lead to increased morbidity and mortality. Total intravenous anesthesia is commonly administered with propofol, while remimazolam has been suggested as an alternative to propofol because of advantages such as a more stable hemodynamic profile and less respiratory suppression. We conducted a single-blind, parallel-group randomized controlled trial to compare the incidence of intraoperative hypotension between patients administered with remimazolam and propofol. Methods: A total of 132 patients, aged between 65 to 80 years and undergoing laparoscopic cholecystectomy or transurethral resection of bladder tumors were randomly assigned to the propofol or remimazolam group with a permuted block system while being blinded to the hypnotic agent. Remifentanil was administered via target-controlled infusion in both groups, with an initial effect-site concentration of 3.0 ng/mL and titration range of 1.5 to 4.0 ng/mL intraoperatively. The primary outcome of this study was the overall incidence of hypotension during general anesthesia. Results: Patients in the propofol group experienced higher intraoperative hypotension than those in the remimazolam group (59.7% vs 33.3%, P = .006). Multivariate logistic regression analysis showed that remimazolam administration was associated with reduced hypotension (adjusted odds ratio, 0.34; 95% CI, 0.16–0.73). Secondary outcomes such as recovery time, delirium, and postoperative nausea and vomiting were comparable in both groups. Conclusion: Total intravenous anesthesia with remimazolam was associated with less intraoperative hypotension than propofol in older patients, with a comparable recovery profile.

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“…Consequently, guidelines have recommended avoiding routine preoperative use of BZ to mitigate the risk of POD 112 . However, a recent systematic review and meta‐analysis indicated that intraoperative use of BZ did not increase the risk of POD or compromise intraoperative awareness, and it actually reduced intraoperative awareness 148 . These findings suggest a need to re‐evaluate the association between perioperative benzodiazepine use and POD.…”

Section: Interventions Targeting Sd and Their Impact On Pndmentioning

confidence: 99%

The influence of sleep disorders on perioperative neurocognitive disorders among the elderly: A narrative review

Chen,

Zhai,

Lan

et al. 2024

Ibrain

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This review comprehensively assesses the epidemiology, interaction, and impact on patient outcomes of perioperative sleep disorders (SD) and perioperative neurocognitive disorders (PND) in the elderly. The incidence of SD and PND during the perioperative period in older adults is alarmingly high, with SD significantly contributing to the occurrence of postoperative delirium. However, the clinical evidence linking SD to PND remains insufficient, despite substantial preclinical data. Therefore, this study focuses on the underlying mechanisms between SD and PND, underscoring that potential mechanisms driving SD‐induced PND include uncontrolled central nervous inflammation, blood–brain barrier disruption, circadian rhythm disturbances, glial cell dysfunction, neuronal and synaptic abnormalities, impaired central metabolic waste clearance, gut microbiome dysbiosis, hippocampal oxidative stress, and altered brain network connectivity. Additionally, the review also evaluates the effectiveness of various sleep interventions, both pharmacological and nonpharmacological, in mitigating PND. Strategies such as earplugs, eye masks, restoring circadian rhythms, physical exercise, noninvasive brain stimulation, dexmedetomidine, and melatonin receptor agonists have shown efficacy in reducing PND incidence. The impact of other sleep‐improvement drugs (e.g., orexin receptor antagonists) and methods (e.g., cognitive‐behavioral therapy for insomnia) on PND is still unclear. However, certain drugs used for treating SD (e.g., antidepressants and first‐generation antihistamines) may potentially aggravate PND. By providing valuable insights and references, this review aimed to enhance the understanding and management of PND in older adults based on SD.

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Effect of perioperative benzodiazepine use on intraoperative awareness and postoperative delirium: a systematic review and meta-analysis of randomised controlled trials and observational studies

Cited by 19 publications

References 47 publications

Comparison of Remimazolam and Propofol on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer: A Single-Center Prospective Randomized Controlled Study

Comparison of Remimazolam and Propofol on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer: A Single-Center Prospective Randomized Controlled Study

Incidence of intraoperative hypotension in older patients undergoing total intravenous anesthesia by remimazolam versus propofol: A randomized controlled trial

The influence of sleep disorders on perioperative neurocognitive disorders among the elderly: A narrative review

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