Effects of Remimazolam and Propofol on Emergence Agitation in Elderly Patients Undergoing Hip Replacement: A Clinical, Randomized, Controlled Study

Abstract

Purpose The aim of this study was to compare the effects of remimazolam and propofol on emergence agitation (EA) in elderly patients undergoing hip replacement. Methods A total of 60 elderly patients undergoing hip replacement were recruited for this prospective, single-center, clinical, randomized, controlled study from February to April 2023. They were randomly assigned to two groups: the remimazolam group (group R) and the propofol group (group P). In group R, remimazolam was administered intravenously during the induction and maintenance of anesthesia, In group P, propofol was used during the induction and maintenance of anesthesia. The incidence of EA was recorded as the primary indicator. Secondary indicators included heart rate (HR) and mean arterial pressure (MAP) values at the following moments: 5 min prior to anesthetic induction (T 0 ), 1 min following induction (T 1 ), 5 min after the laryngeal mask was inserted (T 2 ), the beginning of surgery (T 3 ), the moment the laryngeal mask was removed (T 4 ), and the overall incidence of postoperative adverse events (bleeding or splitting of the surgical incision, removal of the intravenous infusion needle, falling off the bed, hypoxemia, and hypertension). Results The incidence of EA was significantly lower in group R than in group P (10% vs 33%, P < 0.05). At T 1 , T 2 , and T 3 , the HR and MAP values of group R were higher than those of group P ( P < 0.05). The overall incidence of postoperative adverse events was significantly lower in group R than in group P ( P < 0.05). Conclusion Remimazolam further reduced the incidence of emergence agitation when compared to propofol during geriatric hip replacement. Moreover, it has a minor hemodynamic effect and lower the incidence of postoperative adverse events.

Effect of remimazolam on electroencephalogram burst suppression in elderly patients undergoing cardiac surgery: Protocol for a randomized controlled noninferiority trial

“…Recent studies suggested that the pharmacokinetics of remimazolam was not influenced by the baseline factors such as age, sex, and weight [ 36 ], without accumulation or prolonged efficacy even after a long-term or high-dose infusion [ 37 ]. Duan et al enrolled 60 elderly patients who had hip replacement to show that remimazolam anesthesia, when compared with propofol anesthesia, could reduce the incidence of emergence agitation [ 38 ]. Another recent study found that remimazolam anesthesia did not increase POD among elderly patients undergoing orthopedic surgical procedures [ 39 ].…”

The effect of remimazolam-based total intravenous anesthesia versus sevoflurane-based inhalation anesthesia on emergence delirium in children undergoing tonsillectomy and adenoidectomy: study protocol for a prospective randomized controlled trial

“…The association of benzodiazepines with the occurrence of emergence delirium remains to be discussed. Nevertheless, recent studies have reported that remimazolam is associated with a decreased incidence of emergence delirium ( Duan et al, 2023 ; Yang et al, 2023 ). A study conducted by Duan et al found that remimazolam not only effectively reduced the incidence of ED compared with propofol but also demonstrated minor hemodynamic effects and a lower occurrence of postoperative adverse events in geriatric hip-replacement patients ( Duan et al, 2023 ).…”

“…Nevertheless, recent studies have reported that remimazolam is associated with a decreased incidence of emergence delirium ( Duan et al, 2023 ; Yang et al, 2023 ). A study conducted by Duan et al found that remimazolam not only effectively reduced the incidence of ED compared with propofol but also demonstrated minor hemodynamic effects and a lower occurrence of postoperative adverse events in geriatric hip-replacement patients ( Duan et al, 2023 ). Yang et al demonstrated that older adult patients undergoing general anesthesia with remimazolam had a low incidence of emergence delirium, similar to propofol ( Yang et al, 2023 ).…”

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“…The association of benzodiazepines with the occurrence of emergence delirium remains to be discussed. Nevertheless, recent studies have reported that remimazolam is associated with a decreased incidence of emergence delirium (Duan et al, 2023;Yang et al, 2023). A study conducted by Duan et al found that remimazolam not only effectively reduced the incidence of ED compared with propofol but also demonstrated minor hemodynamic effects and a lower occurrence of postoperative adverse events in geriatric hip-replacement patients (Duan et al, 2023).…”

“…Nevertheless, recent studies have reported that remimazolam is associated with a decreased incidence of emergence delirium (Duan et al, 2023;Yang et al, 2023). A study conducted by Duan et al found that remimazolam not only effectively reduced the incidence of ED compared with propofol but also demonstrated minor hemodynamic effects and a lower occurrence of postoperative adverse events in geriatric hip-replacement patients (Duan et al, 2023). Yang et al demonstrated that older adult patients undergoing general anesthesia with remimazolam had a low incidence of emergence delirium, similar to propofol (Yang et al, 2023).…”