Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
Emergency Life-Saving Technique Academy of Tokyo, Foundation for Ambulance Service Development, Tokyo, Japan.
J Anesth. 2023 Feb;37(1):13-22. doi: 10.1007/s00540-022-03119-7. Epub 2022 Oct 12.
Postoperative delirium is one of the most common complications after cardiovascular surgery in older adults. Benzodiazepines are a reported risk factor for delirium; however, there are no studies investigating remimazolam, a novel anesthetic agent. Therefore, we prospectively investigated the effect of remimazolam on postoperative delirium.
We included elective cardiovascular surgery patients aged ≥ 65 years at Hamamatsu University Hospital between August 2020 and February 2022. Patients who received general anesthesia with remimazolam were compared with those who received other anesthetics (control group). The primary outcome was delirium within 5 days after surgery. Secondary outcomes were delirium during intensive care unit stay and hospitalization, total duration of delirium, subsyndromal delirium, and differences in the Mini-Mental State Examination scores from preoperative to postoperative days 2 and 5. To adjust for differences in the groups' baseline covariates, we used stabilized inverse probability weighting as the primary analysis and propensity score matching as the sensitivity analysis.
We enrolled 200 patients; 78 in the remimazolam group and 122 in the control group. After stabilized inverse probability weighting, 30.3% of the remimazolam group patients and 26.6% of the control group patients developed delirium within 5 days (risk difference, 3.8%; 95% confidence interval -11.5% to 19.1%; p = 0.63). The secondary outcomes did not differ significantly between the groups, and the sensitivity analysis results were similar to those for the primary analysis.
Remimazolam was not significantly associated with postoperative delirium when compared with other anesthetic agents.
术后谵妄是老年人心血管手术后最常见的并发症之一。苯二氮䓬类药物是谵妄的报告风险因素；然而，尚无研究调查新型麻醉剂 remimazolam 对术后谵妄的影响。因此，我们前瞻性地研究了 remimazolam 对术后谵妄的影响。
我们纳入了 2020 年 8 月至 2022 年 2 月在滨松大学医院接受择期心血管手术的年龄≥65 岁的患者。接受 remimazolam 全身麻醉的患者与接受其他麻醉剂（对照组）的患者进行比较。主要结局是术后 5 天内发生谵妄。次要结局是 ICU 住院期间和住院期间的谵妄、谵妄总持续时间、亚综合征性谵妄以及从术前到术后第 2 天和第 5 天的简易精神状态检查评分的差异。为了调整组间基线协变量的差异，我们使用稳定逆概率加权作为主要分析，倾向评分匹配作为敏感性分析。
我们纳入了 200 例患者；remimazolam 组 78 例，对照组 122 例。经稳定逆概率加权后，remimazolam 组 30.3%的患者和对照组 26.6%的患者在 5 天内发生谵妄（风险差异，3.8%；95%置信区间，-11.5%至 19.1%；p=0.63）。次要结局在组间无显著差异，敏感性分析结果与主要分析相似。
与其他麻醉剂相比，remimazolam 与术后谵妄无显著相关性。
