Liu Bing, Wang Peijuan, Liang Lirong, Zhu Wei, Zhang Hui
State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Anesthesiology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, People's Republic of China.
Drug Des Devel Ther. 2024 Dec 9;18:5895-5904. doi: 10.2147/DDDT.S491223. eCollection 2024.
Elderly patients undergoing dental extraction are particularly susceptible to delayed cognitive recovery after sedation. This study aimed to compare the effects of remimazolam and midazolam on early postoperative cognitive recovery in elderly patients undergoing dental extraction.
This was a single-centre randomized controlled study with elderly patients scheduled for receiving dental extraction under sedation of remimazolam (Group R) or midazolam (Group M). The primary outcome was postoperative cognitive recovery, as measured by the Montreal cognitive assessment 5-minute (MoCA 5-minute) 30 min postoperatively (T). Secondary outcomes included MoCA 5-minute score 1 h postoperatively (T), incidence of post-extraction bleeding, intraoperative adverse events, success rate of sedation, time to discharge, and complications.
106 patients (53 in each group) were eligible for the study. At T, MoCA 5-minute score was 25 (IQR 23.5, 27) in Group R, significantly higher than that of 23 (IQR 21, 25) in Group M (P < 0.001). This difference persisted at T [27 (IQR 26, 28) vs 26 (IQR 25, 27), P = 0.003]. Group R also exhibited better hemostasis, with a lower post-extraction bleeding rate at T (5.67% vs 33.96%, χ = 13.36, P < 0.001). Group R showed significantly shorter times to peak sedation after the first dose of medication, awake time, and time to discharge compared to Group M (P < 0.001, P < 0.001, P < 0.001).
Remimazolam sedation significantly improves early postoperative cognitive recovery, leading to expedited hemostasis and a shorter discharge time.
接受拔牙手术的老年患者在镇静后特别容易出现认知恢复延迟。本研究旨在比较瑞米唑仑和咪达唑仑对接受拔牙手术的老年患者术后早期认知恢复的影响。
这是一项单中心随机对照研究，纳入计划在瑞米唑仑镇静（R组）或咪达唑仑镇静（M组）下接受拔牙手术的老年患者。主要结局是术后认知恢复，通过术后30分钟（T）的蒙特利尔认知评估5分钟（MoCA 5分钟）进行测量。次要结局包括术后1小时（T）的MoCA 5分钟评分、拔牙后出血发生率、术中不良事件、镇静成功率、出院时间和并发症。
106例患者（每组53例）符合研究条件。在T时，R组的MoCA 5分钟评分为25（四分位间距23.5，27），显著高于M组的23（四分位间距21，25）（P<0.001）。这种差异在T时持续存在[27（四分位间距26，28）对26（四分位间距25，27），P = 0.003]。R组的止血效果也更好，T时拔牙后出血率较低（5.67%对33.96%，χ = 13.36，P<0.001）。与M组相比，R组在首次用药后达到镇静峰值的时间、清醒时间和出院时间明显更短（P<0.001，P<0.001，P<0.001）。
瑞米唑仑镇静显著改善术后早期认知恢复，实现更快止血并缩短出院时间。
