Xue Xiaoming, Ma Xiangzheng, Zhao Bing, Liu Bo, Zhang Jiaqi, Li Zhao, Li Huizhou, Liu Xin, Zhao Shuang
Department of Anesthesiology, Third Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Tumor Surgery, Second Hospital of Hebei Medical University, Shijiazhuang, China.
Minerva Anestesiol. 2025 Jan-Feb;91(1-2):70-79. doi: 10.23736/S0375-9393.24.18338-1. Epub 2025 Jan 23.
The administration of benzodiazepines has been linked to the occurrence of postoperative delirium (POD) among patients undergoing surgery. In this review, we aim to appraise the current controversy regarding the role of remimazolam in POD.
A systematic review and meta-analysis of randomized controlled trials was conducted to examine the effects of remimazolam administration on postoperative delirium compared to propofol from inception to April 2024. We conducted a comprehensive search of PubMed, EMBASE, Cochrane Library, Web of Science, Wanfang, and ZhiWang Chinese databases. In the fixed-effects and random-effects statistical models, pooled risk ratios (RRs) or mean differences, 95% CIs, and P values were estimated for endpoints. The trial sequential analysis was used for sensitivity analysis.
Among the 479 records screened, 11 randomized controlled trials with 1682 patients were eligible for inclusion. POD did not differ between groups (RR,0.82; 95% CI 0.53-1.26; P=0.36; df=10; I=42%). There were no statistically significant differences between groups in the incidence of nausea and vomiting, hypoxemia, and length of stay. However, remimazolam had a lower incidence of hypotension and bradycardia than propofol. Analyses of subgroups did not reveal a difference in delirium based on the type of surgery, assessment timing, or definition of cognitive impairment. This result has been supported by the trial sequential analysis.
Based on the available evidence, perioperative remimazolam administration is not associated with a significant rise in the incidence of POD.
苯二氮䓬类药物的使用与手术患者术后谵妄（POD）的发生有关。在本综述中，我们旨在评估目前关于瑞马唑仑在POD中作用的争议。
进行了一项随机对照试验的系统评价和荟萃分析，以研究自开始至2024年4月期间，与丙泊酚相比，使用瑞马唑仑对术后谵妄的影响。我们全面检索了PubMed、EMBASE、Cochrane图书馆、科学网、万方和知网中文数据库。在固定效应和随机效应统计模型中，估计终点的合并风险比（RRs）或平均差异、95%置信区间（CIs）和P值。采用试验序贯分析进行敏感性分析。
在筛选的479条记录中，11项随机对照试验（共1682例患者）符合纳入标准。两组之间的POD无差异（RR，0.82；95%CI 0.53 - 1.26；P = 0.36；自由度 = 10；I² = 42%）。两组在恶心呕吐发生率、低氧血症和住院时间方面无统计学显著差异。然而，瑞马唑仑的低血压和心动过缓发生率低于丙泊酚。亚组分析未发现基于手术类型、评估时间或认知障碍定义的谵妄差异。该结果得到了试验序贯分析的支持。
基于现有证据，围手术期使用瑞马唑仑与POD发生率的显著升高无关。
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