A comparative study of remimazolam and midazolam in elderly patients during general anesthesia：a randomized controlled study

Abstract

Abstract Background Elderly patients are a vulnerable group with an elevated perioperative risk.Reduce the duration of anesthesia is important for older patients.Remimazolam is a benzodiazepine sedative that is indicated for the induction and maintenance during general anesthesia,with supposed advantages of rapid induction and rapid recovery.Most reports focused on non-elderly patients. Aim To compared the time of lost consciousness、PACU stay time and occurrence of adverse events in patients who are older than 65 years undergoing general anesthesia with remimazolam versus midazolam. Methods This study was conducted in a university hospital between February 2022 to March 2023. We included 100 patients aged 65 years or older under general anesthesia. Patients were administered intravenous remimazolam combined with midazolam. The primary outcome was the lose consciousness time. The secondary outcomes included the extubation time and the PACU stay time. We also recorded the total anesthesia time、extubation time、total dosage of drug administered、flumazenil use percentage and the occurrence of adverse events. Results A total of 96 patients undergoing general anesthesia were included in the final analysis, with 46 patients in remimazolam group, and 50 patients in midazolam group.The lose consciousness time was 304(222, 330)seconds in the remimazolam group and 95༈67, 25༉seconds in the midazolam group ,it was significantly lower in the midazolam group than in the remimazolam group (p = 0.000).The extubation time was 24.93 ± 11.617 minutes in the remimazolam group and 34.88 ± 19.740 minutes in the midazolam group ,it was significantly lower in the remimazolam group than in the midazolam group (p = 0.003).The PACU stay time was 55༈48, 64༉minutes in the remimazolam group and 65༈55, 85༉minutes in the midazolam group ,it was significantly lower in the remimazolam group than in the midazolam group (p = 0.001).The flumazenil use percentage was 6% in the remimazolam group and 20% in the midazolam group, it was significantly lower in the remimazolam group than in the midazolam group (p = 0.003).The possibly related to the intraoperative awareness percentage was 8.7% in the remimazolam group and 16% in the midazolam group, and there were no significant differences btween two groups (p = 0.280). Conclusion General anesthesia with remimazolam have proved the efficacy and safety in the surgery of elderly patients.The extubation time、PACU stay time and flumazenil use percentage was significantly lower in remimazolam than midazolam for elderly patients.