Dose-Dependent Effects of Remimazolam on Early Perioperative Neurocognitive Disorders in Elderly Colorectal Cancer Patients Undergoing Laparoscopic Surgery.

IF 4.7 2区医学 Q1 CHEMISTRY, MEDICINAL

Drug Design, Development and Therapy Pub Date : 2025-06-30 eCollection Date: 2025-01-01 DOI:10.2147/DDDT.S502910

Zhenqi Liu, Xinyu Zhang, Xuebing Wang, Ziyang Liu, Yong Pang

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引用次数: 0

Abstract

Objective: To study the effect of different doses of remimazolam on the maintenance of anesthesia and its impact on postoperative cognitive function in elderly patients undergoing laparoscopic colorectal surgery.

Methods: A total of 120 elderly patients scheduled for laparoscopic colorectal surgery under general anesthesia (both sexes included, ASA grade (II-III) were randomly assigned to experimental groups (R1-R3) and control group (P), with 30 cases per group. The experimental groups received different remimazolam maintenance doses: R1 (0.5 mg/kg/h), R2 (1.0 mg/kg/h), and R3 (1.5 mg/kg/h), while the control group received propofol for sedation. Perioperative cognitive function was evaluated using MMSE (Mini-Mental State Examination) and MoCA (Montreal Cognitive Assessment) preoperatively, and on postoperative days 3 and 7, to analyze differences in cognitive effects and safety profiles of remimazolam across the four groups.

Results: A total of 117 patients were ultimately included, with 3 excluded due to intraoperative conversion to open surgery. Participants were randomly allocated into four groups according to remimazolam maintenance dosing regimens: 30 in the R1 group, 28 in the R2 group, 30 in the R3 group, and 29 in the P group.There was no statistically significant difference in postoperative cognitive function scores between the R2 and R3 groups, and both groups had scores that were significantly higher than those of the R1 and P groups, with statistically significant differences.

Conclusion: Compared to propofol, remimazolam at medium and high doses can reduce the incidence of perioperative neurocognitive dysfunction in elderly patients. High-dose remimazolam anesthesia maintenance may prolong extubation time, increase the incidence of postoperative shivering, and potentially lead to re-sedation after awakening, so medium-dose remimazolam is more suitable for intraoperative anesthesia maintenance in elderly patients without increasing the incidence of adverse events.

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雷马唑仑对老年结直肠癌腹腔镜手术患者早期围手术期神经认知障碍的剂量依赖性影响。

目的：研究不同剂量雷马唑仑对老年腹腔镜结直肠手术患者麻醉维持的影响及其对术后认知功能的影响。方法：选取120例全麻下行腹腔镜结直肠手术的老年患者（男女均可），ASA分级（II-III），随机分为实验组（R1-R3）和对照组(P)，每组30例。实验组给予雷马唑仑维持剂量R1 （0.5 mg/kg/h）、R2 （1.0 mg/kg/h）、R3 (1.5 mg/kg/h)，对照组给予异丙酚镇静。术前、术后第3天和第7天采用MMSE （Mini-Mental State Examination）和MoCA （Montreal cognitive Assessment）评估围手术期认知功能，分析四组间雷马唑仑认知效果和安全性的差异。结果：最终纳入117例患者，其中3例因术中转为开放手术而被排除。根据雷马唑仑维持给药方案，参与者被随机分为四组：R1组30人，R2组28人，R3组30人，P组29人。R2组和R3组术后认知功能评分差异无统计学意义，且两组评分均显著高于R1组和P组，差异有统计学意义。结论：与异丙酚相比，中、高剂量雷马唑仑可降低老年患者围手术期神经认知功能障碍的发生率。大剂量雷马唑仑麻醉维持可能延长拔管时间，增加术后颤抖发生率，并有可能导致苏醒后再镇静，因此中剂量雷马唑仑更适合老年患者术中麻醉维持，且不会增加不良事件的发生率。

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.