Remimazolam versus propofol for postoperative delirium prevention in geriatric surgery: A systematic review and meta-analysis of randomized controlled trials

Background

As a novel ultra-short-acting benzodiazepine derivative, remimazolam’s impact on postoperative neurocognitive recovery remains poorly characterized. Our research specifically evaluated its influence on postoperative delirium (POD) incidence compared with propofol in the geriatric surgical population.

Methods

A comprehensive literature search was performed across four electronic databases, including the Cochrane Library, PubMed, Embase, and Web of Science, to identify eligible randomized controlled trials (RCTs). The methodological quality of the included studies was assessed using the Cochrane Collaboration’s risk of bias tool. Statistical analyses were performed using Review Manager 5.3 software; effect estimates were expressed as risk ratios (RR), standardized mean differences (SMD), and 95% confidence intervals (CI). The overall quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Results

The meta-analysis incorporated five RCTs encompassing 1,368 patients. Pooled analysis revealed no statistically significant difference in POD incidence between the remimazolam and propofol groups (RR = 0.88, 95% CI: 0.58–1.33; P = 0.53). However, remimazolam administration was associated with a significant reduction in hypotensive events (RR = 0.55, 95% CI: 0.34–0.90; P < 0.05). No between-group differences were detected in postoperative nausea and vomiting incidence.

Conclusion

The current meta-analysis provided evidence that perioperative remimazolam administration did not significantly increase the risk of POD in elderly surgical patients, while demonstrating clinically significant benefits in hemodynamic stability.