Perioperative remimazolam administration to prevent delirium and neurocognitive disorders after surgery: a systematic review and meta-analysis.

Aims: Remimazolam is a novel, ultra-short-acting intravenous benzodiazepine. Its efficacy in reducing the occurrence of postoperative delirium (POD) and neurocognitive disorders remains unclear. Therefore, we conducted a meta-analysis to evaluate the long-term effects of remimazolam on POD and neurocognitive disorders.

Methods and results: We searched PubMed, Embase, and Web of Science, covering the period from their inception to September 30, 2024. Randomized controlled trials (RCTs) and cohort studies comparing remimazolam with propofol or other sedative medical therapy were included. The primary outcome was the incidence of POD, while secondary outcomes included hypotension, hypoxia, bradycardia, agitation, and vomiting. A total of 11 studies involving 2188 patients were included (remimazolam group: 981, control group: 1207). Compared to the control group, remimazolam showed no significant improvement in POD (OR = 0.79, 95% confidence interval (CI) 0.53-1.17, p = 0.24, I2 = 50%), vomiting (OR = 1.35, 95% CI 0.85-2.15, p = 0.21, I2 = 0%), hypoxia (OR = 0.59, 95% CI 0.12-3.00, p = 0.53, I2 = 76%), and agitation (OR = 0.48, 95% CI 0.15-1.46, p = 0.19, I2 = 62%). However, remimazolam was associated with a lower incidence of hypotension (OR = 0.29, 95% CI 0.20-0.42, p < 0.001, I2 = 0%) and bradycardia (OR = 0.19, 95% CI 0.05-0.76, p = 0.03, I2 = 67%).

Conclusion: Our research indicates that remimazolam exhibits no superiority in preventing postoperative delirium. Further prospective studies are needed to confirm the effects of remimazolam on postoperative cognitive dysfunction.

Systematic review protocol: International Prospective Register of Systematic Reviews (PROSPERO): CRD42024593338.