Effect of remimazolam on early postoperative cognitive function in frail elderly patients under general anesthesia

YU Jiaqi; ZHAO Xiaohong

doi:10.3969/j.issn.1002-266X.2026.02.019

Abstract：Objective To evaluate the effect of remimazolam on the early postoperative cognitive function of frail el-derly patients under general anesthesia.Methods A total of 80 frail elderly patients undergoing total knee arthroplasty were divided into the remimazolam group(group R)and propofol group(group P)using the random number table,with 40 cases in each group.Both groups underwent the operation under general anesthesia.In the remimazolam group,anesthesia was induced and maintained using remimazolam,whereas in the propofol group,induction and maintenance were achieved with propofol.Perioperative early cognitive function was assessed using the Mini-Mental State Examination(MMSE)at 1 day before surgery and at 1,3,and 7 days after surgery.Heart rate(HR),mean arterial pressure(MAP),and the bispectral index(BIS)were recorded at baseline(T1),loss of consciousness(T2),5 minutes after laryngeal mask inser-tion(T3),30 minutes after surgery initiation(T4),return of consciousness(T5),and laryngeal mask removal(T6).Venous blood was collected at 1 day before surgery and at 6 and 24 h after surgery to measure serum levels of interleukin-6(IL-6)and C-reactive protein(CRP).Additionally,the following data were recorded:anesthesia induction time,re-covery time,laryngeal mask removal time,and the occurrence of perioperative adverse events.Results MMSE scores were significantly higher in the remimazolam group than in the propofol group on both postoperative day 1 and day 3(both P<0.05).In the remimazolam group,HR at T2 and T3 as well as MAP at T2,T3 and T4 were significantly higher than those in the propofol group.Both HR and MAP in the remimazolam group were significantly lower than those of the propo-fol group at T5 and T6(both P<0.05).The remimazolam group showed significantly higher BIS values at T2,T3,T4,and T6,and significantly lower serum levels of IL-6 and CRP at 6 and 24 h postoperatively than the propofol group(all P<0.05).Anesthesia induction time was significantly longer in the remimazolam group than in the propofol group(P<0.05).However,no statistically significant differences in the recovery time or laryngeal mask removal time were ob-served between the two groups(both P>0.05).Following Bonferroni correction,no statistically significant difference in the adverse event rate was found between these two groups(P>0.01).Conclusion The use of remimazolam for general anesthesia in frail elderly patients is associated with less impact on early postoperative cognitive function and this may be related to its ability to stabilize blood hemodynamics and electroencephalographic activity,as well as to reduce the level of inflammatory response.