Effects of remimazolam combined with nerve block on hemodynamics and postoperative cognitive function in elderly patients undergoing laparoscopic surgery for colorectal malignant tumors under general anesthesia

ZHANG Yu; WANG Yonghao; ZHONG Yuling; FANG Haiyan; JIANG Qiuxiang; QU Hanqing; DAI Luming; GONG Zheng

doi:10.3969/j.issn.1674-3806.2025.09.08

Abstract：Objective To explore the effects of remimazolam combined with nerve block on intraoperative hemodynamics and postoperative cognitive function in elderly patients undergoing laparoscopic surgery for colorectal malignant tumors under general anesthesia.Methods A total of 120 elderly patients undergoing elective laparoscopic surgery for colorectal malignant tumors in the People's Hospital of Guangxi Zhuang Autonomous Region from June 2023 to December 2024 were recruited.The patients were divided into four groups by using random number table method:simple general anesthesia group(group G),general anesthesia combined with nerve block group(group N),general anesthesia combined with remimazolam group(group R),and general anesthesia combined with remimazolam and nerve block group(group RN).In group R and group RN,remimazolam was continuously pumped 10 minutes before anesthesia induction until the end of the operation.In group N and group RN,bilateral rectus sheath block and transversus abdominis plane block were performed after anesthesia induction.All the patients in the four groups received the same anesthesia induction and maintenance regimens.The mean arterial pressure(MAP)and heart rate(HR)were recorded 10 minutes before anesthesia induction(T0),during tracheal intubation(T1),5 minutes after tracheal intubation(T2),1 hour after the start of the operation(T3),and at the end of the operation(T4).The changing values of MAP and HR at each time point compared to those at T0 were calculated and were denoted as ΔMAP and ΔHR,respectively.The Mini-Mental State Examination(MMSE)scores of the patients were compared at 1 day before the operation,3 days after the operation,and 7 days after the operation.The incidence rates of postoperative cognitive dysfunction(POCD)and adverse reactions of the patients were recorded.Results The ΔMAP and ΔHR in group RN and group R were lower than those in group G and group N at the time points of T,and T2(P＜0.05).The ΔMAP and ΔHR in group RN were lower than those in group R,group N and group G at the time points of T3 and T4(P＜0.05).The MMSE scores of the patients in group R and group RN were higher than those in group G and group N at 3 days and 7 days after the operation(P＜0.05).There was no statistically significant difference in the incidence of POCD of the patients among the four groups(P＞0.05).There was no statistical difference in the incidence of adverse reactions of the patients among the four groups(P＞0.05).Conclusion In laparoscopic surgery for the elderly patients with colorectal malignant tumors under general anesthesia,the application of remimazolam combined with nerve block on the basis of conventional anesthesia is beneficial for maintaining the patients' intraoperative hemodynamic stability,improving their postoperative cognitive function,and does not increase the incidence of adverse reactions,thus exhibiting high safety.