• Eur J Anaesthesiol · Dec 2024

    Association of remimazolam with delirium and cognitive function: A systematic review and meta-analysis of randomised controlled trials.

    • Jaime Andres Arias, Gustavo Roberto Minetto Wegner, Bruno Francisco Minetto Wegner, Larissa Santos Silva, Francisco José Lucena Bezerra, and Rafaela Goes Machado Filardi.
    • From the Universidade Federal da Bahia, Hospital Ana Nery, Salvador, Brazil (JAA), Universidade Federal da Fronteira Sul, Passo Fundo (GRMW), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (BFMW), Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil (LSS), São Paulo (FJLB) and Universidade de São Paulo, São Paulo, Brazil (RGMF).
    • Eur J Anaesthesiol. 2024 Dec 19.

    Background And Study ObjectiveDelirium is an organic mental syndrome significantly associated with long-term cognitive decline, increased hospital stays and higher mortality. This systematic review of randomised controlled trials (RCTs) with meta-analysis assesses the association of remimazolam with postoperative cognitive function and delirium compared with non-benzodiazepine hypnotics.DesignSystematic review of RCTs with meta-analysis.Data SourcesPubMed, Embase, Cochrane Library and Web of Science databases up to 27 April 2024.Eligibility CriteriaAdult patients undergoing general anaesthesia or sedation procedures; use of remimazolam as the primary hypnotic or as an adjunct, administered via intermittent bolus or continuous infusion; comparison with other hypnotics or sedatives; evaluation of cognitive function or delirium.Main ResultsTwenty-three RCTs with 3598 patients were included. The incidence of delirium was not significantly different between remimazolam and other sedatives in general anaesthesia and sedation procedures [n = 3261; odds ratio (OR) = 1.2, 95% confidence interval (CI), 0.76 to 1.91; P = 0.378843; I2 = 17%]. Regarding cognitive function evaluation, remimazolam showed no difference compared with the control group in Mini-Mental State Examination (MMSE) scores on the first postoperative day (n = 263; mean difference = 0.60, 95% CI, -1.46 to 2.66; P = 0.5684; I2 = 90%) or on the third postoperative day (n = 163; mean difference  = 1.33, 95% CI, -0.72 to 3.38; P = 0.2028; I2 = 93%). Remimazolam exhibited superiority over the control group in MMSE scores on the seventh postoperative day (n = 247; mean difference = 0.53, 95% CI, 0.30 to 0.75; P < 0.0001; I2 = 28%).ConclusionRemimazolam does not increase the incidence of delirium or cognitive impairments compared with non-benzodiazepine hypnotics. However, the analysis showed that the type of surgery significantly influenced the incidence of delirium. Additionally, remimazolam was associated with better short-term postoperative cognitive function.Systematic Review RegistrationPROSPERO CRD42024532751.Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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