Remimazolam versus propofol for elderly patients undergoing laparoscopic gastrointestinal surgery: a randomized trial concentrating on delirium and hemodynamic stability
In brief
Remimazolam did not lower delirium; rates were 11%-13% versus 6.5%
Among 186 patients aged 60 to 80, delirium within five days occurred in 11.3% to 12.9% with remimazolam and 6.5% with propofol, with no statistically significant difference. Remimazolam improved blood pressure stability and reduced treated hypotension and vasopressor use, but recovery was slower; low delirium rates mean the trial could not rule out a meaningful difference.
- Journal
- Frontiers in medicine (Q1)
- Published
- 16 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Hongna Fan, Xiaotong Chen, Linlin Xu, Bin Zou, Da Li, Cheng Zhang, et al.
- PMID
- 42964328
- DOI
- 10.3389/fmed.2026.1992969
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 2 November 2026): Randomized anaesthetic-agent comparison assessing delirium and hemodynamics
Abstract
BACKGROUND: Postoperative delirium (POD) is a common complication in elderly surgical patients that can impede recovery. While remimazolam offers superior hemodynamic stability compared to propofol, its impact on POD incidence remains unclear. This randomized trial aimed to determine whether two induction doses of remimazolam are more effective than propofol in reducing POD and improving hemodynamic stability in older patients undergoing laparoscopic gastrointestinal surgery. METHODS: In this prospective trial, 186 patients (aged 60-80 years) were randomized to receive anesthesia induction with remimazolam 0.15 mg/kg (R1), remimazolam 0.3 mg/kg (R2), or propofol 1.5 mg/kg (P). The primary endpoint was the incidence of POD within 5 days post-surgery, assessed using the 3-Minute Diagnostic Interview for Confusion Assessment Method. Secondary endpoints included hemodynamic parameters, recovery times, and adverse events. RESULTS: The incidence of POD was 12.9% in the R1 group, 11.3% in the R2 group, and 6.5% in the P group (P = 0.467). Both remimazolam groups exhibited significantly higher mean arterial pressure following induction and intubation (both P < 0.05). Furthermore, remimazolam was associated with a lower incidence of treated hypotension (P = 0.010), fewer bradycardia events (P < 0.001), and reduced vasopressor requirements (P < 0.05). However, the time to loss of consciousness (P < 0.001) and extubation time (P < 0.001) were longer with remimazolam. CONCLUSIONS: Remimazolam at induction doses of 0.15 mg/kg and 0.3 mg/kg did not reduce the incidence of POD compared with propofol. Nevertheless, the study was not adequately powered to exclude a clinically relevant difference in POD incidence given the substantially lower-than-expected event rate, as no statistically significant between-group difference was detected. In addition, remimazolam at these doses was associated with higher post-induction blood pressure, fewer hypotensive events, and lower vasopressor requirements compared with propofol. Therefore, remimazolam at these induction doses may serve as suitable alternatives for this vulnerable patient population. CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn, Chinese Clinical Trial Registry ChiCTR2400082176.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.