Effects of remimazolam on early postoperative cognitive function in elderly patients with hip fracture
AIM:To evaluate the effect of remima-zolam on early postoperative cognitive function in elderly patients with hip fracture based on a ran-domized controlled trial.METHODS:A total of 106 elderly patients,aged 65-90 years,ASA grade Ⅱ orⅢ,who underwent hip fracture surgery under com-bined spinal-epidural anesthesia in the Sixth Affiliat-ed Hospital of Wenzhou Medical University from De-cember 2022 to June 2023 and met the inclusion cri-teria,were selected and randomized into remima-zolam group(group R)and propofol group(group P)according to the random number table,with 53 cas-es in each group.Patients in group P received a slow intravenous injection of propofol at a dose of 0.3-0.5 mg/kg(injection time of 1min),followed by a pump infusion at 0.5-3 mg·kg1·h-1 for maintenance.In group R,intraoperative sedation was maintained by remimazolam at 0.1-0.3 mg·kg-1·h-1 after a load-ing dose of 0.05 mg/kg(injection time of 1min).The pump infusion rate were adjusted by maintaining MOAA/S score at 3-4 and BIS value at 75-85,and stopped administering sedatives while suturing the incision.MOAA/S score,MAP,HR,RR,SpO2 and BIS values were recorded before sedation(T0),5(T1),10(T2),15(T3),30(T4)and 60(T5)min after seda-tion and at the end of surgery.The emergence time,intraoperative amnesia,the incidence of postopera-tive delirium(POD)and delayed neurocognitive re-covery(DNR)within 7 days after operation,and the occurrence of adverse events during perioperative observation were recorded.RESULTS:Compared with T0,the BIS and MOAA/S scores of the two groups at T1-T5 were significantly decreased,and the MAP and HR of the two groups at T1-T6 were significantly lower(P＜0.05).Compared with group P,group R showed higher MAP at all time points from T1 to T6(all P＜0.05),shorter emergence time(6.6± 1.8 vs.7.7±2.2 min,P＜0.05),less decline in Hopkins Verbal Learning Test scores on postoperative day 7(3.9±3.9 vs.6.2±4.6,P＜0.05),lower incidence of postoperative delirium and DNR(7.5％vs.28.3％,5.7％vs.20.8％,P＜0.05),higher incidence of intraop-erative amnesia(52.8％vs.28.3％,P＜0.05)lower in-cidence of hypotension and bradycardia(15.1％vs.37.7％,5.6％vs.22.6％,P＜0.05),and fewer frequent use of vasoactive drugs(P＜0.05).CONCLUSION:Ap-plication of remimazolam for perioperative sedation in elderly patients with hip fracture can provide ef-fective sedation and stable hemodynamic,with lit-tle effect on early neurocognitive function,and over-all safety higher than propofol.
remimazolamelderly patientscom-bined spinal-epidural anesthesiasedationneuro-cognitive function
万方数据
维普
