Anesthetic comparison leaves postoperative delirium difference uncertain in older patients
Among older patients, pooled studies found no statistically significant delirium difference between remimazolam and propofol. Low blood pressure and sleep disturbances were less frequent with remimazolam.
Based on the published abstract. The full paper may contain additional methods, results and limitations.
The 30-second takeaway
For older patients receiving anesthesia or sedation, the pooled analysis did not establish a difference between remimazolam and propofol in postoperative delirium, a state of confusion. Remimazolam was associated with fewer episodes of low blood pressure and fewer sleep disturbances. Those secondary findings do not resolve the uncertainty about delirium or prove that the drugs are equivalent.
The abstract does not identify the included studies' designs or outcome assessment periods. The delirium confidence interval allows effects in either direction, so the nonsignificant finding cannot establish equivalence.
What researchers found
Delirium incidence
Remimazolam versus propofol: relative risk 0.86, 95% confidence interval 0.66–1.12. The postoperative assessment period is unspecified; the interval includes both lower and higher risk.
The main question remains open
Delirium was the primary outcome. A relative risk compares how often it occurred in the drug groups. Because the confidence interval crosses the point representing equal risk, this analysis leaves the direction of the difference uncertain.
Secondary outcomes were mixed
Low blood pressure and sleep disturbances favored remimazolam, but other secondary outcomes did not show statistically significant differences. These included low blood oxygen, nausea and vomiting, pain, time to breathing-tube removal, and hospital stay.
The original publication
The effects of remimazolam and propofol on delirium following anesthesia and sedation in elderly patients: a systematic review and meta-analysis.
Li A, Zhou Y, Wu L et al.
BMC Anesthesiol · 2025
- PubMed ID
- 40597651
- Record checked
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