Association of remimazolam with delirium and cognitive function
Jaime Andres Arias, Gustavo Roberto Minetto Wegner, Bruno Francisco Minetto Wegner, Larissa Santos Silva, Francisco José Lucena Bezerra, Rafaela Goes Machado Filardi
Abstract
BACKGROUND AND STUDY OBJECTIVE: Delirium 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. DESIGN: Systematic review of RCTs with meta-analysis. DATA SOURCES: PubMed, Embase, Cochrane Library and Web of Science databases up to 27 April 2024. ELIGIBILITY CRITERIA: Adult 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 RESULTS: Twenty-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%). CONCLUSION: Remimazolam 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 REGISTRATION: PROSPERO CRD42024532751.