Zeifei Zhu,1,2 Guanyu Yang,3 Qinjun Chu,3 Ming Cheng,4 Zeping Li,1 Liang Zang,1 Long He,1 Linna Chen,5 Qian He,6 Jianjun Yang,1 Zhentao Sun,1 Hongwei Wang1 

1Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; 2Department of Interventional Operating Room, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; 3Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, People’s Republic of China; 4Department of Medical Information, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; 5Department of Anesthesiology, the First Hospital of Jilin University, Changchun, People’s Republic of China; 6Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Xinxiang Medical University, Weihui, People’s Republic of China

Correspondence: Hongwei Wang, Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, Henan, 450052, People’s Republic of China, Email ZZUwhw@163.com Zhentao Sun, Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, Henan, 450052, People’s Republic of China, Email fccsunzt@zzu.edu.cn

Background: Postoperative delirium (POD) is a common complication. Remimazolam, a novel ultra-short-acting benzodiazepine, has been introduced in anesthesia practice, but its impact on the incidence of POD remains unclear. This study aims to evaluate the association between intraoperative use of remimazolam and the incidence of POD.
Methods: In this retrospective cohort study, patients aged 65 years and older who underwent elective non-cardiac surgery and were directly transferred to the ICU postoperatively were included. Based on intraoperative use of remimazolam, patients were categorized into the remimazolam group or the non-remimazolam group. The primary outcome was the incidence of POD within seven days postoperatively or until discharge (whichever occurred first), assessed using the CAM-ICU or the 3D-CAM. Propensity score matching (PSM) and multivariable logistic regression analyses were performed to adjust for potential confounders.
Results: After PSM, 826 pairs of patients were analyzed. The overall incidence of POD was 10.29%. The incidence of POD was 9.32% in the remimazolam group and 11.26% in the non-remimazolam group (P = 0.225). Multivariable logistic regression showed that remimazolam use was not significantly associated with POD incidence (aOR = 0.810, 95% CI = 0.588– 1.113, P = 0.196). Intraoperative use of dexmedetomidine was associated with a reduced incidence of POD (aOR = 0.345, 95% CI = 0.236– 0.511, P < 0.001), while postoperative administration of esketamine was an independent risk factor for POD (aOR = 2.644, 95% CI = 1.269– 5.156, P = 0.006).
Conclusion: In elderly patients undergoing non-cardiac surgery, intraoperative use of remimazolam was not significantly associated with the incidence of postoperative delirium.

Keywords: remimazolam, postoperative delirium, intensive care unit, elder, non-cardiac