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Effectiveness of remimazolam in preventing postoperative delirium in elderly patients with proximal femoral fractures

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Abstract

Purpose

Elderly patients with proximal femoral fractures are known to be a high-risk group for postoperative delirium (POD). The aim of this study was to determine the association of the benzodiazepine drug remimazolam with POD in elderly patients with proximal femoral fractures.

Methods

In this single-center retrospective observational study, we included patients aged 65 years or older who underwent general anesthesia for proximal femoral fractures. We collected data for the incidence of POD within 3 days after surgery. We also obtained data for complications, preoperative blood examinations, maintenance anesthetic and intraoperative vital data. The occurrence of POD in patients who received remimazolam for general anesthesia (remimazolam group) was compared to that in patients who received general anesthesia with other anesthetic agents (other group). We finally conducted a multivariate analysis to assess the independent association of remimazolam with the risk of POD.

Results

A total of 230 patients, including 54 patients who received remimazolam for maintenance anesthesia, were included in this study. The incidence of POD in the patients was 26.1%. The incidence of delirium within 3 days after surgery was significantly lower in the remimazolam group than in the other group (14.8% vs. 29.5%, p  =  0.03). The multivariate analysis showed that the use of remimazolam independently reduced the occurrence of POD (adjusted odds ratio  =  0.42, p  =  0.04).

Conclusion

This retrospective observational study showed that the use of remimazolam is independently associated with a reduced incidence of POD. Remimazolam may be considered as an option to reduce POD in elderly patients with proximal femoral fractures.

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Data availability

Data supporting the results of this study are available from the corresponding author, Daichi Fujimoto, upon reasonable request.

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Acknowledgements

The authors are indebted to the senior resident Dr. Noel D. Hauser. This study did not receive any specific grant from funding agencies in the commercial, public, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Anesthesiology, Hyogo Prefectural Tamba Medical Center, 2002-7 Hikami-Cho Iso, Tamba, Hyogo, 669-3495, Japan

    Daichi Fujimoto

  2. Department of Anesthesiology, Kobe University Hospital, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan

    Daichi Fujimoto, Norihiko Obata & Satoshi Mizobuchi

Authors
  1. Daichi Fujimoto
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  2. Norihiko Obata
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  3. Satoshi Mizobuchi
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Contributions

DF designed the study, collected data, and analyzed the data. DF, NO and SM wrote the manuscript.

Corresponding author

Correspondence to Daichi Fujimoto.

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Fujimoto, D., Obata, N. & Mizobuchi, S. Effectiveness of remimazolam in preventing postoperative delirium in elderly patients with proximal femoral fractures. J Anesth (2024). https://doi.org/10.1007/s00540-024-03339-z

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  • DOI: https://doi.org/10.1007/s00540-024-03339-z

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