Trephine
AboutSpecialtiesPricingLoading...

Copyright © 2024 Trephine. All rights reserved. The content of this site is intended for health care professionals.

TREPHINE

Terms Of UsePrivacy Policy

European journal of anaesthesiologySystematic Review - Meta-Analysis

01 Apr 2025

Association of remimazolam with delirium and cognitive function: A systematic review and meta-analysis of randomised controlled trials.

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.

References:

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association Publishing; 2022.
  • Hamilton GM, Wheeler K, Di Michele J, et al. A systematic review and meta-analysis examining the impact of incident postoperative delirium on mortality. Anesthesiology 2017; 127:78–88.
  • Maldonado JR. Acute brain failure: pathophysiology, diagnosis, management, and sequelae of delirium. Crit Care Clin 2017; 33:461–519.
  • Goldberg TE, Chen C, Wang Y, et al. Association of delirium with long-term cognitive decline: a meta-analysis. JAMA Neurol 2020; 77:1373–1381.
  • Zaal IJ, Devlin JW, Hazelbag M, et al. Benzodiazepine-associated delirium in critically ill adults. Intensive Care Med 2015; 41:2130–2137.

Article info

Journal issue:

  • Volume: 42
  • Issue: 4

Doi:

10.1097/EJA.0000000000002107

More resources:

Ingenta plc

Full Text Sources

Paid

MedlinePlus Health Information

Medical

Free resource

Ovid Technologies, Inc.

Full Text Sources

Paid

NCI CPTAC Assay Portal

Miscellaneous

Free resource

Wolters Kluwer

Full Text Sources

Paid

Share: