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

IF 4.2 2区医学 Q1 ANESTHESIOLOGY European Journal of Anaesthesiology Pub Date : 2024-12-19 DOI:10.1097/EJA.0000000000002107

Jaime Andres Arias, Gustavo Roberto Minetto Wegner, Bruno Francisco Minetto Wegner, Larissa Santos Silva, Francisco José Lucena Bezerra, Rafaela Goes Machado Filardi

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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.

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雷马唑仑与谵妄和认知功能的关联：随机对照试验的系统回顾和荟萃分析。

背景和研究目的：谵妄是一种器质性精神综合征，与长期认知能力下降、住院时间增加和死亡率升高显著相关。本研究对随机对照试验（RCTs）进行了系统回顾，并进行了荟萃分析，评估了与非苯二氮卓类催眠药相比，雷马唑仑与术后认知功能和谵妄的关系。设计：采用meta分析对随机对照试验进行系统评价。数据来源：PubMed， Embase， Cochrane图书馆和Web of Science数据库，截止日期为2024年4月27日。资格标准：接受全身麻醉或镇静手术的成年患者；使用雷马唑仑作为主要催眠药或辅助催眠药，通过间歇大剂量或连续输注给予；与其他催眠药或镇静剂的比较；认知功能或谵妄的评估。主要结果：纳入23项随机对照试验，共3598例患者。在全身麻醉和镇静过程中，雷马唑仑与其他镇静剂谵妄的发生率无显著差异[n = 3261；优势比(OR) = 1.2, 95%可信区间（CI）， 0.76 ~ 1.91；p = 0.378843；i2 = 17%]。在认知功能评估方面，雷马唑仑组术后第一天的MMSE评分与对照组比较无差异(n = 263；平均差异= 0.60,95% CI, -1.46 ~ 2.66；p = 0.5684；I2 = 90%)或术后第三天(n = 163；平均差异= 1.33,95% CI, -0.72 ~ 3.38；p = 0.2028；i2 = 93%)。雷马唑仑在术后第7天的MMSE评分上优于对照组(n = 247；平均差异= 0.53,95% CI, 0.30 ~ 0.75；结论：与非苯二氮卓类催眠药相比，雷马唑仑不会增加谵妄或认知障碍的发生率。然而，分析显示手术类型对谵妄的发生率有显著影响。此外，雷马唑仑可改善术后短期认知功能。系统评价注册：PROSPERO CRD42024532751。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Anaesthesiology 医学-麻醉学

CiteScore

6.90

自引率

11.10%

发文量

351

审稿时长

6-12 weeks

期刊介绍： The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).