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.
Similar content being viewed by others
Data availability
Data supporting the results of this study are available from the corresponding author, Daichi Fujimoto, upon reasonable request.
References
Masui K. Remimazolam besilate, a benzodiazepine, has been approved for general anesthesia!! J Anesth. 2020;34:479–82.
Ko C-C, Hung K-C, Illias AM, Chiu C-C, Yu C-H, Lin C-M, Chen I-W, Sun C-K. The use of remimazolam versus propofol for induction and maintenance of general anesthesia: a systematic review and meta-analysis. Front Pharmacol. 2023;14:1101728.
Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BRH, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41:263–306.
Tsuda T. Epidemiology of fragility fractures and fall prevention in the elderly: a systematic review of the literature. Curr Orthop Pract. 2017;28:580–5.
Wang C, Qin Y, Wan X, Song L, Li Z, Li H. Incidence and risk factors of postoperative delirium in the elderly patients with hip fracture. J Orthop Surg. 2018;13:186.
Martocchia A, Curto M, Comite F, Scaccianoce S, Girardi P, Ferracuti S, Nicoletti F, Falaschi P. The prevention and treatment of delirium in elderly patients following hip fracture surgery. Recent Patents CNS Drug Discov. 2015;10:55–64.
Inouye SK. Clarifying confusion: the confusion assessment method: a new method for detection of delirium. Ann Intern Med. 1990;113:941.
Saczynski JS, Kosar CM, Xu G, Puelle MR, Schmitt E, Jones RN, Marcantonio ER, Wong B, Isaza I, Inouye SK. A tale of two methods: chart and interview methods for identifying delirium. J Am Geriatr Soc. 2014;62:518–24.
Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and cox regression. Am J Epidemiol. 2007;165:710–8.
Bramley P, McArthur K, Blayney A, McCullagh I. Risk factors for postoperative delirium: an umbrella review of systematic reviews. Int J Surg. 2021;93: 106063.
Swarbrick CJ, Partridge JSL. Evidence-based strategies to reduce the incidence of postoperative delirium: a narrative review. Anaesthesia. 2022;77:92–101.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (strobe) statement: guidelines for reporting observational studies. The Lancet. 2007;370:1453–7.
Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.
Kaneko S, Morimoto T, Ichinomiya T, Murata H, Yoshitomi O, Hara T. Effect of remimazolam on the incidence of delirium after transcatheter aortic valve implantation under general anesthesia: a retrospective exploratory study. J Anesth. 2023;37:210–8.
Aoki Y, Kurita T, Nakajima M, Imai R, Suzuki Y, Makino H, Kinoshita H, Doi M, Nakajima Y. Association between remimazolam and postoperative delirium in older adults undergoing elective cardiovascular surgery: a prospective cohort study. J Anesth. 2023;37:13–22.
Yang J-J, Lei L, Qiu D, Chen S, **ng L-K, Zhao J-W, Mao Y-Y, Yang J-J. Effect of remimazolam on postoperative delirium in older adult patients undergoing orthopedic surgery: a prospective randomized controlled clinical trial. Drug Des Devel Ther. 2023;17:143–53.
Liu T, Lai T, Chen J, Lu Y, He F, Chen Y, **e Y. Effect of remimazolam induction on hemodynamics in patients undergoing valve replacement surgery: a randomized, double-blind, controlled trial. Pharmacol Res Perspect. 2021;9: e00851.
Park CG, Lee D, Jung WS, Kim DS, Jo YY, Kwak HJ. Impact of remimazolam versus sevoflurane anesthesia on cerebral oxygenation and intracranial pressure during gynecological laparoscopy with mild hypercapnia. Med Sci Monit. 2023;29:e941315–21.
Nam SW, Yim S, Choi CI, Park I, Joung K-W, Song I-A. Effects of remimazolam on hemodynamic changes during cardiac ablation for atrial fibrillation under general anesthesia: a propensity-score-matched retrospective cohort study. Can J Anesth Can Anesth. 2023;70:1495–503.
Wachtendorf LJ, Azimaraghi O, Santer P, Linhardt FC, Blank M, Suleiman A, Ahn C, Low YH, Teja B, Kendale SM, Schaefer MS, Houle TT, Pollard RJ, Subramaniam BEikermann M, Wongtangman K. Association between intraoperative arterial hypotension and postoperative delirium after noncardiac surgery: a retrospective multicenter cohort study. Anesth Analg. 2022;134:822–33.
Lee S-J, Sung T-Y. Emergence agitation: current knowledge and unresolved questions. Korean J Anesthesiol. 2020;73:471–85.
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.
Author information
Authors and Affiliations
Contributions
DF designed the study, collected data, and analyzed the data. DF, NO and SM wrote the manuscript.
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
About this article
Cite this article
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
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00540-024-03339-z