Comparative study of the efficacy and safety of remimazolam and midazolam for general anesthesia in elderly patients: a randomized controlled trial
Abstract Background Elderly patients are a vulnerable group with high perioperative risks. Thus, reducing the duration of anesthesia is important. Remimazolam is a benzodiazepine sedative commonly used for the induction and maintenance of general anesthesia given its rapid induction and rapid recove...
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2025-05-01
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| Series: | Perioperative Medicine |
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| Online Access: | https://doi.org/10.1186/s13741-025-00525-9 |
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| author | Yang Wan-jun Geng Zhi-long Gao Yuan-yuan Cui Chao-yuan Chen Zheng-ze Tian Zi-wei Guo Xi-lin Zhang Ya-nan Wang Lu Huo Rui Ma Chen-wei Niu Jing |
| author_facet | Yang Wan-jun Geng Zhi-long Gao Yuan-yuan Cui Chao-yuan Chen Zheng-ze Tian Zi-wei Guo Xi-lin Zhang Ya-nan Wang Lu Huo Rui Ma Chen-wei Niu Jing |
| author_sort | Yang Wan-jun |
| collection | DOAJ |
| description | Abstract Background Elderly patients are a vulnerable group with high perioperative risks. Thus, reducing the duration of anesthesia is important. Remimazolam is a benzodiazepine sedative commonly used for the induction and maintenance of general anesthesia given its rapid induction and rapid recovery. Most reports have focused on nonelderly patients. Aim To compare the time to loss of consciousness, length of PACU stay and incidence of adverse events in patients older than 65 years who received remimazolam for general anesthesia with those of patients who received midazolam. Methods This study was conducted at a university hospital between February 2022 and March 2023. We included 100 patients aged 65 years or older who were scheduled for surgery under general anesthesia. Patients were divided into 2 groups, namely, the midazolam group and the remimazolam group, with 50 patients in each group. The primary outcome was the time to loss of consciousness. The secondary outcomes included the time to extubation and length of PACU stay. We also recorded the percentage of flumazenil used and incidence of adverse events. Results Clinical data from 96 patients who were scheduled for surgery under general anesthesia were included in the final analysis, with 46 patients in the remimazolam group and 50 patients in the midazolam group. The time to loss of consciousness was 304 (222, 330) s in the remimazolam group and 95 (67, 25) s in the midazolam group, and the difference was significant (p = 0.000). The time to extubation was 24.93 ± 11.617 min in the remimazolam group and 34.88 ± 19.740 min in the midazolam group, revealing a significant difference (p = 0.003). The length of PACU stay was 55 (48, 64) min in the remimazolam group and 65 (55, 85) min in the midazolam group, and the difference was significant (p = 0.001). The percentage of flumazenil used was 6% in the remimazolam group and 20% in the midazolam group, and the difference was significant (p = 0.003). Conclusion General anesthesia with remimazolam has been shown to be effective and safe for surgery in elderly patients. The time to extubation was significantly shorter, length of PACU stay was shorter, and percentage of flumazenil used was lower in the remimazolam group than in the midazolam group. |
| format | Article |
| id | doaj-art-b5917bcd56a8474ebc14f174739f41ba |
| institution | Kabale University |
| issn | 2047-0525 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Perioperative Medicine |
| spelling | doaj-art-b5917bcd56a8474ebc14f174739f41ba2025-08-20T03:53:13ZengBMCPerioperative Medicine2047-05252025-05-0114111010.1186/s13741-025-00525-9Comparative study of the efficacy and safety of remimazolam and midazolam for general anesthesia in elderly patients: a randomized controlled trialYang Wan-jun0Geng Zhi-long1Gao Yuan-yuan2Cui Chao-yuan3Chen Zheng-ze4Tian Zi-wei5Guo Xi-lin6Zhang Ya-nan7Wang Lu8Huo Rui9Ma Chen-wei10Niu Jing11Department of Anesthesiology, The Second Affiliated Hospital of Xi’an Medical UniversityDepartment of Anesthesiology, The Second Affiliated Hospital of Air Force Medical UniversityDepartment of Anesthesiology, The Second Affiliated Hospital of Xi’an Medical UniversityDepartment of Anesthesiology, The Second Affiliated Hospital of Xi’an Medical UniversityDepartment of Anesthesiology, The Second Affiliated Hospital of Xi’an Medical UniversityDepartment of Anesthesiology, The Second Affiliated Hospital of Xi’an Medical UniversityDepartment of Anesthesiology, The Second Affiliated Hospital of Xi’an Medical UniversityDepartment of Anesthesiology, The Second Affiliated Hospital of Xi’an Medical UniversityDepartment of Anesthesiology, The Second Affiliated Hospital of Xi’an Medical UniversityDepartment of Anesthesiology, The Second Affiliated Hospital of Xi’an Medical UniversityDepartment of Anesthesiology, The Second Affiliated Hospital of Xi’an Medical UniversityDepartment of Anesthesiology, The Second Affiliated Hospital of Air Force Medical UniversityAbstract Background Elderly patients are a vulnerable group with high perioperative risks. Thus, reducing the duration of anesthesia is important. Remimazolam is a benzodiazepine sedative commonly used for the induction and maintenance of general anesthesia given its rapid induction and rapid recovery. Most reports have focused on nonelderly patients. Aim To compare the time to loss of consciousness, length of PACU stay and incidence of adverse events in patients older than 65 years who received remimazolam for general anesthesia with those of patients who received midazolam. Methods This study was conducted at a university hospital between February 2022 and March 2023. We included 100 patients aged 65 years or older who were scheduled for surgery under general anesthesia. Patients were divided into 2 groups, namely, the midazolam group and the remimazolam group, with 50 patients in each group. The primary outcome was the time to loss of consciousness. The secondary outcomes included the time to extubation and length of PACU stay. We also recorded the percentage of flumazenil used and incidence of adverse events. Results Clinical data from 96 patients who were scheduled for surgery under general anesthesia were included in the final analysis, with 46 patients in the remimazolam group and 50 patients in the midazolam group. The time to loss of consciousness was 304 (222, 330) s in the remimazolam group and 95 (67, 25) s in the midazolam group, and the difference was significant (p = 0.000). The time to extubation was 24.93 ± 11.617 min in the remimazolam group and 34.88 ± 19.740 min in the midazolam group, revealing a significant difference (p = 0.003). The length of PACU stay was 55 (48, 64) min in the remimazolam group and 65 (55, 85) min in the midazolam group, and the difference was significant (p = 0.001). The percentage of flumazenil used was 6% in the remimazolam group and 20% in the midazolam group, and the difference was significant (p = 0.003). Conclusion General anesthesia with remimazolam has been shown to be effective and safe for surgery in elderly patients. The time to extubation was significantly shorter, length of PACU stay was shorter, and percentage of flumazenil used was lower in the remimazolam group than in the midazolam group.https://doi.org/10.1186/s13741-025-00525-9RemimazolamElderly patientsMidazolam |
| spellingShingle | Yang Wan-jun Geng Zhi-long Gao Yuan-yuan Cui Chao-yuan Chen Zheng-ze Tian Zi-wei Guo Xi-lin Zhang Ya-nan Wang Lu Huo Rui Ma Chen-wei Niu Jing Comparative study of the efficacy and safety of remimazolam and midazolam for general anesthesia in elderly patients: a randomized controlled trial Perioperative Medicine Remimazolam Elderly patients Midazolam |
| title | Comparative study of the efficacy and safety of remimazolam and midazolam for general anesthesia in elderly patients: a randomized controlled trial |
| title_full | Comparative study of the efficacy and safety of remimazolam and midazolam for general anesthesia in elderly patients: a randomized controlled trial |
| title_fullStr | Comparative study of the efficacy and safety of remimazolam and midazolam for general anesthesia in elderly patients: a randomized controlled trial |
| title_full_unstemmed | Comparative study of the efficacy and safety of remimazolam and midazolam for general anesthesia in elderly patients: a randomized controlled trial |
| title_short | Comparative study of the efficacy and safety of remimazolam and midazolam for general anesthesia in elderly patients: a randomized controlled trial |
| title_sort | comparative study of the efficacy and safety of remimazolam and midazolam for general anesthesia in elderly patients a randomized controlled trial |
| topic | Remimazolam Elderly patients Midazolam |
| url | https://doi.org/10.1186/s13741-025-00525-9 |
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