Incidence of postoperative delirium and quality of recovery in older patients undergoing gastrectomy under general anaesthesia with remimazolam vs. propofol: a randomised non‐inferiority study

Jul 14, 2025Anaesthesia

Post-surgery confusion and recovery quality in older patients having stomach surgery with remimazolam versus propofol anesthesia

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Abstract

In a study involving 432 patients aged 65 and older, the incidence of delirium was 7.9% for both remimazolam and propofol groups.

The incidence of postoperative delirium was identical in both the remimazolam and propofol groups, with 17 out of 216 patients experiencing delirium.
Quality of recovery scores at 24 hours postoperatively were similar between the two groups, indicating comparable recovery experiences.
Median quality of recovery scores were 109 for both groups, suggesting no significant difference in postoperative recovery quality.

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INTRODUCTION: Due to its haemodynamic stability and rapid recovery from anaesthesia, remimazolam is an attractive hypnotic drug for general anaesthesia in older patients. However, remimazolam must show non-inferiority in terms of the incidence of delirium and quality of postoperative recovery to be used as an alternative to propofol for maintenance of general anaesthesia.

METHODS: Patients aged ≥ 65 y scheduled to undergo gastrectomy were randomly allocated to maintenance of general anaesthesia with a remimazolam infusion (remimazolam group) or propofol target-controlled infusion (propofol group) in a 1:1 ratio. The primary outcome measure was the incidence of delirium within 72 h of surgery (assessed using the confusion assessment method). Secondary outcomes included the quality of recovery at 24 h postoperatively (assessed using the translated Korean version of the 15-item Quality of Recovery questionnaire) and the incidence of postoperative nausea, retching and vomiting.

RESULTS: Of 461 patients randomly allocated in the study, 432 were included in the analysis (216 in each group). The incidence of delirium was 17/216 (7.9%) in patients allocated to the remimazolam group and 17/216 (7.9%) in those allocated to the propofol group (unadjusted odds ratio 1.00, 95%CI 0.50-2.02, p = 1.000). Quality of recovery scores were also similar between groups at 24 h postoperatively (median (IQR [range]) 109 (102-115 [54-140]) vs. 109 (104-115 [70-137]) for the remimazolam and propofol groups, respectively (p = 0.627); unadjusted odds ratio -0.03, 95%CI -0.19-0.13).

DISCUSSION: Remimazolam can be used as an alternative to propofol in older patients undergoing gastrectomy from the perspective of the incidence of postoperative delirium and quality of recovery.

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Incidence of postoperative delirium and quality of recovery in older patients undergoing gastrectomy under general anaesthesia with remimazolam vs. propofol: a randomised non‐inferiority study

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