Incidence and predictors of postoperative delirium following remimazolam administration: a systematic review and meta-analysis of 29 randomized trials

Apr 24, 2025BMC anesthesiology

How often and why delirium happens after using remimazolam in surgery: a review of 29 clinical trials

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Abstract

The pooled incidence of following remimazolam administration was 5%.

  • Patients classified as ASA III-IV had a delirium rate of 19%, in contrast to 1% for ASA I-II patients.
  • Children exhibited the highest delirium rate at 11%, followed by elderly patients at 8%, while adults had a rate of 1%.
  • Oncologic surgeries were associated with the highest delirium incidence at 16%, and orthopedic surgeries at 12%, whereas gastrointestinal and endoscopic procedures showed 0%.
  • Higher doses of remimazolam were linked to a lower incidence of delirium compared to moderate doses.
  • Surgery type was identified as a primary predictor of delirium incidence, with orthopedic surgery presenting the greatest risk.

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Key numbers

5%
Pooled Delirium Incidence
Calculated from 29 RCTs involving 2,435 patients.
19%
Delirium Rate in ASA III-IV Patients
Compared to 1% in ASA I-II patients.
11% (children), 8% (elderly), 1% (adults)
Delirium Rate by Age Group
Rates reflect findings from multiple studies.

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