Minerva anestesiologicaJan 23, 2025

Remimazolam versus propofol and their effects on confusion after surgery: a review and combined analysis

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 4, 2026

Abstract

Among 1682 patients included in the analysis, remimazolam administration is not associated with a significant increase in postoperative delirium compared to propofol.

Postoperative delirium did not differ significantly between patients receiving remimazolam and those receiving propofol (risk ratio 0.82).
No statistically significant differences were observed in the incidence of nausea and vomiting, hypoxemia, or length of hospital stay between the two groups.
Remimazolam was associated with a lower incidence of hypotension and bradycardia compared to propofol.
Subgroup analyses indicated no variation in delirium rates based on surgery type, assessment timing, or cognitive impairment definitions.

Simplified

INTRODUCTION: The administration of benzodiazepines has been linked to the occurrence of postoperative delirium (POD) among patients undergoing surgery. In this review, we aim to appraise the current controversy regarding the role of remimazolam in POD.

EVIDENCE ACQUISITION: A systematic review and meta-analysis of randomized controlled trials was conducted to examine the effects of remimazolam administration on postoperative delirium compared to propofol from inception to April 2024. We conducted a comprehensive search of PubMed, EMBASE, Cochrane Library, Web of Science, Wanfang, and ZhiWang Chinese databases. In the fixed-effects and random-effects statistical models, pooled risk ratios (RRs) or mean differences, 95% CIs, and P values were estimated for endpoints. The trial sequential analysis was used for sensitivity analysis.

EVIDENCE SYNTHESIS: Among the 479 records screened, 11 randomized controlled trials with 1682 patients were eligible for inclusion. POD did not differ between groups (RR,0.82; 95% CI 0.53-1.26; P=0.36; df=10; I=42%). There were no statistically significant differences between groups in the incidence of nausea and vomiting, hypoxemia, and length of stay. However, remimazolam had a lower incidence of hypotension and bradycardia than propofol. Analyses of subgroups did not reveal a difference in delirium based on the type of surgery, assessment timing, or definition of cognitive impairment. This result has been supported by the trial sequential analysis. 2

CONCLUSIONS: Based on the available evidence, perioperative remimazolam administration is not associated with a significant rise in the incidence of POD.

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Remimazolam versus propofol and their effects on confusion after surgery: a review and combined analysis

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