Objective: To observe the effect of intraoperative continuous pump infusion of remimazolam on postoperative delirium (POD)in elderly patients with hip fracture under subarachnoid block.
Methods: A total of 236 elderly patients undergoing elective hip fracture surgery under subarachnoid block, 82 males and 154 females, aged ≥ 65 years, BMI 18.5-31.0 kg/m2, ASA physical status Ⅰ-Ⅲ, were divided into two groups by using the randomized number table method: remimazolam group (group R)and control group (group C), 118 patients in each group. When the surgical site was disinfected and covered, the patients in group R were administered the first dose of reminmazolam 0.1 mg/kg and followed by a continuous infusion 0.2 mg·kg-1·h-1 intravenously to maintain the modified observer's assessment of alert/sedation (MOAA/S) 1 or 2 scores. Reminmazolam infusion was stopped at the end of the surgery. The same volume of normal saline was injected for patients in group C. POD was assessed by the confusion assessment method-Chinese revised version (CAM-CR) 1-3 days after the surgery. The anxiety scores one day before and one day after the surgery, and plasma cortisol concentrations when the patients were admitted into the operating room and at the end of the surgery were recorded. The incidence of intraoperative hypertension, hypotension, bradycardia, hypoxemia, and postoperative nausea and vomiting were also recorded.
Results: Compared with group C, POD incidence in group R was significantly decreased (P < 0.05), anxiety score one day after surgery and plasma cortisol concentration at the end of the surgery in group R were significantly decreased (P < 0.05), and the incidence of intraoperative hypertension in group R was significantly decreased (P < 0.05). There were no significant differences in the plasma cortisol concentrations when the patients were admitted into the operating room and the incidences of intraoperative hypotension, bradycardia, hypoxemia, and postoperative nausea and vomiting between the two groups.
Conclusion: Remimazolam can reduce the incidence of postoperative delirium in elderlypatients undergoing hip fracture surgery under subarachnoid block, which may be related to alleviating intraoperative anxiety and inhibiting intraoperative stress response. |
