Remimazolam vs. propofol anaesthesia for delirium in older patients recovering from lung resections: a randomised non-inferiority trial.
Wei Wang, Fengping Zhang, Yi Ge et al.
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In 30 seconds
This randomised non-inferiority trial compared remimazolam with propofol anaesthesia in patients aged 65 years or older undergoing lung resection. Delirium was assessed in the post-anaesthesia care unit and during the first 3 postoperative days. Among 455 patients in the modified intent-to-treat population, delirium occurred in 108/227 (48%) assigned remimazolam and 71/228 (31%) assigned propofol (risk ratio 1.53, 95%CI 1.21-1.94). The absolute risk difference was 16.5% (95%CI 7.7-25.3%), exceeding the prespecified 10% margin; non-inferiority was not established.
Key findings
- Delirium occurred in 108/227 (48%) remimazolam patients versus 71/228 (31%) propofol patients (risk ratio 1.53, 95%CI 1.21-1.94).
- The absolute risk difference was 16.5% (95%CI 7.7-25.3%), exceeding the 10% non-inferiority margin.
- Emergence delirium occurred in 105/227 (46%) versus 64/228 (28%) patients (risk ratio 1.65, 95%CI 1.28-2.12), while delirium after post-anaesthesia care unit discharge was uncommon and similar.
Why it matters
Delirium is an important postoperative outcome in older adults. In this surgical population, the trial found a higher incidence with remimazolam than with propofol, particularly around emergence from anaesthesia. These results help clarify the delirium profile of remimazolam relative to propofol in lung resection, while the observed difference should be interpreted within the population and outcomes studied.
What to keep in mind
The findings concern patients aged 65 years or older undergoing lung resection and delirium assessed during the initial 3 postoperative days; applicability to other populations or procedures is not established by this trial.