Effects of Remimazolam and Propofol on Emergence Agitation in Elderly Patients Undergoing Hip Replacement: A Clinical, Randomized, Controlled Study

Abstract

Purpose: The aim of this study was to compare the effects of remimazolam and propofol on emergence agitation (EA) in elderly patients undergoing hip replacement.

Methods: A total of 60 elderly patients undergoing hip replacement were recruited for this prospective, single-center, clinical, randomized, controlled study from February to April 2023. They were randomly assigned to two groups: the remimazolam group (group R) and the propofol group (group P). In group R, remimazolam was administered intravenously during the induction and maintenance of anesthesia, In group P, propofol was used during the induction and maintenance of anesthesia. The incidence of EA was recorded as the primary indicator. Secondary indicators included heart rate (HR) and mean arterial pressure (MAP) values at the following moments: 5 min prior to anesthetic induction (T₀), 1 min following induction (T₁), 5 min after the laryngeal mask was inserted (T₂), the beginning of surgery (T₃), the moment the laryngeal mask was removed (T₄), and the overall incidence of postoperative adverse events (bleeding or splitting of the surgical incision, removal of the intravenous infusion needle, falling off the bed, hypoxemia, and hypertension).

Results: The incidence of EA was significantly lower in group R than in group P (10% vs 33%, P < 0.05). At T₁, T₂, and T₃, the HR and MAP values of group R were higher than those of group P (P < 0.05). The overall incidence of postoperative adverse events was significantly lower in group R than in group P (P < 0.05).

Conclusion: Remimazolam further reduced the incidence of emergence agitation when compared to propofol during geriatric hip replacement. Moreover, it has a minor hemodynamic effect and lower the incidence of postoperative adverse events.

Keywords: elderly; emergence agitation; hip replacement; propofol; remimazolam.

Figure 1

Study flow diagram. A total of 62 patients were initially included in the study, but one patient refused to participate, and another had a history of mental illness and was excluded. Ultimately, 60 patients (30 in each group) completed the trial.

Figure 2

Comparison of MAP and HR between two groups of patients at different moments. (a): Comparison of MAP between the two groups, the MAP value was higher in the R group at the T₁-T₃ time point and the comparison was statistically significant (*P < 0.05); (b): Comparison of HR between the two groups, the HR value was higher in the R group at the T₁-T₃ time point and the comparison was statistically significant (*P < 0.05).