Effect Of Remimazolam On Postoperative Cognitive Function In Elderly Patients With Total Hip Arthroplasty

Objective:Investigating the impact of remimazolam on cognitive performance in elderly people who have undergone total hip replacement surgery.Methods:Randomly dividing 60 patients aged between 65-85 and with ASA classification Ⅱ-Ⅲ into three groups,the plan specified the remimazolam group（Group R）,the midazolam group（Group M）,and the saline group（Group N）.In each group,20 patients were present.After completion of combined spinal and epidural anesthesia,sedation was started when the anesthetic level was fixed at the appropriate level.group R: a loading dose of remimazolam 0.1mg/kg was given intravenously at a rate of 0.18mg/kg/h to sustain a BIS of 60-80.Thirty minutes prior to the conclusion of the procedure,the infusion was terminated.group M: a loading dose of midazolam0.04mg/kg was given intravenously,The infusion was stopped 30 mins before the end of the procedure.group N: pumped with saline at the same rate as group R.No other sedative medication was given during the procedure.The MAP,RR,SpO₂,HR and MOAA/S scores were monitored and recorded at the time of admission（T0）,when the anesthetic level was fixed（T1）,20 minutes after the start of surgery（T2）,30 minutes before the end of surgery（T3）and when the BIS value was >90（T4）in each of the three groups.the patients’ time to sleep and time awake were recorded,and adverse events were recorded.The MMSE and the MoCA were employed to evaluate the cognition of the patients at 1 d prior to（D0）,1 d subsequent to（D1）,3 d subsequent to（D3）,and 7 d subsequent to（D7）surgery.Venous blood was collected from the elbow at D0,D1 and D3 to measure S100β protein and IL-6 levels by ELISA.Main results:1.Group R and Group N’s RR values at T2 were significantly greater than those of Group M（P < 0.05）.,while the BIS values and MOAA/S scores of both Groups R and N were significantly higher at T4（P < 0.05）compared to Group M.The time to reach the expected depth and the time to awaken were less in group R than in group M（P < 0.05）.intraoperative adverse effects were less in group R than in groups M and N（P < 0.05）.2.Patients in the R group had lower S100β and IL-6 concentrations than those in the M and N groups at D1（P < 0.05）.The R and N groups exhibited lower S100βconcentrations at D3 than the M group（P < 0.05）in both cases.3.At D1,MMSE scores were significantly higher in group R than in group N（P< 0.05）.At D1,the R group’s MMSE score only declined in comparison to D0（P <0.05）.The R group exhibited a significantly higher MoCA score at D1 than the M and N groups（P < 0.05）At D7,the MoCA score of the N group was significantly inferior to that of the R and M groups,with a p-value of less than 0.05（P < 0.05）.Conclusion:Remimazolam has less respiratory depression than midazolam,faster awakening,higher quality of awakening,and is effective in reducing intraoperative inflammatory factors,and is more suitable for the elderly to protect patients’ cognitive function.