Application Of Remimazolam In Elderly Patients Undergoing Orthopedic Surgery And Its Effect On Short-term Postoperative Cognitive Function

Objective:The purpose of this study was to compare the effects of remimazolam induced maintenance and midazolam induced propofol maintenance on short-term postoperative cognitive function,anesthesia recovery and hemodynamics in elderly patients undergoing orthopedic surgery under general anesthesia.To provide new ideas for reducing the incidence of Postoperative cognitive dysfunction（POCD）in elderly patients.Methods:A total of 82 elderly patients,aged≥65 years,with ASA grade IIto III,who underwent elective orthopedic surgery under general anesthesia were randomly divided into experimental group and control group.Mini-mental State Examination（MMSE）was used to assess the cognitive function of patients in the 2 groups before,1day and 3days after surgery,respectively,and c-reactive protein（CRP）levels were recorded before and 48h after surgery as inflammation indicators.In the experimental group,0.1mg·kg^-1remimazolam was injected intravenously during anesthesia induction,0.5～1mg·kg^-1·h^-1remimazolam and0.1mg·kg^-1·h^-1cis-atracurium were injected intravenously during anesthesia maintenance.The control group was intravenously injected with midazolam 0.05mg·kg^-1during intraoperative anesthesia induction,and intravenously pumped with propofol 4～12mg·kg^-1·h^-1during maintenance.Heart rate,blood oxygen saturation,mean arterial pressure and Bispectral index were measured and recorded in operating room（T1）,anesthesia intubation（T2）,surgical skin resection（T3）,30min after skin resection（T4）,at the end of surgery（T5）and 5min after extubation（T6）.BIS is between 40 and 60.Results:The incidence of POCD was 33.8%in all patients 3 days after operation.MMSE scores in both groups showed a trend of decreasing first and then increasing.The decrease of MMSE scores and the incidence of cognitive decline 1d after operation in the experimental group were lower than those in the control group,the differences were statistically significant（P<0.05）.There was no significant difference in the decrease value of MMSE and the incidence of POCD in 3 days after operation between the two groups（P>0.05）.There was no statistically significant difference in CRP difference between the two groups before and after surgery（P=0.094）.There was no significant difference in HR between the two groups（P>0.05）.Postoperative extubation time in the experimental group was significantly shorter than that in the control group,with statistical significance（P<0.05）.There was no statistical difference in the incidence of postoperative nausea and vomiting,agitation,respiratory depression,dizziness and headache,and lethargy between 2 groups（P>0.05）.Conclusion:Induction and maintenance of remimazolam can provide safe and effective anesthetic sedation and hypnosis effect for elderly patients undergoing orthopedic surgery.Compared with traditional midazolam-induced propofol maintenance,remimazolam had less effect on cognitive function 1 day after surgery,faster recovery from anesthesia,and more stable intraoperative hemodynamics.Figure 4,table 14,reference 58...