Effect Of Remimazolam Tosilate On Early Cognitive Function In Elderly Patients Undergoing Gastroscopy

Objective: To evaluate the effect of remimazolam tosilate(RT)on early postoperative cognitive function in elderly patients undergoing gastroscopy,and assess its safety dosage.Methods: This study was a randomized,double-blind,parallelcontrolled study.99 elderly patients who underwent gastroscopy in the Third Xiangya Hospital between August 2020 and February 2021 were selected as the study objects.All patients were randomized into three groups equally: 0.1mg/kg RT,0.2mg/kg RT and 1.0-1.5 mg/kg propofol,denoted as R1 group,R2 group and P group,respectively.Pulse oximetry,electro-cardiograph and blood pressure were included in routine patient monitoring.All patients received butorphnol(0.01mg/kg)before receiving the assigned investigational sedative medicine,which was administered three minutes later.After the initial dose was administered,perioperative hypotension,hypoxemia,nausea/vomiting,intraoperative awareness,procedure time,sedation time,and recovery time were recorded.Cognitive functions(memory,attention amd executive function)were measured via neuropsychological tests(AVLT-H、DSST、TMT),which were conducted before sedation and 5 minutes after recovery to full alertness.Results:(1)The incidences of DNR measured 5 minutes after recovery to full alertness were 12.12%(R1),27.27%(R2)and 6.06%(P),respectively.There was no significant difference in the incidence of DNR between the R1 group and the P group(P > 0.05).The incidence of DNR in the R2 group was significantly higher than that in the P group(P < 0.05).In each cognitive domain,there were no statistical differences between postoperative and baseline results for R1 group.Patients in R2 group represented worsened postoperative cognitive functions(immediate recall and short delay recall)than baseline(P < 0.05),and there were no significant differences in other domains in R2 group(P > 0.05).However,there was an improvement in memory(immediate recall and short-delayed recall)and attention for the propofol-treated patients(P < 0.05).Further comparison in the change from baseline in each group,compared with P group,scores demonstrated worse restoration of immediate recall in R1 group,immediate recall,short-delayed recall,and attention function in R2group(P < 0.05).There was no significant difference in the restoration of all cognitive domains between the R1 group and the R2 group(P > 0.05).(2)The sedation time and recovery time of R2 group were significantly longer than the P group and R1 group(P < 0.05),while there was no significance between the R1 group and the P group(P > 0.05).In term of hypotension,the incidence rate in group R1 was significantly lower than that in group P(P < 0.05),but there was no significant difference between the R2 group and the R1 group and no significant difference between the P group and the R1 group(P > 0.05).Conclusion: Compared with propofol,low-dose remimazolam tosilate had comparable effect on early delay neurocognitive recovery in elderly patients undergoing gastroscopy,but less negative impact on circulation.