Comparison of the effects of remimazolam and dexmedetomidine on early postoperative cognitive function in elderly patients with gastric cancer.

PURPOSE: To compare the effects of remimazolam and dexmedetomidine on early postoperative cognitive dysfunction (POCD) in aged gastric cancer patients.

METHODS: From June to December 2022, 104 elderly patients (aged 65-80 years) received laparoscopic radical resection of gastric cancer at the First Affiliated Hospital of Nanchang University. Using the random number table approach, the patients were separated into three groups: remimazolam (Group R), dexmedetomidine (Group D), and saline (Group C). The primary outcome was the incidence of POCD, and secondary outcomes included TNF-α and S-100β protein concentrations, hemodynamics, VAS scores, anesthesia recovery indicators, and the occurrence of adverse events within 48 h postoperatively.

RESULTS: At 3 and 7 days after surgery, there were no statistically significant differences in the incidence of POCD, the MMSE and MoCA scores between groups R and D ( p  > 0.05). However, compared to the saline group, both groups had higher MMSE and MoCA scores and decreased incidences of POCD. These differences were statistically significant ( p  < 0.05). Between group R and group D, there were no statistically significant changes ( p  > 0.05) in the levels of TNF-α and S-100β protein at the three time points (at the end of the surgery, 1 day later, and 3 days later). Even though neither group's concentration of the two factors was as high as that of the saline group, the differences were statistically significant ( p  < 0.05). At all three time points-following induction (T2 ), 30 min into the operation (T3 ), and at the conclusion of the surgery (T4 )-the heart rate and blood pressure in group R were greater than those in groups D and C. Statistics showed that the differences were significant ( p  < 0.05). The incidence of intraoperative hypotension was highest in group D and lowest in group R ( p  < 0.05). The dose of propofol and remifentanil, group C > group R > group D. Extubation and PACU residence times did not differ statistically significantly ( p  > 0.05) between the three groups. There was no significant difference in VAS scores between groups R and D after 24 h postoperatively ( p  > 0.05), although both had lower scores than group C, and the difference was statistically significant ( p  < 0.05). The VAS scores between the three groups at 72 h (T6 ) and 7 days (T7 ) were not statistically significant ( p  > 0.05). Adverse reactions such as respiratory depression, hypotension, bradycardia, agitation, drowsiness, and nausea and vomiting had the lowest incidence in group R and the highest incidence in group C ( p  < 0.05).

CONCLUSION: Remimazolam is similarly beneficial as dexmedetomidine in lowering the incidence of early POCD in aged patients after radical gastric cancer resection, probably due to reduced inflammatory response.