Neuroanesthesia & neurocritical care
Effect of remimazolam versus propofol anaesthesia on postoperative delirium in neurovascular surgery: a randomised noninferiority trial
Primary result · Cumulative incidence of POD (CAM-ICU or 3D-CAM, assessed twice daily)Result — go to the resultRisk difference 1.97 percentage points 95% CI −2.85 to 6.80Authors' conclusion
Remimazolam-based TIVA met the prespecified criterion for noninferiority to propofol-based TIVA with respect to postoperative delirium after elective neurovascular surgery. Interpretation should take into account that the observed incidence of postoperative delirium was lower than anticipated when the noninferiority margin was defined.
Study context
- Population
- Adults undergoing elective intracranial aneurysm clipping, arteriovenous malformation resection, microvascular decompression, or superficial temporal artery-middle cerebral artery bypasspatients in the modified intention-to-treat analysis
- Participants
- 686 adults
- Comparison
- Remimazolam-based total intravenous anaesthesia (TIVA) is noninferior to propofol-based TIVA for postoperative delirium (POD)
- Remimazolamn = 344
- Propofoln = 342
- Primary endpoint
- Cumulative incidence of POD (Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) or 3D-CAM, assessed twice daily)
- Follow-up
- Within 5 days
Primary result
As reported in the abstract
Risk difference
1.97 percentage points
95% CI −2.85 to 6.80
one-sided P<0.001 for noninferiority
Events by treatment group
Further findings
Hypotensive burden below a mean arterial pressure threshold of 65 mm Hg · lower in the remimazolam group
P < 0.001
Tracheal extubation in the operating room
Tracheal extubation in the operating room
- More frequent in the remimazolam group
Original publication
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