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Effect of remimazolam on the incidence of delirium after transcatheter aortic valve implantation under general anesthesia: a retrospective exploratory study

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A Letter to the Editor to this article was published on 23 December 2022

Abstract

Purpose

Delirium after transcatheter aortic valve implantation (TAVI) should be prevented because it is associated with worse patient outcomes. Perioperative administration of benzodiazepines is a risk factor for postoperative delirium; however, the association between remimazolam, a newer ultrashort-acting benzodiazepine for general anesthesia, and postoperative delirium remains unclear. This study aimed to evaluate whether remimazolam administration during TAVI under general anesthesia affected the incidence of postoperative delirium.

Methods

This single-center retrospective study recruited all adult patients who underwent transfemoral TAVI (TF-TAVI) under general anesthesia between March 2020 and May 2022. Patients were divided into the remimazolam (R) and propofol (P) groups according to the sedative used for anesthesia. In the R group, all patients received flumazenil after surgery. The primary endpoint was the incidence of delirium within 3 days after surgery. Factors associated with delirium after TF-TAVI were examined by multiple logistic regression analysis.

Results

Ninety-eight patients were included in the final analysis (R group, n = 40; P group, n = 58). The incidence of postoperative delirium was significantly lower in the R group than in the P group (8% vs. 26%, p = 0.032). Multiple logistic regression analysis revealed that remimazolam (odds ratio 0.17, 95% CI 0.04–0.80, p = 0.024) was independently associated with the incidence of postoperative delirium, even after adjustment for age, sex, preoperative cognitive function, history of stroke, and TF-TAVI approach.

Conclusion

Remimazolam may benefit TF-TAVI in terms of postoperative delirium; however, its usefulness must be further evaluated in extensive prospective studies.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank www.editage.jp for English language editing.

Funding

No funding was received for this work.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Shohei Kaneko, Takayuki Morimoto, Taiga Ichinomiya, Hiroaki Murata, Osamu Yoshitomi & Tetsuya Hara

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  1. Shohei Kaneko
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  2. Takayuki Morimoto
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  3. Taiga Ichinomiya
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  4. Hiroaki Murata
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Contributions

All authors contributed to the study conception and design. Material preparation was performed by SK, TM, and TI. Data collection, analysis, visualization, and project administration were performed by SK. The first draft of the manuscript was written by SK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Shohei Kaneko.

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Kaneko, S., Morimoto, T., Ichinomiya, T. et al. Effect of remimazolam on the incidence of delirium after transcatheter aortic valve implantation under general anesthesia: a retrospective exploratory study. J Anesth 37, 210–218 (2023). https://doi.org/10.1007/s00540-022-03148-2

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  • DOI: https://doi.org/10.1007/s00540-022-03148-2

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