Effects of remimazolam and propofol on sleep rhythm and delirium after spinal surgery in elderly patients

作者：Li Yaqiu, Zhou Heng, Wu Ruimin, Wang Xuri · 发表于：Perioperative Medicine · 年份：2025 · DOI：10.1186/s13741-025-00500-4 · 被引用次数：13 · 研究领域：Intensive Care Unit Cognitive Disorders、Sleep and related disorders、Anesthesia and Sedative Agents

OBJECTIVE: This study aims to investigate the effects of remimazolam on postoperative melatonin secretion, sleep rhythm, and postoperative delirium (POD) in elderly patients undergoing spinal surgery. METHODS: We selected 120 elderly patients scheduled for elective spinal surgery (lumbar interbody fusion via a posterior approach) under general anaesthesia from November 2023 to January 2024. They were divided into 2 groups according to medication, the remimazolam group (R group) and the propofol group (P group), with 60 patients in each group. The R group received an induction dose of remimazolam 0.2 ~ 0.3 mg/kg, followed by a continuous infusion of remimazolam at 0.1-0.2 mg/kg/h for maintenance. The P group received an induction dose of propofol 1.5 ~ 2.0 mg/kg, followed by a continuous infusion of propofol at 4-6 mg/kg/h for maintenance. Melatonin and cortisol concentrations were measured at 04:00 on the day of surgery and postoperative days 1, 2, and 3. The Pittsburgh Sleep Quality Index (PSQI) and resting visual analog scale (VAS) pain scores were recorded on the day before surgery, and on postoperative days 1 and 2, as well as prior to discharge. Additionally, we documented extubation time, PACU stay duration, total and effective button presses on the analgesia pump, instances of supplemental analgesia, and occurrence of complications. RESULTS: Compared to the P group, the R group exhibited significantly shorter extubation time and PACU stay duration (P < 0.05). On postop...