Effects of remimazolam on cerebral oxygen saturation and postoperative cognitive function in elderly undergoing nasal endoscopic surgery: a retrospective exploratory study

Abstract Background Remimazolam is a new type of benzodiazepine, which has been widely used for general anesthesia and sedation. However, the association between remimazolam and intraoperative cerebral oxygen saturation and postoperative cognitive function in older patients undergoing nasal endoscopic surgery remains unclear. This study aimed to evaluate the effects of general anesthesia with remimazolam during nasal endoscopic surgery on intraoperative cerebral oxygen saturation and postoperative cognitive function in the elderly. Methods This single-center retrospective study reviewed data from patients older than 65 years who underwent nasal endoscopic surgery under general anesthesia at our institution between December 2020 and December 2021. Patient intraoperative regional cerebral oxygen saturation (rcSO2) and Montreal Cognitive Assessment (MoCA) scores were obtained from patient records. According to the sedatives used in anesthesia, the patients were divided into the remimazolam (R) and propofol groups (P) for analysis. Results Sixty patients were included in the final analysis (R group, n = 30; P group, n = 30). The relative maximum reduction of intraoperative rcSO2 was significantly lower in the R group than in the P group (P < 0.05), and the rcSO2 in the R group was significantly higher than in the P group (P < 0.05) after intraoperative controlled hypotension. However, there was no significant difference in MoCA scores between the two groups. Conclusion Remimazolam may benefit elderly patients during nasal endoscopic surgery in terms of rcSO2, but has no significant association with postoperative cognitive function.