Remimazolam noninferior to propofol for delirium in neurovascular surgery

A single-centre, double-blind, randomised noninferiority trial compared remimazolam-based and propofol-based total intravenous anaesthesia in patients undergoing elective neurovascular surgery. The trial reported postoperative delirium within 5 days in 12.8% of remimazolam patients versus 10.8% of propofol patients, meeting the prespecified noninferiority margin, while remimazolam was associated with less intraoperative hypotension and more frequent operating-room extubation. The authors note that observed delirium incidence was lower than anticipated when the noninferiority margin was set.

Most relevant for: Patients undergoing elective intracranial aneurysm clipping, arteriovenous malformation resection, microvascular decompression, or STA-MCA bypass under total intravenous anaesthesia.

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