Abstract
EFFECT OF REMIMAZOLAM VS CONVENTIONAL ANESTHESIA (PROPOFOL OR DESFLURANE) ON POSTOPERATIVE DELIRIUM IN PATIENTS WITH CARDIAC SURGERY: RANDOMIZED CONTROLLED TRIAL (REDCARD TRIAL)
Journal of cardiothoracic and vascular anesthesia, Vol.39(12 Suppl), pp.14-15
12/2025
DOI: 10.1053/j.jvca.2025.09.063
Abstract
Objective
Remimazolam is a new benzodiazepine-based anesthetic with an ultra-short duration of action, and its use in cardiac surgery is increasing due to its minimal impact on hemodynamics. Cardiac surgery is associated with a high risk of postoperative delirium, and benzodiazepine-based agents are considered risk factors for delirium; however, the effects of remimazolam on postoperative delirium remain unclear.
To evaluate the incidence of postoperative delirium within 5 days after surgery in patients undergoing scheduled cardiac surgery under general anesthesia, comparing the use of remimazolam as a maintenance anesthetic with conventional anesthetics (propofol and desflurane) in a randomized, double-blind, controlled trial (jRCT1051210195).
Design and method
The target number of patients was set at 250, and anesthesia was managed with a target bispectral index value of 40 to 60 and a target mean arterial pressure range of 50 to 100 mmHg. The primary outcome was the incidence of delirium within 5 days postoperatively, assessed using the Intensive Care Delirium Screening Checklist (ICDSC) score. The incidence rates between groups adjusted for age (age 75 and over / under) and their 95% confidence intervals (CI) will be calculated using a Poisson regression model. Subgroup analyses were performed for cardiac function (left ventricular ejection fraction 50% and over / under) and other factors as secondary analyses of the primary outcome. Other intraoperative and postoperative secondary outcomes were compared using chi-square tests or Mann-Whitney U tests.
Results and conclusions
The incidence rate of delirium was 2.9 in the remimazolam group (n=123) and 3.0 in the conventional anesthetics group (n=123), with an adjusted incidence rate ratio of 0.964 (95% CI 0.607, 1.531). In patients with left ventricular ejection fraction <50%, the remimazolam group tended to have a lower incidence of postoperative delirium (adjusted incidence ratio 0.472; 95% CI 0.200, 1.116). There was no significant difference in the intraoperative use of circulatory agents, but the intraoperative use of remifentanil was significantly higher in the remimazolam group (p=0.005). There was no significant difference in the incidence of postoperative acute kidney injury.
In cardiac surgery patients, general anesthesia using remimazolam did not increase the incidence of postoperative delirium compared to conventional general anesthetics.
Details
- Title: Subtitle
- EFFECT OF REMIMAZOLAM VS CONVENTIONAL ANESTHESIA (PROPOFOL OR DESFLURANE) ON POSTOPERATIVE DELIRIUM IN PATIENTS WITH CARDIAC SURGERY: RANDOMIZED CONTROLLED TRIAL (REDCARD TRIAL)
- Creators
- Naoya IguchiYuri HayashiEriko TakeyamaHiroshi AkasakaYukiko YasunobeSatomi Okamura
- Resource Type
- Abstract
- Publication Details
- Journal of cardiothoracic and vascular anesthesia, Vol.39(12 Suppl), pp.14-15
- DOI
- 10.1053/j.jvca.2025.09.063
- ISSN
- 1053-0770
- Language
- English
- Date published
- 12/2025
- Academic Unit
- Anesthesia
- Record Identifier
- 9985027357902771
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