Comparison of remimazolam and dexmedetomidine on perioperative hemodynamics, postoperative mood, cognition, and delirium in elderly stroke patients undergoing mechanical thrombectomy: a single-center prospective cohort study.

Authors

Nan Chen, Zhichao Yu, Yankai Ma, Zhaoqian Shi, Guanjun Feng, Guiping Xu

Published in

Naunyn-Schmiedeberg's archives of pharmacology. Aug 10, 2026. Epub Aug 10, 2026.

Abstract

Optimal sedation strategies for elderly patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT) remain uncertain, particularly regarding their combined effects on hemodynamic stability and early neuropsychological outcomes. To compare remimazolam (RM) and dexmedetomidine (DEX) in terms of perioperative hemodynamic stability and early postoperative mood, cognitive function, and delirium. In this single-center prospective cohort study, 138 elderly AIS patients undergoing MT under general anesthesia were categorized into control (C, n = 45), DEX (n = 45), and RM (n = 48) groups based on sedation exposure. The primary outcome was MAP_range across T0-T6. Secondary outcomes included hypotension, neuropsychological scales (PHQ-9, GAD-7, SLUMS, 4AT), pain, biomarkers, and in-hospital outcomes. Multivariable regression analyses were performed. Both DEX and RM significantly reduced perioperative MAP_range compared with controls (β =  - 9.74 and - 12.49, respectively; P < 0.001). The incidence of hypotension was lower in the DEX (OR = 0.33, P = 0.047) and RM groups (OR = 0.22, P = 0.017), accompanied by reduced use of vasoactive agents. Both interventions markedly decreased the risk of delirium (DEX: OR = 0.05; RM: OR = 0.03; P < 0.001) and cognitive decline (DEX: OR = 0.27, P = 0.0077; RM: OR = 0.24, P = 0.0045). PHQ-9 (β =  - 5.91 and - 7.07) and GAD-7 scores (β =  - 2.71 and - 2.79) were also lower in both groups. Postoperative pain burden was reduced, reflected by lower VAS_AUC and decreased need for rescue analgesia (DEX: 17.8%; RM: 10.4%; control: 44.4%). Both RM and DEX were associated with greater perioperative hemodynamic stability and more favorable early neuropsychological outcomes in elderly AIS patients undergoing MT. These findings suggest that the two agents may be considered as candidate sedation strategies in this high-risk setting, while confirmation in randomized studies remains necessary.

PMID:
42572042
Bibliographic data and abstract were imported from PubMed on 10 Aug 2026.

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