Chinese Journal of Alzheimer's Disease and Related Disorders · Oct 23, 2026
Anesthetic effects of remimazolam and propofol in older patients undergoing lumbar spine surgery and their effects on postoperative cognitive function
By 王震东
OBJECTIVE: To observe the clinical effects of remimazolam and propofol on perioperative hemodynamics, inflammatory markers, and cognitive function in older patients undergoing lumbar spine surgery. METHODS: A total of 84 older patients undergoing lumbar spine surgery in the departments of orthopedics and trauma surgery at our hospital from April 2025-April 2026 were selected as study participants and assigned to the propofol group or the remimazolam group using a random number table, with 42 patients in each group; changes in heart rate (HR) and mean arterial pressure (MAP) were monitored in both groups before anesthesia induction (T0), after anesthesia induction when BIS＜60 (T1), immediately after successful tracheal intubation (T2), and 30 min after anesthesia induction (T3); changes in blood inflammatory factors, including IL-6, IL-10, and TNF-α, were measured in both groups before anesthesia induction and after extubation following completion of surgery; changes in delirium and cognitive function were compared between the two groups preoperatively and 72 h postoperatively; quality of recovery from anesthesia and the occurrence of adverse events were compared between the two groups. RESULTS: Repeated-measures analysis of variance showed a statistically significant time effect for HR (P＜0.001) and statistically significant between-group and time effects for MAP (P＜0.05). HR at T1 and MAP at T1 and T3 were higher in the remimazolam group than in the propofol group (P＜0.05). Postoperative IL-6, IL-10, and TNF-α levels were higher than preoperative levels in both groups (P＜0.001), and postoperative IL-6 and TNF-α levels were lower in the remimazolam group than in the propofol group (P＜0.05). MMSE scores at 72 h postoperatively were lower than preoperative scores in both groups, and MMSE scores at 72 h postoperatively were higher in the remimazolam group than in the propofol group (P＜0.05); there were no statistically significant differences between the two groups in the incidence of postoperative delirium or quality of recovery from anesthesia (P＞0.05). The overall incidence of perioperative adverse events was lower in the remimazolam group than in the propofol group (21.43% vs. 45.24%, P＜0.05). CONCLUSIONS: Compared with propofol, remimazolam for general anesthesia in older patients undergoing lumbar spine surgery can better maintain perioperative HR and MAP stability, reduce postoperative inflammatory responses, have less effect on postoperative cognitive function, and reduce the incidence of perioperative adverse events, demonstrating a favorable safety profile in clinical use.