Remimazolam is associated with superior cerebral and pulmonary protection over propofol in elderly thoracic surgery: a real-world study validated by propensity score matching.

Using robust propensity score matching to emulate a randomized comparison, this study provides real-world evidence that a remimazolam-based anesthetic strategy, integrated with lung-protective ventilation, is associated with significantly better cerebral oxygenation, accelerated neurocognitive and pulmonary recovery, and lower rates of key postoperative complications compared to propofol in elderly patients undergoing VATS lobectomy.