Comparison of remimazolam and dexmedetomidine on perioperative hemodynamics, postoperative mood, cognition…

Cohort studyNaunyn-Schmiedeberg's archives of pharmacology· Aug 2026

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.

Nan Chen, Zhichao Yu, Yankai Ma … Guiping Xu

Sedation & Anesthetic PharmacologyCohort studyTreatmentQ2IF 4.7

Remimazolam sedation was linked to markedly lower odds of postoperative delirium than controls

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.

Nan Chen … Guiping Xu

Naunyn-Schmiedeberg's archives of pharmacology · Aug 2026 · Q2 in General Medicine

Background

Optimal sedation strategies for elderly patients with acute ischemic stroke (acute ischemic stroke) undergoing mechanical thrombectomy (mechanical thrombectomy) remain uncertain, particularly regarding their combined effects on hemodynamic stability and early neuropsychological outcomes.

Purpose

To compare remimazolam (remimazolam) and dexmedetomidine (dexmedetomidine) in terms of perioperative hemodynamic stability and early postoperative mood, cognitive function, and delirium.

Methods

In this single-center prospective cohort study, 138 elderly acute ischemic stroke patients undergoing mechanical thrombectomy under general anesthesia were categorized into control (C, n = 45), dexmedetomidine (n = 45), and remimazolam (n = 48) groups based on sedation exposure.

n = 45

Results

remimazolam sedation sharply cut delirium risk versus controls

44.4%

Control

17.8%

DEX

10.4%

RM

More results

The primary outcome was MAP_range across T0-T6.

Both dexmedetomidine and remimazolam significantly reduced perioperative MAP_range compared with controls (β = - 9.74 and - 12.49, respectively; P < 0.001).

More results

The incidence of hypotension was lower in the dexmedetomidine (OR = 0.33, P = 0.047) and remimazolam groups (OR = 0.22, P = 0.017), accompanied by reduced use of vasoactive agents.

Postoperative pain burden was reduced, reflected by lower VAS_AUC and decreased need for rescue analgesia (dexmedetomidine: 17.8%; remimazolam: 10.4%; control: 44.4%).

“

Conclusion

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.

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.

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.

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