Objective:

To assess the impact of remimazolam tosilate with flumazenil on early postoperative neurocognitive function and recovery quality in cirrhotic patients undergoing endoscopic variceal procedures.

Approach:

• Study Design: Randomized controlled trial involving 108 cirrhotic patients assigned to receive either propofol or remimazolam tosilate.
• Primary Outcomes: Neurocognitive performance measured using the Number Connection Test-A (NCT-A) and Digit Symbol Test (DST) preoperatively and at 6 and 24 hours postoperatively.
• Secondary Outcomes: Time to spontaneous respiration, eye opening, response to command, extubation, and modified Observer's Assessment of Alertness/Sedation (MOAA/S) scores.

Key Findings:

• No significant difference in NCT-A and DST scores between groups at baseline, 6 h, and 24 h post-surgery (P > 0.05).
• Both groups showed significant improvement in NCT-A and DST scores at 24 h compared to preoperative values (P < 0.05).
• Group R (remimazolam) had significantly faster recovery times for spontaneous respiration, eye opening, response to command, and extubation compared to Group P (P < 0.01).
• At extubation, Group R had higher modified MOAA/S and Steward scores than Group P (P < 0.05).

Interpretation:

Remimazolam tosilate with flumazenil resulted in faster recovery and better extubation quality compared to propofol, while early postoperative neurocognitive performance was similar between both groups.

Conclusion:

Remimazolam tosilate combined with flumazenil is a viable anesthetic option for cirrhotic patients undergoing endoscopic variceal procedures, offering quicker recovery without compromising neurocognitive function.

Sources:

• Clinical Trials Registration