Objective:

To assess the impact of remimazolam versus propofol anesthesia on postoperative gastrointestinal function recovery and complication rates in elderly patients undergoing radical resection for colorectal cancer.

Approach:

• Study Design: Prospective cohort study including elderly patients undergoing radical cancer resection from January 2023 to January 2025, comparing remimazolam and propofol anesthesia.
• Data Collection: Gastrointestinal hormones were measured preoperatively and 24 hours postoperatively. Recovery times for bowel sounds, first flatus, first defecation, and first solid food intake were recorded.
• Outcome Measures: Postoperative complications, including nausea/vomiting and delirium, were monitored, and recovery quality was assessed using the QoR-15 scale one week postoperatively.

Key Findings:

• Motilin and gastrin levels were higher in the remimazolam group at 24 hours postoperatively.
• The remimazolam group showed shorter gastrointestinal recovery times.
• Nausea/vomiting rates were lower in the remimazolam group (5.22% vs. 13.28%).
• Delirium rates were lower in the remimazolam group (10.43% vs. 21.88%).
• QoR-15 scores were higher in the remimazolam group (125.44 vs. 119.89).

Interpretation:

Remimazolam anesthesia was associated with improved gastrointestinal recovery and lower complication rates compared to propofol in elderly patients undergoing colorectal cancer surgery.

Limitations:

• The study design was not randomized, limiting causal interpretations.
• Findings require confirmation in randomized studies.

Conclusion:

Remimazolam anesthesia may optimize postoperative recovery in elderly patients undergoing colorectal cancer surgery within an ERAS framework.