This prospective observational cohort study evaluates the effectiveness and safety of two benzodiazepine sedatives-remimazolam and midazolam-used for general anesthesia induction in elderly patients (≥65 years) undergoing elective non-cardiac surgery. Elderly patients have reduced organ reserve and altered pharmacokinetics/pharmacodynamics, increasing their susceptibility to anesthesia-related complications such as intraoperative hypotension, delayed emergence, and postoperative delirium. Remimazolam, an ultra-short-acting benzodiazepine metabolized by organ-independent tissue esterases, is hypothesized to offer greater hemodynamic stability, faster recovery, and a more favorable safety profile than midazolam in this vulnerable population. Investigators prospectively observe and collect data without altering routine clinical care; the choice of sedative is made by the attending anesthesiologist according to standard practice. Propensity score methods will be used to reduce confounding by indication.
Inclusion Criteria:
Age 65 years or older.
Scheduled for elective non-cardiac surgery under general anesthesia.
American Society of Anesthesiologists physical status I to IV.
Planned airway management with tracheal intubation or a laryngeal mask airway.
Written informed consent provided by the participant or the participant's legally authorized representative.
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Exclusion Criteria:
7.Refusal to provide informed consent.
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zryanmin@zju.edu.cn
Elderly patients who receive remimazolam as the benzodiazepine sedative during general anesthesia induction (final dose and sequence determined individually by the attending anesthesiologist).
Elderly patients who receive midazolam as the benzodiazepine sedative during general anesthesia induction (final dose and sequence determined individually by the attending anesthesiologist).
Comparison Between Remimazolam Tosilate and Midazolam in Elderly Patients Undergoing Gastrointestinal Endoscopy
Clinical Studies of the Efficacy and Safety of Remimazolam for Anesthesia Induction and Maintenance in Elderly Patients
The Role of Remazolam in Reducing the Incidence of Postoperative Delirium in Elderly Patients
Remimazolam vs. Midazolam for Sedation and Cognitive Outcomes in Orthopedic Surgery