Comparison of efficacy and safety of remimazolam and midazolam in elderly patients undergoing laparoscopic cholecystectomy: a retrospective study

Remimazolam is a novel benzodiazepine, but its comparative efficacy against midazolam in elderly patients undergoing laparoscopic cholecystectomy (LC) remains understudied. Objective To compare the efficacy and safety of remimazolam and midazolam in elderly patients with moderate surgical risk (ASA II-III) undergoing LC. A retrospective analysis was conducted on 184 patients who underwent LC under general anesthesia between January 2022 and January 2024. Patients were divided into remimazolam (n = 81) and midazolam (n = 103) groups. The primary outcome was extubation time, defined as the time from the end of anesthesia to successful extubation. Secondary outcomes included post-anesthesia care unit (PACU) stay duration, hemodynamic and respiratory parameters, and adverse events. The remimazolam group exhibited significantly shorter extubation times (33 min [IQR 24.0-44.5] vs. 42 min [IQR 30.0-61.0], p = 0.0003) and PACU stays (55 min [IQR 45-65] vs. 65 min [IQR 55-80], p = 0.0001) compared to the midazolam group. Hemodynamic profiles and the incidence of adverse events, including hypotension and bradycardia, were comparable between the two groups (p > 0.05). No respiratory depression or postoperative nausea and vomiting were observed in either group. An association between remimazolam use and clear clinical advantages over midazolam in LC was observed, including faster recovery and shorter PACU stays, with comparable hemodynamic stability and safety profiles. These findings suggest that remimazolam is a promising alternative for anesthesia in minimally invasive surgeries. Further multicenter studies are warranted to confirm these results and explore its utility in diverse surgical settings.