Effects of remimazolam vs. an etomidate–propofol mixture on postoperative cognitive function in elderly female patients undergoing radical mastectomy for breast cancer: a randomized controlled trial

Objective This study aimed to evaluate remimazolam’s anesthetic efficacy and impact on postoperative cognitive function in breast cancer patients undergoing radical mastectomy. Methods A total of 80 patients were randomized into two groups: Group R (remimazolam, n = 40) and Group EP (etomidate–propofol mixture, n = 40). Mean arterial pressure (MAP) and heart rate (HR) were recorded at T₀ (pre-induction), T₁ (post-intubation), T₂ (1 h intraoperation), and T₃ (post-extubation). Pain, measured using the visual analog scale (VAS), was assessed upon awakening and at PACU discharge. Cognitive function, measured using the Mini-Mental State Examination/Montreal Cognitive Assessment (MMSE/MoCA), was evaluated on postoperative days 1 and 3. Recovery times and adverse events were also compared between groups. Results Baseline characteristics were comparable between groups ( p > 0.05). At T₁, HR was lower in Group R than in Group EP ( p < 0.05). At T₂, MAP was higher in Group R ( p < 0.05). VAS scores showed no intergroup differences postoperatively ( p > 0.05). MMSE and MoCA scores were significantly higher in Group R at postoperative days 1 and 3 ( p < 0.05). Following flumazenil antagonism, eye-opening and extubation times were shorter in Group R than in Group EP ( p < 0.05). The overall adverse event rate was significantly lower in Group R (12.5% vs. 32.5%, p < 0.05). Conclusion Remimazolam provides effective anesthesia for elderly female patients undergoing radical mastectomy, offering superior hemodynamic stability at key time points, faster recovery, fewer adverse events, and significantly better preservation of early postoperative cognitive function compared with an etomidate–propofol mixture. Clinical trial registration number identifier ChiCTR2500106237.