The Effects of Remimazolam Tosylate on Postoperative Memory Function in Young and Middle-Aged Patients Undergoing Laparoscopic Surgery

Purpose: This randomized controlled trial compared the effects of remimazolam tosylate versus propofol on postoperative memory function in young and middle-aged adults undergoing laparoscopic surgery. Patients and Methods: 228 patients were randomized to receive either remimazolam or propofol (n=114 each) for induction and maintenance of general anesthesia, guided by Bispectral Index (BIS). Memory and cognitive functions were assessed preoperatively and on postoperative days 1 and 3 using the Three-Word Recall Test (TRT), Memory and Executive Screening (MES), and Montreal Cognitive Assessment (MoCA), with a follow-up at one month via the Telephone Interview for Cognitive Status-modified (TICS-m). Serum levels of IL-6, S100β, and NfL were measured preoperatively, at 30 minutes, and 24 hours post-surgery. Perioperative parameters and adverse events were recorded. Results: The incidence of early postoperative memory decline on days 1 and 3 was significantly lower in the remimazolam group compared to the propofol group (P < 0.05). The remimazolam group also exhibited significantly lower postoperative levels of IL-6 and S100β, more stable hemodynamics, and a reduced incidence of hypotension and bradycardia (all P < 0.05). The incidence of postoperative cognitive dysfunction (POCD) did not differ significantly between groups. Multivariate analysis identified lower educational level, diabetes, propofol use, and longer anesthesia duration as independent risk factors for early postoperative memory decline. Conclusion: For young and middle-aged patients undergoing laparoscopic surgery, remimazolam reduces the incidence of early postoperative memory decline (within the first three days) and provides superior hemodynamic stability with a milder inflammatory response compared to propofol. However, no significant difference was observed in cognitive function at one month postoperatively, indicating that the benefits are primarily confined to the early recovery period. Keywords: remimazolam tosylate, propofol, postoperative memory function, laparoscopic surgery