Objective:To explore the effects of remimazolam versus dexmedetomidine combined with spinal-epidural anesthesia in elderly patients undergoing hip replacement.Methods:A total of 100 elderly patients who needed total hip replacement in the Nanjing Lishui People′s Hospital from March 2021 to March 2023 were selected and divided into two groups by dynamic randomization, with 50 cases in each group. Both groups underwent surgery under combined spinal-epidural anesthesia. The control group was given dexmedetomidine for anesthesia, and the observation group was given remimazolam for anesthesia. The depth of sedation [eye-opening time, post anesthesia care unit (PACU) stay time, awakening time], cognitive function at different time periods [Mini-Mental State Examination (MMSE) score], inflammatory factor indexes [interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], and hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP)] were compared between the two groups.Results:The eye-opening time and PACU stay time in the observation group were shorter than those in the control group (all P<0.05), and there was no significant difference in awakening time between the two groups ( P>0.05). The MAP of both groups at post-skin incision (T 1) and completion of internal fixation (T 2) was higher than that after anesthesia induction (T 0), and decreased at the end of surgery (T 3); the HR of both groups at T 1 was lower than that at T 0, but increased at T 2, and then decreased at T 3. There were no significant differences in MAP and HR between the two groups at each time point (all P>0.05). The MMSE scores of the observation group at 1, 4, and 7 days after surgery were significantly higher than those of the control group (all P<0.05). The serum levels of IL-1β, IL-6, and TNF-α in both groups at post-anesthesia (t 1), end of surgery (t 2), and post-surgery (t 3) were significantly higher than those at 1 day before surgery (t 0), and the serum levels of IL-1β, IL-6, and TNF-α in the observation group at t 1, t 2, and t 3 were lower than those in the control group (all P<0.05). Conclusions:Both remimazolam and dexmedetomidine can effectively maintain hemodynamic stability in elderly patients undergoing hip replacement surgery, while remimazolam can more effectively shorten the time to reach the required depth of sedation, reduce the occurrence of cognitive dysfunction, and decrease the secretion of inflammatory factors.

Objective:To explore the effects of remimazolam versus dexmedetomidine combined with spinal-epidural anesthesia in elderly patients undergoing hip replacement.Methods:A total of 100 elderly patients who needed total hip replacement in the Nanjing Lishui People′s Hospital from March 2021 to March 2023 were selected and divided into two groups by dynamic randomization, with 50 cases in each group. Both groups underwent surgery under combined spinal-epidural anesthesia. The control group was given dexmedetomidine for anesthesia, and the observation group was given remimazolam for anesthesia. The depth of sedation [eye-opening time, post anesthesia care unit (PACU) stay time, awakening time], cognitive function at different time periods [Mini-Mental State Examination (MMSE) score], inflammatory factor indexes [interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], and hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP)] were compared between the two groups.Results:The eye-opening time and PACU stay time in the observation group were shorter than those in the control group (all P<0.05), and there was no significant difference in awakening time between the two groups ( P>0.05). The MAP of both groups at post-skin incision (T 1) and completion of internal fixation (T 2) was higher than that after anesthesia induction (T 0), and decreased at the end of surgery (T 3); the HR of both groups at T 1 was lower than that at T 0, but increased at T 2, and then decreased at T 3. There were no significant differences in MAP and HR between the two groups at each time point (all P>0.05). The MMSE scores of the observation group at 1, 4, and 7 days after surgery were significantly higher than those of the control group (all P<0.05). The serum levels of IL-1β, IL-6, and TNF-α in both groups at post-anesthesia (t 1), end of surgery (t 2), and post-surgery (t 3) were significantly higher than those at 1 day before surgery (t 0), and the serum levels of IL-1β, IL-6, and TNF-α in the observation group at t 1, t 2, and t 3 were lower than those in the control group (all P<0.05). Conclusions:Both remimazolam and dexmedetomidine can effectively maintain hemodynamic stability in elderly patients undergoing hip replacement surgery, while remimazolam can more effectively shorten the time to reach the required depth of sedation, reduce the occurrence of cognitive dysfunction, and decrease the secretion of inflammatory factors.