Perioperative neurocognitive disorders and remimazolam: A narrative review of the currently available evidence

There has been a lot of debate surrounding the impact of anesthesia on cognitive impairment. A significant amount of data suggests that, in certain patient populations, exposure to general anesthesia during surgery is linked to the development of delayed neurocognitive recovery. Perioperative neurocognitive disorders (PND) refer to neurocognitive abnormalities detected in the perioperative period, both pre-operatively and post-operatively. As the population ages and the number of surgeries increase, PND has gained worldwide attention as a public health issue. Remimazolam, a novel ultrashort-acting benzodiazepine with anesthetic, anxiolytic and sedative effects, has been widely accepted for procedural sedation and general anesthesia. Increasingly more research shows that remimazolam has several benefits compared to other anesthetics in terms of hemodynamic stability, lack of injection pain, absence of accumulation with prolonged infusion and the availability of a reversal agent. Remimazolam has also proven effective in reducing the incidence of perioperative neurocognitive disorders in specific surgical categories. The aim of this review is to summarize the present literature on postoperative delirium and postoperative cognitive dysfunction in adults having undergone surgical procedures with remimazolam and to deduce whether the positive effects of remimazolam can be extrapolated to the different surgical interventions.