Abstract

Background: Postoperative delirium (POD) is an acute disturbance in mental status that typically occurs within the first five postoperative days. Its incidence increases with age, affecting up to 50% of patients over 60. Risk factors include benzodiazepine use, female gender, emergency surgery, and comorbidities such as diabetes and cerebrovascular disease. The development of POD is associated with increased morbidity and prolonged hospital stays.

A 71-year-old Caucasian female underwent a total laparoscopic robotic hysterectomy. Her medical history included anxiety, hypertension, and diabetes. Although anxious preoperatively, she did not receive anxiolytic medication. General anesthesia was induced with fentanyl, lidocaine, propofol, and succinylcholine. Following an uncomplicated procedure, the patient failed to respond appropriately during emergence, raising concern for postoperative delirium.

Propofol is widely used for anesthetic induction due to its rapid onset and clearance; however, remimazolam is a newer agent with similar properties and may be associated with lower rates of POD. Its use in this patient may have reduced preoperative anxiety, perioperative stress, and delirium while providing equivalent anesthesia and amnesia.

Clinical Question: In geriatric patients undergoing general anesthesia, how does induction with remimazolam affect the incidence of postoperative delirium in comparison to induction with propofol?

Evidence-Based Discussion: Literature review suggests remimazolam is non-inferior—and possibly superior—to propofol in reducing POD, with no evidence of increased risk. Notably, remimazolam consistently provides greater hemodynamic stability. Its rapid metabolism via ester hydrolysis and reversibility with flumazenil may facilitate smoother emergence. Additional benefits include reduced emergence agitation and sleep disturbances.

Translation to Practice: Although further large-scale trials are needed, current evidence supports remimazolam as an equal or potentially superior induction agent in geriatric patients at risk for POD. Anesthesia providers should assess POD risk preoperatively, consider remimazolam when appropriate, ensure flumazenil availability, and utilize standardized delirium screening tools postoperatively.

Author Details

Bailey R. Byrne, DNP(c), BSN, RN BLS, ACLS, and PALS certifications former CCRN certification 5+ years of ICU nursing experience (including a background in cardiovascular thoracic surgery, neurosurgery, and trauma, as well as general medical pathophysiologic conditions)

Mary Beth Greenway, DNP, CRNA - Adjunct instructor and nurse anesthesia simulation coordinator at Moffett & Sanders School of Nursing, Samford University.  17+ years of experience as a CRNA with significant involvement with international medical missions.

Sigma Membership

Theta Delta

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Postoperative Delirium, Geriatric Patients, Older Patients, General Anesthesia, Remimazolam, Benzodiazepines

Advisor

Mary Beth Greenway

Second Advisor

Cassandra D. King

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2026-01-28

Full Text of Presentation

wf_yes

Download
Click on the above link to access the poster.

Share

COinS