Postoperative Delirium (POD)NCT07569614
Comparative Effects of Remimazolam Tosylate and Dexmedetomidine on Postoperative Delirium in Elderly Patients Undergoing Thoracoscopic Surgery.
A study testing Dexmedetomidine, Remimazolam Besylate and Normal Saline in people with Postoperative Delirium (POD) and Thoracoscopic Surgery, run by First Affiliated Hospital of Kunming Medical University at 1 site in China.
Trial summary
Postoperative delirium (POD) is a common acute brain dysfunction in the perioperative period, characterized by acute fluctuations in attention, consciousness, and cognition, typically occurring early after surgery. Read more about this study
- Who is it for?
- Ages 60 to 75 years
- Conditions the study is for
- Postoperative Delirium (POD), Thoracoscopic Surgery, Dexmedetomidine
- What is being tested?
- Dexmedetomidine, Remimazolam Besylate and Normal Saline
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 105 participants
- Where
- 1 siteChina
- Study dates
- 1 Apr 2025to 1 Feb 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 60 to 75 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age ≥ 60 years;
- BMI: 18.5-23.9 kg/m²;
- ASA grade II-III;
- Preoperative MMSE score ≥ 25;
- Signed informed consent before surgery.
Who cannot join
- Recent history of sedative, analgesic, or opioid use;
- Severe hypertension or significant hepatic or renal insufficiency;
- Allergy to the study medications;
- Alzheimer's disease or acute phase of mental illness;
- History of chronic pain or receipt of analgesic therapy;
- Hearing/visual impairment with communication difficulties.
Trial locations and contacts
1 site in 1 country.
China1 site
First Affiliated Hospital of Kunming Medical University Kunming
Kunming, Yunnan, 6500000
About this study
Official title: Comparative Effects of Remimazolam Tosylate and Dexmedetomidine on Postoperative Delirium in Elderly Patients Undergoing Thoracoscopic Surgery: A Randomized Controlled Trial
Postoperative delirium (POD) is a common acute brain dysfunction in the perioperative period, characterized by acute fluctuations in attention, consciousness, and cognition, typically occurring early after surgery. POD is closely associated with prolonged hospital stay, increased complications, delayed recovery, and higher mortality .
POD has multifactorial risk factors spanning preoperative, intraoperative, and postoperative phases. Its pathophysiology involves neuroinflammation, oxidative stress, blood-brain barrier dysfunction, and neurotransmitter imbalance . Advanced age, baseline cognitive impairment, infection, and malnutrition increase POD risk . Intraoperative hypotension, benzodiazepine exposure, and other anesthetic factors may also contribute .
Read more
Elderly patients have higher anesthesia risk due to age-related physiological decline. Cardiovascular reserve decreases with age, causing hemodynamic instability, especially during one-lung ventilation in thoracoscopic surgery . Among patients over 70 undergoing thoracoscopic lobectomy, 35.7% develop pulmonary complications; ASA grade ≥III, one-lung ventilation time, smoking history, and COPD are independent risk factors . Additionally, reduced hepatic and renal function slow anesthetic metabolism, increasing drug accumulation and delayed emergence .
Video-assisted thoracoscopic surgery (VATS) offers reduced trauma, faster recovery, and lower complication rates compared to open surgery . VATS shows clinical value in lung cancer and mediastinal tumors . Uniportal VATS allows faster recovery of pulmonary function (VC, FVC, TLC) and lower inflammatory markers (CRP, PCT, TNF-α) . However, caution is needed in elderly patients .
Despite reduced surgical trauma, elderly VATS patients may still develop POD. Anesthetic drugs, surgical stress, poor pain management, and neuroinflammation are key contributing factors . Therefore, optimizing perioperative anesthesia, maintaining hemodynamic stability, and reducing unnecessary sedative-analgesic loads are important strategies to lower POD risk.
Dexmedetomidine is a highly selective α2-adrenergic receptor agonist with advantages in sedation, analgesia, and neuroprotection . It activates central α2-receptors, causing hyperpolarization of noradrenergic neurons and reducing norepinephrine release, producing sympatholytic effects without significant respiratory depression . It also has anti-inflammatory properties that may help prevent POD . Perioperative dexmedetomidine may reduce POD risk by alleviating stress, improving sleep-like sedation, and reducing opioid requirements . However, it can cause hypotension and bradycardia, requiring careful dosing in elderly patients .
Remimazolam tosilate is a newer ultra-short-acting benzodiazepine with rapid onset, fast metabolism, and mild circulatory depression. Its potential advantages in elderly and hemodynamically compromised patients are increasingly recognized, but its effect on POD remains inconclusive.
In summary, elderly VATS patients are at high risk for POD. Dexmedetomidine has preventive evidence but is limited by hypotension and bradycardia. Remimazolam may offer a smoother sedation alternative, but direct comparative evidence is lacking. This study aims to compare remimazolam versus dexmedetomidine on POD and perioperative recovery, providing evidence for individualized anesthesia management in elderly VATS patients.
Read the detailed description
To explore whether toremazolam can improve postoperative delirium in patients undergoing thoracoscopic surgery. The purpose and significance of this study are to compare the effects of the two on postoperative delirium in patients undergoing thoracoscopic surgery, in order to provide new ideas for preventing postoperative delirium. Select patients who underwent elective general anesthesia and thoracoscopic surgery at the First Affiliated Hospital of Kunming Medical University from April 2025 to February 2026. Complete relevant examinations before the operation and exclude patients who do not meet the inclusion criteria. Record the patients' preoperative age, gender, and ASA classification. The patients were divided into three groups: N, D, and R. The D group was given 1 microgram/kg of dexmedetomidine as a loading dose and 0.4 microgram/kg/h for maintenance until 30 minutes before the end of the surgery; the R group was given 0.2 mg/kg of toremazolam in addition to the induction anesthesia, and 0.3-0.5 mg/kg/h of toremazolam was pumped after intubation until 30 minutes before the end of the surgery. The N group was given an equal volume of normal saline as the content and purpose of the study until 30 minutes before the end of the surgery. Record the postoperative extubation time, PACU stay time, and record the adverse reactions (pain, agitation during awakening) and their incidence rates. The definition of extubation time is the time from the cessation of anesthesia to the patient removing the double-lumen bronchial tube; the hospital stay is the time from the day of the surgery to the patient's discharge. Finally, the collected data will be statistically analyzed and compared. Research objective: To confirm that toremazolam tartrate can effectively prevent the occurrence of postoperative delirium in elderly patients undergoing thoracoscopic surgery.
- Conditions
- Postoperative Delirium (POD), Thoracoscopic Surgery, Dexmedetomidine, Remimazolam Besylate
- Being tested
- Dexmedetomidine, Remimazolam Besylate, Normal Saline
- Medical subject headings
- Emergence Delirium
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
DexmedetomidineDrug
Dexmedetomidine grop(Group D):received a loading dose of dexmedetomidine at 0.67 μg/kg 10 minutes before surgery, followed by continuous infusion at 0.4 μg/kg/h until 30 minutes before the end of surgery.
Remimazolam BesylateDrug
Remimazolam besylate grop (Group R):received remimazolam besylate at 0.2 mg/kg during the induction of anesthesia, followed by continuous infusion at 0.3-0.5 mg/kg/h until 30 minutes before the end of surger
Normal SalineDrug
Normal Saline Group (Group N) received an equivalent volume of normal saline.
| Study group | Role | What they receive |
|---|---|---|
| Dexmedetomidine grop(Group D): | Active comparator | received a loading dose of dexmedetomidine at 0.67 μg/kg 10 minutes before surgery, followed by continuous infusion at 0.4 μg/kg/h until 30 minutes before the end of surgery. Receives: Drug: Dexmedetomidine |
| Remimazolam besylate grop (Group R) | Experimental | received remimazolam besylate at 0.2 mg/kg during the induction of anesthesia, followed by continuous infusion at 0.3-0.5 mg/kg/h until 30 minutes before the end of surgery. Receives: Drug: Remimazolam Besylate |
| Normal Saline Group(Group N) | Active comparator | received an equivalent volume of normal saline. Receives: Drug: Normal Saline |
What is being measured
The primary outcome is the main question the study is designed to answer.
Incidence of delirium at 30 minutes postoperatively and on postoperative days 1-3
POD assessed with the 3-minute Diagnostic Interview for CAM (3D-CAM) at 30 min after surgery and on postoperative days 1-3.
Measured: 30 minutes postoperatively and on postoperative days 1-3
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted6 May 2026
- Study start1 Apr 2025
- Primary completion1 Feb 2026
- Study completion1 Feb 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Postoperative Delirium (POD)Studies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Dexmedetomidine grop(Group D): received a loading dose of dexmedetomidine at 0.67 μg/kg 10 minutes before surgery, followed by continuous infusion at 0.4 μg/kg/h until 30 minutes before the end of surgery. Remimazolam group(Group R ):received remimazolam besylate at 0.2 mg/kg during the induction of anesthesia, followed by continuous infusion at 0.3-0.5 mg/kg/h until 30 minutes before the end of surgery. Normal Saline Group(Group N ):received an equivalent volume of normal saline.
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 105 participants (actual)
Sponsor and investigators
- Lead sponsor
- First Affiliated Hospital of Kunming Medical University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Jinqiao Qian, First Affiliated Hospital of Kunming Medical University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07569614
- Sponsor's protocol ID
- （2025）Ethical Review L No.80
- Status last verified
- Apr 2026
- First submitted
- 11 Apr 2026
- Last updated
- 6 May 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes
Study at a glance
From the registry record, last updated by the sponsor on 6 May 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparative Effects of Remimazolam Tosylate and Dexmedetomidine on Postoperative Delirium in Elderly Patients Undergoing Thoracoscopic Surgery: A Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT07569614
- Acronym / sponsor ID
- （2025）Ethical Review L No.80
- Conditions
- Postoperative Delirium (POD), Thoracoscopic Surgery, Dexmedetomidine, Remimazolam Besylate
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 105 participants (actual)
- Lead sponsor
- First Affiliated Hospital of Kunming Medical UniversityUniversity, hospital or other
- Study start
- 1 Apr 2025 (actual)
- Primary completion
- 1 Feb 2026 (actual)
- Study completion
- 1 Feb 2026 (actual)
- First posted
- 6 May 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Postoperative delirium (POD) is a common acute brain dysfunction in the perioperative period, characterized by acute fluctuations in attention, consciousness, and cognition, typically occurring early after surgery. POD is closely associated with prolonged hospital stay, increased complications, delayed recovery, and higher mortality .
POD has multifactorial risk factors spanning preoperative, intraoperative, and postoperative phases. Its pathophysiology involves neuroinflammation, oxidative stress, blood-brain barrier dysfunction, and neurotransmitter imbalance . Advanced age, baseline cognitive impairment, infection, and malnutrition increase POD risk . Intraoperative hypotension, benzodiazepine exposure, and other anesthetic factors may also contribute .
Elderly patients have higher anesthesia risk due to age-related physiological decline. Cardiovascular reserve decreases with age, causing hemodynamic instability, especially during one-lung ventilation in thoracoscopic surgery . Among patients over 70 undergoing thoracoscopic lobectomy, 35.7% develop pulmonary complications; ASA grade ≥III, one-lung ventilation time, smoking history, and COPD are independent risk factors . Additionally, reduced hepatic and renal function slow anesthetic metabolism, increasing drug accumulation and delayed emergence .
Video-assisted thoracoscopic surgery (VATS) offers reduced trauma, faster recovery, and lower complication rates compared to open surgery . VATS shows clinical value in lung cancer and mediastinal tumors . Uniportal VATS allows faster recovery of pulmonary function (VC, FVC, TLC) and lower inflammatory markers (CRP, PCT, TNF-α) . However, caution is needed in elderly patients .
Despite reduced surgical trauma, elderly VATS patients may still develop POD. Anesthetic drugs, surgical stress, poor pain management, and neuroinflammation are key contributing factors . Therefore, optimizing perioperative anesthesia, maintaining hemodynamic stability, and reducing unnecessary sedative-analgesic loads are important strategies to lower POD risk.
Dexmedetomidine is a highly selective α2-adrenergic receptor agonist with advantages in sedation, analgesia, and neuroprotection . It activates central α2-receptors, causing hyperpolarization of noradrenergic neurons and reducing norepinephrine release, producing sympatholytic effects without significant respiratory depression . It also has anti-inflammatory properties that may help prevent POD . Perioperative dexmedetomidine may reduce POD risk by alleviating stress, improving sleep-like sedation, and reducing opioid requirements . However, it can cause hypotension and bradycardia, requiring careful dosing in elderly patients .
Remimazolam tosilate is a newer ultra-short-acting benzodiazepine with rapid onset, fast metabolism, and mild circulatory depression. Its potential advantages in elderly and hemodynamically compromised patients are increasingly recognized, but its effect on POD remains inconclusive.
In summary, elderly VATS patients are at high risk for POD. Dexmedetomidine has preventive evidence but is limited by hypotension and bradycardia. Remimazolam may offer a smoother sedation alternative, but direct comparative evidence is lacking. This study aims to compare remimazolam versus dexmedetomidine on POD and perioperative recovery, providing evidence for individualized anesthesia management in elderly VATS patients.
Detailed description
To explore whether toremazolam can improve postoperative delirium in patients undergoing thoracoscopic surgery. The purpose and significance of this study are to compare the effects of the two on postoperative delirium in patients undergoing thoracoscopic surgery, in order to provide new ideas for preventing postoperative delirium. Select patients who underwent elective general anesthesia and thoracoscopic surgery at the First Affiliated Hospital of Kunming Medical University from April 2025 to February 2026. Complete relevant examinations before the operation and exclude patients who do not meet the inclusion criteria. Record the patients' preoperative age, gender, and ASA classification. The patients were divided into three groups: N, D, and R. The D group was given 1 microgram/kg of dexmedetomidine as a loading dose and 0.4 microgram/kg/h for maintenance until 30 minutes before the end of the surgery; the R group was given 0.2 mg/kg of toremazolam in addition to the induction anesthesia, and 0.3-0.5 mg/kg/h of toremazolam was pumped after intubation until 30 minutes before the end of the surgery. The N group was given an equal volume of normal saline as the content and purpose of the study until 30 minutes before the end of the surgery. Record the postoperative extubation time, PACU stay time, and record the adverse reactions (pain, agitation during awakening) and their incidence rates. The definition of extubation time is the time from the cessation of anesthesia to the patient removing the double-lumen bronchial tube; the hospital stay is the time from the day of the surgery to the patient's discharge. Finally, the collected data will be statistically analyzed and compared. Research objective: To confirm that toremazolam tartrate can effectively prevent the occurrence of postoperative delirium in elderly patients undergoing thoracoscopic surgery.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 3
- Model description
- Dexmedetomidine grop(Group D): received a loading dose of dexmedetomidine at 0.67 μg/kg 10 minutes before surgery, followed by continuous infusion at 0.4 μg/kg/h until 30 minutes before the end of surgery. Remimazolam group(Group R ):received remimazolam besylate at 0.2 mg/kg during the induction of anesthesia, followed by continuous infusion at 0.3-0.5 mg/kg/h until 30 minutes before the end of surgery. Normal Saline Group(Group N ):received an equivalent volume of normal saline.
| Arm | Type | Receives |
|---|---|---|
| Dexmedetomidine grop(Group D): | Active comparator | Drug: Dexmedetomidinereceived a loading dose of dexmedetomidine at 0.67 μg/kg 10 minutes before surgery, followed by continuous infusion at 0.4 μg/kg/h until 30 minutes before the end of surgery. |
| Remimazolam besylate grop (Group R) | Experimental | Drug: Remimazolam Besylatereceived remimazolam besylate at 0.2 mg/kg during the induction of anesthesia, followed by continuous infusion at 0.3-0.5 mg/kg/h until 30 minutes before the end of surgery. |
| Normal Saline Group(Group N) | Active comparator | Drug: Normal Salinereceived an equivalent volume of normal saline. |
Who may qualify
- Ages
- 60 to 75 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Age ≥ 60 years;
- BMI: 18.5-23.9 kg/m²;
- ASA grade II-III;
- Preoperative MMSE score ≥ 25;
- Signed informed consent before surgery.
Key exclusion criteria (6 listed)
- Recent history of sedative, analgesic, or opioid use;
- Severe hypertension or significant hepatic or renal insufficiency;
- Allergy to the study medications;
- Alzheimer's disease or acute phase of mental illness;
- History of chronic pain or receipt of analgesic therapy;
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| DexmedetomidineDexmedetomidine grop(Group D):received a loading dose of dexmedetomidine at 0.67 μg/kg 10 minutes before surgery, followed by continuous infusion at 0.4 μg/kg/h until 30 minutes before the end of surgery. | Drug | Dexmedetomidine grop(Group D): |
| Remimazolam BesylateRemimazolam besylate grop (Group R):received remimazolam besylate at 0.2 mg/kg during the induction of anesthesia, followed by continuous infusion at 0.3-0.5 mg/kg/h until 30 minutes before the end of surger | Drug | Remimazolam besylate grop (Group R) |
| Normal SalineNormal Saline Group (Group N) received an equivalent volume of normal saline. | Drug | Normal Saline Group(Group N) |
Primary outcome
Incidence of delirium at 30 minutes postoperatively and on postoperative days 1-3
Time frame: 30 minutes postoperatively and on postoperative days 1-3
POD assessed with the 3-minute Diagnostic Interview for CAM (3D-CAM) at 30 min after surgery and on postoperative days 1-3.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 6 May 2026.
- Individual participant dataSharing planned: Yes
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Dexmedetomidine, Remimazolam Besylate and Normal Saline in people with Postoperative Delirium (POD) and Thoracoscopic Surgery, run by First Affiliated Hospital of Kunming Medical University at 1 site in China.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 6 May 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Incidence of delirium at 30 minutes postoperatively and on postoperative days 1-3 (time frame: 30 minutes postoperatively and on postoperative days 1-3). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 May 2026.