2025/09/02 by Fu‐Shan Xue, Danfeng Wang, Xiaochun Zheng · 1 voice · 1 citation
Medicine · Neuroscience · #Intensive Care Unit Cognitive Disorders #Anesthesia and Sedative Agents #Anesthesia and Neurotoxicity Research
paper · pdf · doi:10.1111/anae.16763
openalex publication_date 2025/09/02 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/22
Many aspects of the study by Sim et al. [1], which compared the incidence of postoperative delirium and quality of recovery with remimazolam vs. propofol for general anaesthesia in older patients, have been conducted well. However, although pre-operative haemoglobin, albumin and estimated glomerular filtration rate were not significantly different between groups, it was not specified if the two groups were comparable with respect to the incidences of pre-operative anaemia, hypoalbuminaemia and chronic kidney disease. These are common among older surgical patients and are significant risk factors for postoperative delirium [2]. Postoperative delirium assessment was once daily with a face-to-face confusion assessment method interview at 24 h, 48 h and 72 h postoperatively. This means that the interviews were only conducted during the day. As postoperative delirium is a fluctuating condition that manifests commonly late at night [3], it may have been missed. It is reported that a combination of a confusion assessment method interview with a chart review can increase sensitivity while retaining specificity in detecting incident postoperative delirium [4]. The evidence-based and consensus-based guideline on postoperative delirium by the European Society of Anaesthesiology recommends that screening should begin once anaesthesia emergence is completed, and postoperative delirium occurring in the period between completion of emergence from anaesthesia to postoperative day 1 should be included in the results [5]. The once daily screening used in this study would have missed delirium occurring in this period. Additionally, the timeframe of interest for postoperative delirium in this study was 3 days. It was unclear why the timeframe of interest for the quality of recovery score was only 1 day postoperatively. Since measuring the score at 24 h postoperatively cannot provide a true reference for the pre-operative baseline, it is recommended that a follow-up measurement be performed at 48 h [6]. We believe that clarifying the above issues would improve the transparency of this research design and help the interpretation of main findings.