Comparison of Efficacy and Safety of Remimazolam and Midazolam in elderly Patients Undergoing Laparoscopic Cholecystectomy: A Retrospective Study

Background Laparoscopic cholecystectomy (LC) is a widely performed minimally invasive procedure, with patients requiring to be given general anesthesia. Remimazolam and midazolam are two benzodiazepine drugs that have been extensively used for anesthesia induction and maintenance. Objective This study aimed to compare the efficacy and safety of remimazolam and midazolam in patients undergoing LC, focusing on recovery time, hemodynamic stability, and adverse event incidence. Methods A retrospective analysis was conducted on 184 patients who underwent LC under general anesthesia between January 2022 and January 2024. Patients were divided into remimazolam (n = 81) and midazolam (n = 103) groups. The primary outcome was extubation time, defined as the time from the end of anesthesia to successful extubation. Secondary outcomes included post-anesthesia care unit (PACU) stay duration, hemodynamic and respiratory parameters, and adverse events. Results The remimazolam group had significantly shorter extubation times (33 min [IQR 24.0–44.5] vs. 42 min [IQR 30.0–61.0], p = 0.0003) and PACU stay durations (55 min [IQR 45–65] vs. 65 min [IQR 55–80], p = 0.0001) compared to the midazolam group. Both groups achieved a 100% success rate in anesthesia. No significant differences were observed in hemodynamic and respiratory parameters between the two groups at predefined time points. Adverse event rates, including hypotension (13.6% vs. 15.5%) and bradycardia (8.6% vs. 13.6%), were lower in the remimazolam group, although not statistically significant (p > 0.05). No respiratory depression, nausea, or vomiting was observed in either group. Conclusion remimazolam demonstrated clear clinical advantages over midazolam in LC, including faster recovery and shorter PACU stays, with comparable hemodynamic stability and safety profiles. These findings suggest that remimazolam is a promising alternative for anesthesia in minimally invasive surgeries. Further multicenter studies are warranted to confirm these results and explore its utility in diverse surgical settings.