Response to a letter to the editor by Jia and Teng: remimazolam and postoperative delirium in older adults undergoing elective cardiovascular surgery
Response to a letter to the editor by Jia and Teng: remimazolam and postoperative delirium in older adults undergoing elective cardiovascular surgery
复制标题
回复贾和滕致编辑的信：瑞马唑仑与接受择期心血管手术的老年人术后谵妄
DOI：
10.1007/s00540-022-03154-4
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发表时间：
2022
影响因子：
2.8
通讯作者：
Nakajima Yoshiki
中科院分区：
文献类型：
--
作者：
Aoki Yoshitaka;Nakajima Yoshiki
我们感谢Jia和Teng对我们最近发表的题为“接受择期心血管手术的老年人中雷米唑仑与术后谵妄之间的关联：一项前瞻性队列研究”的文章的评论[1，2]。报告这项观察性研究旨在提供雷米唑仑对认知功能影响的最早临床证据。然而，我们同意，我们的研究结果本身并不能确定雷米唑仑对认知功能的影响，需要进行更多的研究。Jia和Teng提到我们的研究包含偏倚因素[1]，引用了一项关于心脏手术后早期谵妄发生率和风险因素的回顾性队列研究[3]。我们不同意他们的意见。即使在Jia和Teng引用的研究中，术后监测谵妄5天，这与我们研究的主要终点一致。我们选择5天与先前报道的随机对照试验一致[4]。此外，正在进行的雷米唑仑随机对照试验的主要终点是术后前5天内的谵妄[5]。先前报告的随机对照试验显示，在调整基线差异后，术后发生谵妄的患者与未发生谵妄的患者之间的平均Mini-MentalState检查评分差异在术后30天显著[4]。然而，在我们的研究中，平均住院时间为17-20天，这使得30天的谵妄随访变得困难。此外，长期评估谵妄可能会受到全身因素的影响，如与麻醉剂选择无关的并发症。因此，我们认为在术后前5天评估谵妄是合理的，并且不接受这种情况会成为我们研究中偏倚的来源。
We appreciate the comments from Jia and Teng on our recently published article entitled “Association between remimazolam and postoperative delirium in older adults undergoing elective cardiovascular surgery: a prospective cohort study”[1, 2]. Reporting this observational study was intended to provide the earliest clinical evidence of the effects of remimazolam on cognitive function. However, we agree that the findings of our study alone do not determine the effects of remimazolam on cognitive function and that additional research is needed. Jia and Teng mention that our study contained an element of bias [1], citing a retrospective cohort study of the incidence of and risk factors for early delirium after cardiac surgery [3]. We disagree with their opinion. Even in the study cited by Jia and Teng, delirium was monitored for 5 days postoperatively, which is consistent with the primary endpoint of our study. We chose 5 days to be consistent with a previously reported randomized controlled trial [4]. Moreover, the primary endpoint in an ongoing randomized controlled trial of remimazolam is delirium within the first 5 postoperative days [5]. The previously reported randomized controlled trial showed that after adjusting for baseline differences, the difference in the mean Mini-MentalState Examination score between patients who developed postoperative delirium and those who did not was significant at 30 days postoperatively [4]. However, the average length of stay was 17–20 days in our study, making 30 days of follow-up for delirium difficult. Furthermore, evaluation of delirium over a long period may be influenced by systemic factors, such as complications unrelated to the choice of anesthetic. Therefore, we believe that it was reasonable to assess delirium during the first 5 postoperative days and do not accept that this setting would have been a source of bias in our study.