Effects of Remimazolam-Propofol Anesthesia on Recovery and Sleep Quality in Older Adult Patients Undergoing Laparoscopic Colorectal Cancer Surgery: A Randomized Controlled Trial.

Purpose: Propofol and remimazolam monotherapy have their own limitations for general anesthesia in elderly patients. Optimizing anesthesia protocols is essential to enhance recovery and postoperative outcomes. This study aimed to evaluate the effects of combined sub-anesthetic doses of remimazolam and propofol on anesthesia recovery and sleep quality in this population. Patients and Methods: This single-center, single-blind, prospective, randomized controlled trial enrolled 92 patients aged 65-80 years scheduled for elective laparoscopic colorectal cancer surgery. Patients were randomly allocated to either group P (propofol alone, 4-12 mg/kg/h) or group PR (propofol 2-4 mg/kg/h combined with remimazolam 0.3 mg/kg/h). The primary outcome was awakening time. The secondary outcomes included sedation scores, intraoperative hemodynamics, postoperative Pittsburgh Sleep Quality Index (PSQI) scores, Visual Analogue Scale (VAS) scores, Quality of Recovery-15 (QoR-15) scores, and the incidence of adverse events. Results: Awakening time was significantly reduced in group PR compared with group P (14.8 ± 4.8 min vs 18.9 ± 5.1 min, P < 0.001). Group PR showed higher QoR-15 scores at 24 h postoperatively (129 [124.3-133] vs 121.5 [118-128], P = 0.002), a lower incidence of sleep disturbances on postoperative days 1 and 3 (P < 0.001), and more stable intraoperative hemodynamics with a lower incidence of hypotension (19.6% vs 54.4%, P < 0.001). No significant differences were observed in VAS scores or other adverse events. Conclusion: Anesthesia maintenance using a sub-anesthetic dose of remimazolam combined with propofol was associated with shorter awakening time and improved postoperative recovery quality. This combination may represent a promising anesthetic strategy, but further research with objective sleep monitoring is warranted to confirm these findings.