Effects of Remimazolam-Propofol Anesthesia on Recovery and Sleep Quality in Older Adult Patients Undergoing Laparoscopic Colorectal Cancer Surgery: A Randomized Controlled Trial.
Shi P, Wang C, et al. • Drug design, development and therapy • 2026
Anesthesia maintenance using a sub-anesthetic dose of remimazolam combined with propofol was associated with shorter awakening time and improved postoperative recovery quality in older adult patients undergoing laparoscopic colorectal cancer surgery.
Key Findings
Results
Awakening time was significantly shorter in the remimazolam-propofol combination group compared to propofol alone.
Awakening time in group PR was 14.8 ± 4.8 min versus 18.9 ± 5.1 min in group P (P < 0.001)
Group P received propofol alone at 4–12 mg/kg/h; group PR received propofol 2–4 mg/kg/h combined with remimazolam 0.3 mg/kg/h
92 patients aged 65–80 years were enrolled in this single-center, single-blind, prospective randomized controlled trial
All patients underwent elective laparoscopic colorectal cancer surgery
Results
Postoperative quality of recovery at 24 hours was significantly better in the combination group.
QoR-15 scores at 24 h postoperatively were 129 [124.3–133] in group PR versus 121.5 [118–128] in group P (P = 0.002)
QoR-15 (Quality of Recovery-15) was used as a secondary outcome measure
No significant differences were observed in VAS pain scores between the two groups
Results
The combination group had a significantly lower incidence of postoperative sleep disturbances on postoperative days 1 and 3.
Sleep disturbances were assessed using the Pittsburgh Sleep Quality Index (PSQI)
The incidence of sleep disturbances was significantly lower in group PR on postoperative days 1 and 3 (P < 0.001)
The authors note that further research with objective sleep monitoring is warranted to confirm these findings
Results
Intraoperative hemodynamics were more stable in the combination group, with a substantially lower incidence of hypotension.
Incidence of intraoperative hypotension was 19.6% in group PR versus 54.4% in group P (P < 0.001)
Group PR also showed more stable overall intraoperative hemodynamics compared to group P
Hemodynamic stability was a secondary outcome measure of the trial
Results
No significant differences in other adverse events were observed between the two anesthesia groups.
VAS scores did not differ significantly between group P and group PR
The incidence of adverse events other than hypotension was not significantly different between groups
The trial was designed as a single-blind study with 92 patients randomized to two groups
Background
The study population consisted of older adult patients aged 65–80 years, for whom both propofol and remimazolam monotherapy have recognized limitations.
The trial enrolled patients scheduled for elective laparoscopic colorectal cancer surgery
The rationale for the combination approach was that propofol and remimazolam monotherapy each have their own limitations for general anesthesia in elderly patients
The study design was a single-center, single-blind, prospective randomized controlled trial
What This Means
This research suggests that combining two anesthetic drugs — remimazolam and propofol — at lower-than-usual doses may offer meaningful advantages over using propofol alone for older adults (aged 65–80) undergoing laparoscopic colorectal cancer surgery. In a randomized trial of 92 patients, those who received the drug combination woke up from anesthesia about 4 minutes faster on average, had better overall recovery scores at 24 hours after surgery, and experienced far fewer episodes of low blood pressure during the operation (about 20% vs. 54% with propofol alone). They also reported fewer sleep problems in the days immediately following surgery.
The practical significance of these findings is that older patients are particularly vulnerable to complications from anesthesia, including slow recovery, blood pressure instability, and disrupted sleep — all of which can affect healing and hospital stay. This research suggests that using a combination of these two drugs at sub-anesthetic doses may reduce some of these risks compared to standard propofol-only anesthesia. Pain levels after surgery were similar between the two groups, and there were no notable differences in other side effects.
The authors caution that sleep quality in this study was measured using a questionnaire (the Pittsburgh Sleep Quality Index) rather than objective monitoring tools, and they call for future research using more rigorous sleep measurement methods to confirm these results. The findings are promising, but this was a single-center study, and broader validation would be needed before wide clinical adoption of this anesthetic combination strategy.
Shi P, Wang C, Tang Y, Hou J, Bian J, Bo L. (2026). Effects of Remimazolam-Propofol Anesthesia on Recovery and Sleep Quality in Older Adult Patients Undergoing Laparoscopic Colorectal Cancer Surgery: A Randomized Controlled Trial.. Drug design, development and therapy. https://doi.org/10.2147/DDDT.S564187