Short-term postoperative neurocognitive safety and recovery profiles of remimazolam tosilate combined with flumazenil vs. propofol in cirrhotic patients undergoing endoscopic variceal treatment: a randomized controlled trial.

Background: Patients with liver cirrhosis frequently exhibit compromised drug metabolism due to hepatic dysfunction, which significantly increases their susceptibility to postoperative neurological adverse events. This study aimed to evaluate the impact of remimazolam tosilate combined with flumazenil on early postoperative neurocognitive function and recovery quality in cirrhotic patients undergoing endoscopic variceal ligation (EVL) and/or endoscopic variceal sclerotherapy (EVS), so as to provide evidence-based guidance for optimizing clinical anesthesia management. Methods: A total of 108 cirrhotic patients scheduled for EVL and/or EVS were randomly assigned to the propofol group (Group P, Results: No statistically significant differences were observed in NCT-A and DST scores between the two groups at baseline, 6 h postoperatively, or 24 h postoperatively ( Conclusion: In cirrhotic patients undergoing endoscopic variceal ligation or sclerotherapy, the administration of remimazolam tosilate with flumazenil demonstrated comparable early postoperative neurocognitive performance to propofol, while significantly shortening recovery time and enhancing the quality of extubation and emergence. Consequently, this regimen represents a neurologically safe (with regard to short-term cognitive outcomes), rapidly controllable, and clinically feasible anesthetic option for this high-risk population. Clinical trials registration: this study was registered on https://www.chictr.org.cn, (ChiCTR2200066161).