Abstract:Objective To explore the application effect of remimazolam tosilate in the induction of general anesthesia for arthroscopic shoulder surgery in elderly patients, and its influence on cognitive impairment and postoperative delirium. Methods A total of 110 elderly patients who underwent arthroscopic shoulder surgery at Neijiang Hospital of Traditional Chinese Medicine from May 2021 to June 2024 were prospectively enrolled. They were divided into the experimental group and the control group with 55 cases each using a random number table method. Both groups received conventional general anesthesia combined with ultrasound-guided nerve block. In the control group, anesthesia induction was performed using propofol 1.0-1.5 mg/kg, sufentanil 0.25 μg/kg, and rocuronium 0.6 mg/kg, while the experimental group replaced propofol with remimazolam tosilate 0.1 mg/kg. The intraoperative hemodynamic parameters [mean arterial pressure (MAP) and heart rate], anesthesia-related indicators [induction time, recovery time, extubation time, and post- anesthesia care unit (PACU) stay time], pain intensity [Visual Analog Scale (VAS) score], cognitive impairment [Mini Mental State Examination (MMSE) score], postoperative delirium, and adverse events were compared between the two groups. Results Compared with pre-administration, MAP and heart rate in both groups decreased at 1 minute after drug administration and immediately after intubation (P<0.05), and the MAP and heart rate in the experimental group were significantly higher than those in the control group (P<0.05). The recovery time, extubation time, and PACU stay time in the experimental group were shorter than those in the control group (P<0.05). There was no statistically significant difference in VAS scores between the two groups at each time point (P>0.05). The MMSE scores of both groups at 1 day and 3 days after surgery were lower than those before surgery (P<0.05), while the score at 3 days after surgery was significantly higher than that at 1 day after surgery (P<0.05). The MMSE scores of the experimental group were higher than those of the control group on 1 day and 3 days after surgery (P<0.05). At 5 days after surgery, the incidence of postoperative delirium in the control group was significantly higher than that in the experimental group (21.82% vs 7.27%, χ²=4.681, P=0.031). There was no statistically significant difference in the incidence of adverse events between the two groups (P>0.05). Conclusion Remimazolam tosilate used in the induction of general anesthesia for arthroscopic shoulder surgery in elderly patients can alleviate postoperative cognitive impairment, reduce the incidence of postoperative delirium, effectively improve recovery quality, and has good safety.