Background/Objectives: Emergence agitation (EA) is common after rhinologic surgery and may cause self-injury, bleeding, and prolonged post-anesthesia care unit (PACU) stay. Remimazolam is an ultra-short-acting benzodiazepine that may reduce EA without delaying recovery. The objective of this study was to evaluate the effect of a single dose of remimazolam administered at the end of surgery on the incidence of EA in adult patients undergoing nasal surgery. Methods: In this prospective, randomized, triple-blind, placebo-controlled trial, 62 adults undergoing elective rhinologic surgery under sevoflurane anesthesia received either remimazolam 0.1 mg/kg or saline immediately after sevoflurane discontinuation and before extubation. EA was assessed using the Richmond Agitation–Sedation Scale (RASS) at extubation and every 5 min for 30 min in the PACU. The primary outcome was presence of EA (RASS ≥ 2) at extubation. Secondary outcomes included Aldrete recovery scores, VAS, PONV incidence and safety outcomes. The study was registered at ClinicalTrials.gov (NCT06398275; 3 May 2024). Results: EA occurred in 12/32 patients (37.5%) in the control group and 0/30 (0%) in the remimazolam group (p < 0.001). Extubation time and operative durations were similar between groups. More patients in the remimazolam group achieved an Aldrete score ≥ 9 at extubation (76.7% vs. 50.0%, p = 0.030). Severe agitation (RASS ≥ 3) requiring rescue sedation occurred in 6/32 control-group patients and in 0/30 patients in the remimazolam group (p = 0.025). Pain scores were low (no VAS > 2). PONV occurred in one patient per group. Clinically relevant postoperative nasal bleeding requiring intervention occurred in 2/32 control-group patients and in 0/30 remimazolam-group patients. No laryngospasm or respiratory complications within 24 h were observed. Conclusions: A single remimazolam bolus given at the end of surgery prevented clinically relevant EA after rhinologic surgery without delaying early recovery.

Background/Objectives: Emergence delirium (ED) is common after sevoflurane anesthesia in children undergoing otolaryngologic surgery. Remimazolam is an ultra-short-acting benzodiazepine that may reduce ED without delaying recovery. This study evaluated the effect of a single remimazolam bolus administered at the end of surgery on ED in children undergoing tonsillectomy and/or adenoidectomy. Methods: In this prospective, randomized, triple-blind, placebo-controlled trial, 110 children aged 3–9 years with American Society of Anesthesiologists physical status I received remimazolam 0.1 mg/kg (n = 57) or an equal volume of normal saline (n = 53) immediately after discontinuation of sevoflurane and before extubation. The primary outcome was ED at extubation, defined as a Pediatric Anesthesia Emergence Delirium (PAED) score ≥ 10. Secondary outcomes included Face, Legs, Activity, Cry, and Consolability (FLACC) scores, emergence time, early recovery, postoperative vomiting, and airway complications. Results: ED occurred in 1 of 57 children (1.8%) receiving remimazolam and in 11 of 53 children (20.8%) receiving placebo (p = 0.002). The absolute risk reduction was 19.0% (95% confidence interval [CI], 7.5–31.8), the relative risk was 0.08 (95% CI, 0.01–0.63), and the number needed to treat was 6. The overall distribution of FLACC scores at extubation differed between groups (p = 0.047), with FLACC scores of 0 occurring more frequently in the remimazolam group. Median emergence time was 10 min in both groups, and all children achieved a modified Aldrete score > 8 within 15 min. Postoperative vomiting was assessed through 30 min; the comparison at 5 min showed no significant between-group difference. Airway complications also did not differ significantly between groups. Conclusions: A single intravenous bolus of remimazolam 0.1 mg/kg administered at the end of surgery significantly reduced PAED-defined ED without prolonging emergence or delaying early postoperative recovery.

Background/Objectives: Hip fractures are associated with high short-term mortality in older adults. This study aimed to determine 30-day mortality after hip fracture surgery and evaluate factors associated with short-term mortality, with particular attention to baseline comorbidity indices and in-hospital adverse events. Methods: This retrospective cohort study included 785 patients who underwent surgery for hip fracture at University Hospital of Split, Croatia, between January 2021 and December 2022. Clinical data were extracted from medical records. The primary outcome was 30-day mortality, including in-hospital and post-discharge deaths. Associations with mortality were examined using univariable and multivariable logistic regression. Baseline-only comorbidity models were constructed using the American Society of Anesthesiologists Physical Status Classification System (ASA PS Classification), the Charlson Comorbidity Index (CCI), and the Elixhauser Comorbidity Index (ECI). Exploratory hospital-course models additionally included in-hospital adverse events, which were interpreted as time-dependent hospital-course events rather than baseline predictors. Results: 30-day mortality was 11.0% (86/785). Older age, male sex, higher comorbidity burden, and in-hospital adverse events were associated with mortality. Mortality was 5.7% without documented adverse events, 24.2% with one adverse event, and 42.4% with two or more adverse events. Baseline-only comorbidity models showed acceptable and broadly comparable discrimination, with AUCs of 0.73–0.77. Exploratory hospital-course models showed higher discrimination, with AUCs of 0.80–0.82. Conclusions: 30-day mortality after hip fracture surgery was associated with baseline patient vulnerability and in-hospital adverse events. Baseline-only models based on the ASA PS Classification, the CCI, and the ECI provided broadly comparable short-term risk stratification. In-hospital adverse events should be viewed as markers of an adverse clinical trajectory, not evidence of causality.