{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:57:07Z","timestamp":1791381427748,"version":"4.3.3"},"reference-count":18,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,21]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Prone spine surgery may increase the risk of cerebral hypoperfusion and postoperative neurological adverse events, particularly in elderly patients. Remimazolam is a novel ultra-short-acting benzodiazepine anaesthetic that may provide greater haemodynamic stability than propofol. However, its effects on cerebral oxygenation during prone spine surgery remain unclear, indicating clinical equipoise between remimazolam and propofol. This study compares the effects of remimazolam and propofol on cerebral oxygenation in elderly patients undergoing thoracic or lumbar spine surgery in the prone position under general anaesthesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      This prospective randomised controlled trial will be conducted at a single tertiary medical centre. Sixty patients scheduled for elective lumbar or thoracic spine surgery in prone position will be randomly assigned in a 1:1 ratio to receive either remimazolam or propofol-based total intravenous anaesthesia. Regional cerebral oxygen saturation (rScO\n                      <jats:sub>2<\/jats:sub>\n                      ) will be continuously monitored using near-infrared spectroscopy. The primary outcome is the between-group difference in time-weighted average change in rScO\n                      <jats:sub>2<\/jats:sub>\n                      (\u0394rScO\n                      <jats:sub>2<\/jats:sub>\n                      ) in the prone position relative to baseline values in the supine position prior to the induction of anaesthesia. Secondary outcomes include cerebral desaturation events, intraoperative haemodynamic changes, vasopressor requirements, intraoperative complications and postoperative neurocognitive disorder assessed using Mini-Cog and Ultra-Brief Confusion Assessment Method.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study was approved by the Clinical Research Review Board of Kameda Medical Center (approval number 25\u2013130; approval date: 5 February 2026). Written informed consent will be obtained from all participants before enrolment. The findings will be disseminated through publication in peer-reviewed journals and presentation at academic conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>Japan Registry of Clinical Trials, jRCT1031250782, first registered on 6 March 2026.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-123988","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:25:43Z","timestamp":1791379543000},"page":"e123988","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of remimazolam versus propofol on cerebral oxygenation in elderly patients undergoing prone spine surgery: study protocol for a randomised controlled trial"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4272-7509","authenticated-orcid":false,"given":"Betina","family":"Lazaro","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Kameda Medical Center, Kamogawa, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuan","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Kameda Medical Center, Kamogawa, Chiba, Japan"},{"name":"Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA"},{"name":"Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yurie","family":"Sugaya","sequence":"additional","affiliation":[{"name":"Advanced Clinical Specialist Center, Kameda Medical Center, Kamogawa, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Ueda","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Kameda Medical Center, Kamogawa, Chiba, Japan"},{"name":"Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"2026100706252714000_16.10.e123988.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0106387","article-title":"Prone position is associated with mild cerebral oxygen desaturation in elderly surgical patients","volume":"9","author":"Deiner","year":"2014","journal-title":"PLoS ONE"},{"key":"2026100706252714000_16.10.e123988.2","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1007\/s40140-013-0020-y","article-title":"Effects of Positioning on Cerebral Oxygenation","volume":"3","author":"Soeding","year":"2013","journal-title":"Curr Anesthesiol Rep"},{"key":"2026100706252714000_16.10.e123988.3","article-title":"Age-Related Alterations of Cerebral Autoregulation","volume":"15","author":"Ungvari","year":"2025","journal-title":"Life (Basel)"},{"key":"2026100706252714000_16.10.e123988.4","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X18789273"},{"key":"2026100706252714000_16.10.e123988.5","doi-asserted-by":"crossref","unstructured":"Ma L , Jasem HJ , Gu WJ , et al . Postoperative neurocognitive disorders in the elderly: how can we stop the harm? A literature review. Front Med 2025;12. doi:10.3389\/fmed.2025.1525639","DOI":"10.3389\/fmed.2025.1525639"},{"key":"2026100706252714000_16.10.e123988.6","doi-asserted-by":"crossref","unstructured":"Daabiss M , Al-Otaibi R , Al-Otaibi M , et al . The Impact of Various Anesthetic Techniques on Cerebral Oxygenation during Spinal Surgery Performed in a Prone Position with Controlled Hypotension. ACCMJ 2024;9. doi:10.23880\/accmj-16000242","DOI":"10.23880\/accmj-16000242"},{"key":"2026100706252714000_16.10.e123988.7","doi-asserted-by":"crossref","unstructured":"Lin WL , Lee MS , Wong CS , et al . Effects of intraoperative propofol-based total intravenous anesthesia on postoperative pain in spine surgery: Comparison with desflurane anesthesia - A randomised trial. Medicine (United States) 2019;98. doi:10.1097\/MD.0000000000015074","DOI":"10.1097\/MD.0000000000015074"},{"key":"2026100706252714000_16.10.e123988.8","doi-asserted-by":"crossref","unstructured":"Gao J , Yang C , Ji Q , et al . Effect of remimazolam versus propofol for the induction of general anesthesia on cerebral blood flow and oxygen saturation in elderly patients undergoing carotid endarterectomy. BMC Anesthesiol 2023;23. doi:10.1186\/s12871-023-02095-z","DOI":"10.1186\/s12871-023-02095-z"},{"key":"2026100706252714000_16.10.e123988.9","doi-asserted-by":"crossref","unstructured":"Chrysoula S , Eleni K , Chrysoula S , et al . Effects of Desflurane Versus Propofol Anesthesia on Regional Cerebral Oxygenation during Spinal Surgery in the Prone Position. ACR 2021;1\u20136. doi:10.31487\/j.ACR.2021.01.02","DOI":"10.31487\/j.ACR.2021.01.02"},{"key":"2026100706252714000_16.10.e123988.10","doi-asserted-by":"crossref","first-page":"3487","DOI":"10.2147\/DDDT.S474854","article-title":"Remimazolam in General Anesthesia: A Comprehensive Review of Its Applications and Clinical Efficacy","volume":"18","author":"Zhang","year":"2024","journal-title":"Drug Des Devel Ther"},{"key":"2026100706252714000_16.10.e123988.11","doi-asserted-by":"crossref","first-page":"xiii","DOI":"10.1016\/j.anclin.2023.06.001","article-title":"Aging and Growing","volume":"41","author":"Akhtar","year":"2023","journal-title":"Anesthesiol Clin"},{"key":"2026100706252714000_16.10.e123988.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2021.05.027"},{"key":"2026100706252714000_16.10.e123988.13","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s00540-022-03135-7","article-title":"Change in cerebral circulation during the induction of anesthesia with remimazolam","volume":"37","author":"Soejima","year":"2023","journal-title":"J Anesth"},{"key":"2026100706252714000_16.10.e123988.14","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1046\/j.1532-5415.2003.51465.x","article-title":"The Mini\u2010Cog as a Screen for Dementia: Validation in a Population\u2010Based Sample","volume":"51","author":"Borson","year":"2003","journal-title":"J American Geriatrics Society"},{"key":"2026100706252714000_16.10.e123988.15","first-page":"101377","article-title":"Comparison of the bispectral indices of patients receiving remimazolam and propofol for general anesthesia: a randomized crossover trial","volume":"43","author":"Yang","year":"2024","journal-title":"Anaesth Crit Care Pain Med"},{"key":"2026100706252714000_16.10.e123988.16","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2024.1364357","article-title":"Target-controlled infusion of remimazolam effect-site concentration for total intravenous anesthesia in patients undergoing minimal invasive surgeries","volume":"11","author":"Chon","year":"2024","journal-title":"Front Med (Lausanne)"},{"key":"2026100706252714000_16.10.e123988.17","doi-asserted-by":"crossref","first-page":"262","DOI":"10.17085\/apm.21121","article-title":"Effect-site concentration of remimazolam at loss and recovery of responsiveness during general anesthesia: a simulation study","volume":"17","author":"Kim","year":"2022","journal-title":"Anesth Pain Med (Seoul)"},{"key":"2026100706252714000_16.10.e123988.18","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/00007632-200201010-00007","article-title":"Near Infrared Spectroscopy for Intraoperative Monitoring of the Spinal Cord","volume":"27","author":"Macnab","year":"2002","journal-title":"Spine"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-123988","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:25:47Z","timestamp":1791379547000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-123988"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":18,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,7]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/bmjopen-2026-123988"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-123988","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]}}}