Efficacy and Safety of Remimazolam in Short Endoscopic Procedures: A Systematic Review and Meta-Analysis
<i>Background and Objectives</i>: Appropriate sedation and anesthesia are crucial for ensuring comfortable endoscopic procedures. Propofol is one of the most often used sedatives. However, its safety and adverse effects restrict its usage. Remimazolam is a relatively new intravenous benz...
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MDPI AG
2025-03-01
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| author | Yueyang Xin Pei Lu Shaodi Guan Shaomeng Si Rao Sun Wei Xia Hui Xu |
| author_facet | Yueyang Xin Pei Lu Shaodi Guan Shaomeng Si Rao Sun Wei Xia Hui Xu |
| author_sort | Yueyang Xin |
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| description | <i>Background and Objectives</i>: Appropriate sedation and anesthesia are crucial for ensuring comfortable endoscopic procedures. Propofol is one of the most often used sedatives. However, its safety and adverse effects restrict its usage. Remimazolam is a relatively new intravenous benzodiazepine that offers many benefits. Our analysis aims to evaluate the effectiveness and safety of remimazolam during short endoscopic procedures. <i>Materials and Methods:</i> We conducted a comprehensive search of the PubMed, Web of Science, ClinicalTrials.gov, and Turning Research Into Practice databases up to 31 December 2023, for randomized controlled trials published in English. Statistical analyses were performed using Cochrane Review Manager 5.4.1 and Stata Software/MP. <i>Results:</i> The success rate of sedation with remimazolam was slightly lower than that with propofol (RR: 0.99, 95% CI: 0.98~1.00; <i>p</i> = 0.004; I<sup>2</sup> = 42%). As for anesthetic effect-related outcomes, remimazolam did not show advantages in onset time (MD = 12.72, 95% CI: 6.53~18.90, <i>p</i> < 0.001, I<sup>2</sup> = 94%), recovery time (MD = 0.86, 95% CI: −0.55~2.27, <i>p</i> = 0.23, I<sup>2</sup> = 98%), or intraoperative body movement (RR: 1.18, 95% CI: 0.60~2.32, <i>p</i> = 0.62, I<sup>2</sup> = 87%). However, compared to propofol, remimazolam significantly reduced the incidence of several adverse events, including injection pain (RR: 0.07, 95% CI: 0.03~0.14, <i>p</i> < 0.001, I<sup>2</sup> = 69%), intraoperative hypotension (RR: 0.38, 95% CI: 0.31~0.47, <i>p</i> < 0.001, I<sup>2</sup> = 65%), bradycardia (RR: 0.25, 95% CI: 0.15~0.45, <i>p</i> < 0.001, I<sup>2</sup> = 0%), and respiratory depression (RR: 0.34, 95% CI: 0.25~0.46, <i>p</i> < 0.001, I<sup>2</sup> = 50%). The incidence of postoperative nausea and vomiting (PONV) was slightly higher with remimazolam (RD: 0.01, 95% CI: 0.00~0.03, <i>p</i> = 0.04, I<sup>2</sup> = 33%). <i>Conclusions:</i> Remimazolam is a promising sedative for short endoscopic procedures due to its superior safety profile despite a slightly lower sedation success rate compared to propofol. |
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| spelling | doaj-art-7fffbcfc10ca4d3ba3c5669884faef132025-08-20T01:49:00ZengMDPI AGMedicina1010-660X1648-91442025-03-0161345310.3390/medicina61030453Efficacy and Safety of Remimazolam in Short Endoscopic Procedures: A Systematic Review and Meta-AnalysisYueyang Xin0Pei Lu1Shaodi Guan2Shaomeng Si3Rao Sun4Wei Xia5Hui Xu6Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, ChinaDepartment of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, ChinaDepartment of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, ChinaDepartment of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, ChinaDepartment of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, ChinaDepartment of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, ChinaDepartment of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China<i>Background and Objectives</i>: Appropriate sedation and anesthesia are crucial for ensuring comfortable endoscopic procedures. Propofol is one of the most often used sedatives. However, its safety and adverse effects restrict its usage. Remimazolam is a relatively new intravenous benzodiazepine that offers many benefits. Our analysis aims to evaluate the effectiveness and safety of remimazolam during short endoscopic procedures. <i>Materials and Methods:</i> We conducted a comprehensive search of the PubMed, Web of Science, ClinicalTrials.gov, and Turning Research Into Practice databases up to 31 December 2023, for randomized controlled trials published in English. Statistical analyses were performed using Cochrane Review Manager 5.4.1 and Stata Software/MP. <i>Results:</i> The success rate of sedation with remimazolam was slightly lower than that with propofol (RR: 0.99, 95% CI: 0.98~1.00; <i>p</i> = 0.004; I<sup>2</sup> = 42%). As for anesthetic effect-related outcomes, remimazolam did not show advantages in onset time (MD = 12.72, 95% CI: 6.53~18.90, <i>p</i> < 0.001, I<sup>2</sup> = 94%), recovery time (MD = 0.86, 95% CI: −0.55~2.27, <i>p</i> = 0.23, I<sup>2</sup> = 98%), or intraoperative body movement (RR: 1.18, 95% CI: 0.60~2.32, <i>p</i> = 0.62, I<sup>2</sup> = 87%). However, compared to propofol, remimazolam significantly reduced the incidence of several adverse events, including injection pain (RR: 0.07, 95% CI: 0.03~0.14, <i>p</i> < 0.001, I<sup>2</sup> = 69%), intraoperative hypotension (RR: 0.38, 95% CI: 0.31~0.47, <i>p</i> < 0.001, I<sup>2</sup> = 65%), bradycardia (RR: 0.25, 95% CI: 0.15~0.45, <i>p</i> < 0.001, I<sup>2</sup> = 0%), and respiratory depression (RR: 0.34, 95% CI: 0.25~0.46, <i>p</i> < 0.001, I<sup>2</sup> = 50%). The incidence of postoperative nausea and vomiting (PONV) was slightly higher with remimazolam (RD: 0.01, 95% CI: 0.00~0.03, <i>p</i> = 0.04, I<sup>2</sup> = 33%). <i>Conclusions:</i> Remimazolam is a promising sedative for short endoscopic procedures due to its superior safety profile despite a slightly lower sedation success rate compared to propofol.https://www.mdpi.com/1648-9144/61/3/453remimazolampropofoldeep sedationshort endoscopic procedures |
| spellingShingle | Yueyang Xin Pei Lu Shaodi Guan Shaomeng Si Rao Sun Wei Xia Hui Xu Efficacy and Safety of Remimazolam in Short Endoscopic Procedures: A Systematic Review and Meta-Analysis Medicina remimazolam propofol deep sedation short endoscopic procedures |
| title | Efficacy and Safety of Remimazolam in Short Endoscopic Procedures: A Systematic Review and Meta-Analysis |
| title_full | Efficacy and Safety of Remimazolam in Short Endoscopic Procedures: A Systematic Review and Meta-Analysis |
| title_fullStr | Efficacy and Safety of Remimazolam in Short Endoscopic Procedures: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Efficacy and Safety of Remimazolam in Short Endoscopic Procedures: A Systematic Review and Meta-Analysis |
| title_short | Efficacy and Safety of Remimazolam in Short Endoscopic Procedures: A Systematic Review and Meta-Analysis |
| title_sort | efficacy and safety of remimazolam in short endoscopic procedures a systematic review and meta analysis |
| topic | remimazolam propofol deep sedation short endoscopic procedures |
| url | https://www.mdpi.com/1648-9144/61/3/453 |
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