The safety of remimazolam versus propofol in gastroscopic sedation: a meta-analysis
Xincan An1, Tianqi Shen2, Xingxing Yin2
1Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Background:
This meta-analysis was designed to compare the safety and efficiency of remimazolam with those of propofol in patients undergoing gastroscope sedation.
Methods:
We searched PubMed, Cochrane Library, Embase, Ovid, Wanfang Database, China National Knowledge Infrastructure, SINOMED, and ClinicalTrials.gov for studies that reported on remimazolam versus propofol for gastroscope sedation from establishment to February 25, 2023. The sedative efficiency and the incidence of adverse events were assessed as outcomes. Version 2 of the Cochrane risk-of-bias assessment tool was used to assess the risk of bias. Review Manager 5.4 and STATA 17 were used to perform all statistical analyses.
Results:
A total of 26 randomized controlled trials involving 3,641 patients were included in this meta-analysis. The results showed that remimazolam had a significantly lower incidence of respiratory depression (risk ratio [RR] = 0.40, 95% confidence interval [CI]: 0.28-0.57; p < 0.01, GRADE high), hypoxemia (RR = 0.34, 95% CI: 0.23-0.49; p < 0.01, GRADE high), bradycardia (RR = 0.34, 95% CI: 0.23-0.51; p < 0.01, GRADE high), dizziness (RR = 0.45, 95% CI: 0.31-0.65; p < 0.01, GRADE high), injection site pain (RR = 0.06, 95% CI: 0.03-0.13; p < 0.01, GRADE high), nausea or vomiting (RR = 0.79, 95% CI: 0.62-1.00; p = 0.05, GRADE moderate), and hypotension (RR = 0.36, 95% CI: 0.26-0.48; p < 0.01, GRADE low).
Conclusions:
Remimazolam can be used safely in gastroscopic sedation and reduces the incidence of respiratory depression, hypoxemia, bradycardia, injection site pain, and dizziness compared with propofol, and doesn't increase the incidence of nausea and vomiting.
Insights
Remimazolam offers a safer and more effective sedation option for gastroscopy compared to propofol. This meta-analysis found lower rates of respiratory depression, hypoxemia, bradycardia, and injection site pain with remimazolam.
Area of Science:
- Anesthesiology
- Pharmacology
- Gastroenterology
Background:
- Gastroscope sedation commonly uses propofol, but concerns exist regarding its safety profile.
- Remimazolam, a novel ultra-short-acting benzodiazepine, presents a potential alternative for procedural sedation.
Approach:
- A comprehensive meta-analysis was conducted, systematically searching multiple databases for randomized controlled trials.
- Included studies compared remimazolam with propofol for gastroscope sedation, assessing sedative efficiency and adverse events.
- Risk of bias was evaluated using the Cochrane tool, with statistical analyses performed using Review Manager and STATA.
Key Points:
- The meta-analysis included 26 randomized controlled trials with 3,641 patients.
- Remimazolam demonstrated significantly lower incidences of respiratory depression, hypoxemia, bradycardia, dizziness, and injection site pain compared to propofol.
- While nausea or vomiting showed a trend towards reduction with remimazolam, hypotension was also significantly reduced.
Conclusions:
- Remimazolam is a safe and effective agent for gastroscope sedation.
- It offers significant advantages over propofol by reducing key adverse events like respiratory depression and hypoxemia.
- The findings support the expanded use of remimazolam in endoscopic procedures.
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