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Published on: December 6, 2016
Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and
Eduardo Cerchi Barbosa1, Paula Arruda Espírito Santo2, Stefano Baraldo3
1Department of Medicine, Evangelical University of Goiás, Anápolis, Brazil.
Background:
Propofol has a favourable efficacy profile in gastrointestinal endoscopic procedures, however adverse events remain frequent. Emerging evidence supports remimazolam use in gastrointestinal endoscopy. This systematic review and meta-analysis compares remimazolam and propofol, both combined with a short-acting opioid, for sedation of adults in gastrointestinal endoscopy.
Methods:
We searched MEDLINE, Embase, and Cochrane databases for randomised controlled trials comparing efficacy-, safety-, and satisfaction-related outcomes between remimazolam and propofol, both combined with short-acting opioids, for sedation of adults undergoing gastrointestinal endoscopy. We performed sensitivity analyses, subgroup assessments by type of short-acting opioid used and age range, and meta-regression analysis using mean patient age as a covariate. We used R statistical software for statistical analyses.
Results:
We included 15 trials (4516 subjects). Remimazolam was associated with a significantly lower sedation success rate (risk ratio [RR] 0.991; 95% confidence interval [CI] 0.984-0.998; high-quality evidence) and a slightly longer induction time (mean difference [MD] 9 s; 95% CI 4-13; moderate-quality evidence), whereas there was no significant difference between the sedatives in other time-related outcomes. Remimazolam was associated with significantly lower rates of respiratory depression (RR 0.41; 95% CI 0.30-0.56; high-quality evidence), hypotension (RR 0.43; 95% CI 0.35-0.51; moderate-quality evidence), hypotension requiring treatment (RR 0.25; 95% CI 0.12-0.52; high-quality evidence), and bradycardia (RR 0.42; 95% CI 0.30-0.58; high-quality evidence). There was no difference in patient (MD 0.41; 95% CI -0.07 to 0.89; moderate-quality evidence) and endoscopist satisfaction (MD -0.31; 95% CI -0.65 to 0.04; high-quality evidence) between both drugs.
Conclusions:
Remimazolam has clinically similar efficacy and greater safety when compared with propofol for sedation in gastrointestinal endoscopies.
Insights
Remimazolam offers comparable efficacy to propofol for gastrointestinal endoscopy sedation but with significantly fewer adverse events, including respiratory depression and hypotension. This makes remimazolam a safer alternative for patient sedation during these procedures.
Area of Science:
- Medical Anesthesiology
- Gastroenterology
- Clinical Pharmacology
Background:
- Propofol is widely used for gastrointestinal endoscopy sedation, but adverse events are common.
- Remimazolam is an emerging sedative agent with potential benefits in procedural sedation.
- This study systematically reviews and meta-analyzes remimazolam versus propofol for gastrointestinal endoscopy.
Purpose of the Study:
- To compare the efficacy and safety of remimazolam and propofol when combined with short-acting opioids for adult sedation in gastrointestinal endoscopy.
- To evaluate patient and endoscopist satisfaction between the two sedative agents.
- To identify potential differences in adverse event rates.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials.
- Searched MEDLINE, Embase, and Cochrane databases for relevant studies.
- Analyzed efficacy, safety, and satisfaction outcomes, including subgroup and meta-regression analyses.
Main Results:
- Remimazolam showed a slightly lower sedation success rate (RR 0.991) and longer induction time (MD 9s) compared to propofol.
- Remimazolam was associated with significantly lower rates of respiratory depression (RR 0.41), hypotension (RR 0.43), and bradycardia (RR 0.42).
- No significant differences were found in patient or endoscopist satisfaction.
Conclusions:
- Remimazolam demonstrates clinically similar efficacy to propofol for gastrointestinal endoscopy sedation.
- Remimazolam offers a significantly improved safety profile with reduced adverse events compared to propofol.
- Remimazolam represents a safer alternative for sedation in gastrointestinal endoscopic procedures.
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