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Remimazolam vs. propofol for general anaesthesia in elderly patients: a meta-analysis with trial sequential analysis

Eduardo Maia Pereira1, Vitor Ryuiti Moraes, Mariana Gaya da Costa

  • 1From the Federal University of Minas Gerais, Department of Medicine, Belo Horizonte, Brazil (EMP), Evangelical University of Goias, Department of Medicine, Anápolis, Brazil (VRM), University of Groningen and University Medical Center of Groningen, Department of Anaesthesiology, Groningen, The Netherlands (MGdC, MMRFS), Cardoso Fontes Federal Hospital, Department of Anaesthesiology (TSdN), Federal University of Rio de Janeiro, Department of Medicine, Rio de Janeiro, Brazil (ES), McMaster University & DeGroote School of Medicine, Department of Anaesthesiology, Hamilton, Ontario, Canada (CGJ), and Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium (MMRFS).

European Journal of Anaesthesiology
|July 29, 2024
PubMed
Abstract

Insights

Remimazolam, an alternative anesthetic, significantly reduced hypotension, bradycardia, and injection pain in elderly patients compared to propofol. While it increased time to loss of consciousness, it

Area of Science:

  • Anesthesiology
  • Geriatric Medicine
  • Pharmacology

Background:

  • Elderly patients require special anesthetic considerations due to age-related physiological changes.
  • Propofol is a traditional anesthetic, while remimazolam is a novel ultra-short-acting benzodiazepine alternative.
  • The safety and efficacy of remimazolam versus propofol in elderly patients undergoing general anesthesia require investigation.

Purpose of the Study:

  • To compare remimazolam and propofol for general anesthesia in elderly patients.
  • To evaluate differences in hypotension, induction characteristics, hemodynamics, and recovery outcomes.

Main Methods:

  • Systematic search of MEDLINE, Embase, and Cochrane for randomized controlled trials (RCTs) up to January 1, 2024.
  • Meta-analysis including sensitivity and trial sequential analyses (TSA) using random effects models.
  • Inclusion criteria: patients aged 60 years or older comparing remimazolam versus propofol.

Main Results:

  • Eleven RCTs (947 patients) were analyzed.
  • Remimazolam showed significantly lower postinduction and intra-operative hypotension, reduced bradycardia, and less injection pain compared to propofol.
  • Remimazolam was associated with a longer time to loss of consciousness and higher bispectral index at loss of consciousness; no differences in emergence or extubation times.

Conclusions:

  • Remimazolam significantly decreases the risk of hypotension, bradycardia, and injection pain in elderly patients.
  • Despite a longer time to loss of consciousness, remimazolam is an effective and well-tolerated alternative to propofol.
  • Further research may explore optimal remimazolam dosing strategies in this demographic.

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