Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and meta-analysis

异丙酚 镇静 医学 置信区间 荟萃分析 不利影响 麻醉 相对风险 子群分析 内科学
作者
Eduardo Cerchi Barbosa,Paula Arruda Espírito Santo,Stefano Baraldo,Gilmara Coelho Meine
出处
期刊:BJA: British Journal of Anaesthesia [Elsevier]
卷期号:132 (6): 1219-1229 被引量:2
标识
DOI:10.1016/j.bja.2024.02.005
摘要

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.
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