Comparing the Efficacy and Safety of Remimazolam versus Propofol in Gastrointestinal Endoscopy or Fiberoptic Bronchoscopy: A systematic review and meta-analysis of Randomized Controlled Trials
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Background While propofol is generally utilized for sedation in endoscopic procedures, its safety has been questioned. Remimazolam, a newer alternative, promises better safety but lacks extensive comparative data. This meta-analysis aims to assess the efficacy and safety of remimazolam in comparison with propofol when used in gastrointestinal endoscopy or fiberoptic bronchoscopy. Methods A comprehensive literature search was carried out across PubMed, the Cochrane Central Register of Controlled Trials, Embase, Web of Science, Wanfang, and VIP databases up until October 2023. This search aimed to identify randomized controlled trials (RCTs) that compared remimazolam with propofol regarding to their efficacy and safety in the context of gastrointestinal endoscopy or fiberoptic bronchoscopy. Sedation success rate was the primary outcome while secondary outcomes encompassing additional efficacy measuresand safety parameters Results Fifteen RCTs were involved in this study. When compared with propofol, remimazolam displayed a lower success rate of sedation ( P < 0.001; I 2 = 58%), but featured a reduced induction time (P = 0.0004; I 2 = 96%), a quicker return to full alertness ( P = 0.001; I 2 = 89%), and fewer adverse events ( P < 0.001; I 2 = 77%). No significant disparities were observed in operation duration, recovery time ( P = 0.52; I 2 = 92%), or discharge time ( P = 0.52; I 2 = 86%). Conclusion Despite a lower sedation success rate compared to propofol, remimazolam offers significant advantages, including a shorter induction time, a quicker recovery to full alertness, and fewer adverse events. These attributes make remimazolam a compelling alternative for sedation in endoscopic procedures.