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World J Gastrointest Pharmacol Ther. Sep 5, 2026; 17(3): 120256
Published online Sep 5, 2026. doi: 10.4292/wjgpt.120256
Published online Sep 5, 2026. doi: 10.4292/wjgpt.120256
Hemodynamic safety of remimazolam vs propofol in elderly patients
Nawal Tahir, Ayesha Irshad, Department of Medicine, Dow Medical College, Karachi 74200, Sindh, Pakistan
Adil Khan, Department of General Surgery, Nowshera Medical College, Nowshera 24171, Khyber Pakhtunkhwa, Pakistan
Sidra Faryal, Muaaz Wasay, Department of General Medicine, Aziz Fatimah Medical and Dental College, Faisalabad 38000, Punjab, Pakistan
Muhammad Faizan, Department of General Surgery, Karachi Medical and Dental College, Karachi 74700, Sindh, Pakistan
Umer Iqbal, Department of Anesthesiology, Pain Management and Surgical Intensive Care, The Indus Hospital, Korangi Campus, Karachi 75190, Sindh, Pakistan
Syed A Arsal, Department of Pediatric Emergency, The Indus Hospital (Korangi Campus), Karachi 75190, Sindh, Pakistan
Aashish Kumar, Department of Pediatrics, The Indus Hospital, Korangi Campus, Karachi 75190, Sindh, Pakistan
Inibehe I Okon, Department of Research, Medical Research Circle (MedRec), Bukavu 50 Goma, Congo
Shafin Bin Amin, Department of General Surgery, Jinnah Postgraduate Medical Centre, Karachi 75510, Pakistan
Author contributions: All authors contributed to the study conception and design. Tahir N, Faizan M, Irshad A and Khan A contributed to material preparation, literature screening, data collection and analysis, as well as the preparation of supplementary tables and manuscript tables; Irshad A, Faryal S, Khan A, Iqbal U, Wasay M and Faizan M contributed to writing the original draft of the manuscript; and all authors contributed to commenting on previous versions of the manuscript; Arsal SA, Kumar A, Okon II and Iqbal U contributed to citation management, thorough manuscript review, editing and English language polishing, as well as study supervision, result validation and data visualization. All authors read and approved the final manuscript, with correspondence addressed to Iqbal U.
AI contribution statement: We confirm that no AI writing tools were used in the preparation, writing, or revision of this manuscript. The manuscript was written, revised, and edited entirely by the authors. Only Grammarly was used for small grammatical errors throughout the manuscript (for example: Commas and full stop placement, use of articles at appropriate places, etc.).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Umer Iqbal, Academic Fellow, Department of Anesthesiology, Pain Management and Surgical Intensive Care, The Indus Hospital, Korangi Campus, Plot C-76, Sector 31/5, Opposite Crossing, Darussalam Society Sector 39 Korangi, Karachi 75190, Sindh, Pakistan. umer.iqbal@tih.org.pk
Received: February 24, 2026
Revised: May 31, 2026
Accepted: June 18, 2026
Published online: September 5, 2026
Processing time: 188 Days and 4.2 Hours
Revised: May 31, 2026
Accepted: June 18, 2026
Published online: September 5, 2026
Processing time: 188 Days and 4.2 Hours
Core Tip
Core Tip: This meta-analysis of 10 randomized controlled trials involving 1994 elderly patients establishes the superior hemodynamic safety of remimazolam over propofol during gastrointestinal endoscopy. Remimazolam reduced the risk of hypotension by more than half compared to propofol, while significantly lowering incidences of bradycardia, respiratory depression, and injection pain. Crucially, these safety advantages were achieved without compromising recovery times or increasing post-operative nausea. These quantitative findings demonstrate that remimazolam serves as a safer, highly stable sedative alternative for mitigating cardiorespiratory risks in vulnerable older populations.