Efficacy and safety of remimazolam in bronchoscopic sedation: A meta-analysis

doi:10.12998/wjcc.v12.i6.1120

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World Journal of Clinical Cases

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Meta-Analysis

World J Clin Cases. Feb 26, 2024; 12(6): 1120-1129
Published online Feb 26, 2024. doi: 10.12998/wjcc.v12.i6.1120

Efficacy and safety of remimazolam in bronchoscopic sedation: A meta-analysis

Ying Zhou, Cheng Zhao, Yi-Xun Tang, Ji-Tong Liu

Ying Zhou, Yi-Xun Tang, Ji-Tong Liu, Department of Anesthesiology, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, Hunan Province, China

Cheng Zhao, Department of Anesthesiology, Zhangjiajie People's Hospital, Zhangjiajie 427000, Hunan Province, China

Author contributions: Zhou Y and Liu JT conducted the systematic review and data collection and proposed an explanation that played an important role in the writing of the paper; Zhao C and Tang YX evaluated and verified the manuscript; Tang YX analyzed the data and reviewed the article; Liu JT developed the concept of reviewing papers and supervised, critically evaluated, and confirmed the manuscript; This article was written and approved by all authors.

Supported by the Fund of the Hunan Provincial Health Commission, No. D20230416797.

Conflict-of-interest statement: The authors claim that the survey did not involve any business or financial links that could be interpreted as potential conflicts of interest.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised in accordance with this checklist.

Corresponding author: Ji-Tong Liu, MD, Chief Doctor, Department of Anesthesiology, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), No. 61 Jiefang East Road, Wucheng District, Changsha 410005, Hunan Province, China. liujitong008@163.com

Received: December 12, 2023
Peer-review started: December 12, 2023
First decision: January 2, 2024
Revised: January 14, 2024
Accepted: January 27, 2024
Article in press: January 27, 2024
Published online: February 26, 2024
Processing time: 70 Days and 1.3 Hours

Abstract

BACKGROUND

Remimazolam is a new benzodiazepine used for procedural sedation and general anesthesia. Several studies have used remimazolam for bendable bronchoscopy.

AIM

To assess the safety and efficacy of remimazolam for sedation in patients undergoing bendable bronchoscopy by performing a meta-analysis of randomized controlled trials (RCTs).

METHODS

We searched the EMBASE, PubMed, Cochrane Library, and Web of Science databases for RCTs on bendable bronchoscopic procedural sedation with remimazolam vs conventional sedatives (CS).

RESULTS

Five studies with 1080 cases were included. Remimazolam had the same sedation success rate compared with CS [relative risk (RR): 1.35, 95%CI: 0.60-3.05, P = 0.474, I² = 99.6%]. However, remimazolam was associated with a lower incidence of hypotension (RR: 0.61; 95%CI: 0.40-0.95, P = 0.027; I² = 65.1%) and a lower incidence of respiratory depression (RR: 0.50, 95%CI: 0.33-0.77, P = 0.002, I² = 42.3%). A subgroup analysis showed a higher success rate of sedation with remimazolam than midazolam (RR: 2.45, 95%CI: 1.76-3.42, P < 0.001). Compared with propofol, the incidence of hypotension (RR: 0.45, 95%CI: 0.32-0.64, P < 0.001, I² = 0.0%), respiratory depression (RR: 0.48, 95%CI: 0.30-0.76, P = 0.002, I² = 78.4%), hypoxemia (RR: 0.36, 95%CI: 0.15-0.87, P = 0.023), and injection pain (RR: 0.04, 95%CI: 0.01-0.28, P = 0.001) were lower.

CONCLUSION

Remimazolam is safe and effective during bronchoscopy. The sedation success rate was similar to that in the CS group. However, remimazolam has a higher safety profile, with fewer inhibitory effects on respiration and circulation.

Keywords: Remimazolam; Bronchoscopy; Procedural sedation; Meta-analysis

Core Tip: We searched the databases of EMBASE, PubMed, Cochrane Library, and the Web of Science for randomized controlled trials of bendable bronchoscopic procedural sedation with remimazolam vs conventional sedatives (CS) from the time the database was created until August 2023. STATA 15.1 software was applied to data analyses. Five studies with 1080 cases were included. We finally came to the conclusion: Remimazolam is safe and effective for cases with bronchoscopy. Its sedation success rate is similar to CS. However, remimazolam has a higher safety profile with less inhibitory effects on respiration and circulation.