Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2024; 12(7): 1272-1283
Published online Mar 6, 2024. doi: 10.12998/wjcc.v12.i7.1272
Safety and efficacy comparison of remimazolam and propofol for intravenous anesthesia during gastroenteroscopic surgery of older patients: A meta-analysis
Fang-Zhuo Li, Cheng Zhao, Yi-Xun Tang, Ji-Tong Liu
Fang-Zhuo Li, 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: Li FZ and Zhao C conducted the systematic review and data collection and proposed an explanation that played an important role in the writing of the paper; Li FZ and Tang YX carefully evaluated and verified the manuscript and confirmed the funding; Li FZ analyzed and reviewed the data; Liu JT reviewed the papers; supervised and critically evaluated the work, and confirmed the manuscript; This article was written and approved by all authors.
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 in accordance with this checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
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 22, 2023
Peer-review started: December 22, 2023
First decision: January 9, 2024
Revised: January 21, 2024
Accepted: February 5, 2024
Article in press: February 5, 2024
Published online: March 6, 2024
Processing time: 70 Days and 1.2 Hours
Abstract
BACKGROUND

Remimazolam is characterized by rapid action and inactive metabolites. It is used as the general anesthetic for many clinical surgeries. In this study, we performed a meta-analysis to evaluate whether remimazolam is superior to propofol for gastroenteroscopy in older patients.

AIM

To compare the adverse events and efficacy of remimazolam and propofol during gastroenteroscopy in older adults.

METHODS

The PubMed, Web of Science, the Cochrane Library databases were queried for the relevant key words "remimazolam,” "and propofol,” "and gastrointestinal endoscopy or gastroscopy.” The search scope was "Title and Abstract,” and the search was limited to human studies and publications in English. Seven studies wherein remimazolam and propofol were compared were included for the meta-analysis.

RESULTS

We selected seven randomized controlled trials involving 1445 cases for the analysis. Remimazolam reduced the hypotension (relative risk, RR = 0.44, 95%CI: 0.29-0.66, P = 0.000), respiratory depression (RR = 0.46, 95%CI: 0.30-0.70, P = 0.000), injection pain (RR = 0.12, 95%CI: 0.05-0.25, P = 0.000), bradycardia (RR = 0.37, 95%CI: 0.24-0.58, P = 0.000), and time to discharge [weighted mean difference (WMD) = -0.58, 95%CI: -0.97 to -0.18, P = 0.005], compared to those after propofol administration. No obvious differences were observed for postoperative nausea and vomiting (RR = 1.09, 95%CI: 0.97-1.24, P = 0.151), dizziness (RR = 0.77, 95%CI: 0.43-1.36, P = 0.361), successful sedation rate (RR = 0.96, 95%CI: 0.93-1.00, P = 0.083), or the time to become fully alert (WMD = 0.00, 95%CI: -1.08-1.08, P = 0.998).

CONCLUSION

Remimazolam appears to be safer than propofol for gastroenteroscopy in older adults. However, further studies are required to confirm these findings.

Keywords: Remimazolam; Propofol; Gastroenteroscopy; Anesthesia; Older adults; Sedation; Adverse events

Core Tip: We searched the databases of PubMed, Web of Science, and the Cochrane Library spanning from its establishment until October 2023. After carefully screening, 7 randomized controlled trials encompassing 1445 cases were included in our study. The Cochrane tool was utilized to evaluate the potential for bias. Ultimately, our findings indicate that using remimazolam in painless gastroenteroscopy for older patients offers greater hemodynamic stability and fewer negative side effects compared to propofol. Thus, remimazolam seemed like a safer option than propofol for gastroenteroscopy for older patients.