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

Table 1 The basic characteristics of included studies

Ref.	Country	Study design	ASA status	Number of patients	Age	Gender (M/F)	Remimazolam	Control
Gao et al[13], 2023	China	RCT	I-III	60	18-70	39/21	Initial dose: 6 mg/kg/h; Maintenance dose: 0.6-2 mg/kg/h	Propofol: Initial dose: 2 mg/kg; Maintenance dose: 4-6 mg/kg/h
Zhang et al[14], 2023	China	RCT	I-III	192	18-64	92/100	Initial dose: 0.2 mg/kg; Top-up dose: 0.05 mg/kg	Propofol: Initial dose: 1.5 mg/kg; Top-up dose: 0.5-1.0 mg/kg
Zhou et al[15], 2022	China	RCT	I-III	310	18-75	154/156	Initial dose: 0.2 mg/kg; Top-up dose: 0.1 mg/kg	Propofol: Initial dose: 2 mg/kg; Top-up dose: 0.75 mg/kg
Pastis et al[16], 2019	USA	RCT	I-III	372	50-74	174/198	Initial dose: 5 mg; Top-up dose: 2.5 mg	Midazolam: Initial dose: 1-1.75 mg; Top-up dose: 0.5-1 mg
Chen et al[17], 2022	China	RCT	I-III	146	45-65	108/38	Initial dose: 12 mg/kg/h; Maintenance dose: 1-2 mg/kg/h	Dexmedetomidine: Initial dose: 0.5 μg/kg; Maintenance dose: 0.2-0.7 μg/kg/h

ASA: American Society of Anesthesiologists.

Table 2 Number of successful sedation in bronchoscopy

Ref.	Study design	Number of patients in each group		Number of successful sedation
		Remimazolam	Control	Remimazolam	Control
Zhou et al[15], 2022	RCT	155	Propofol: 155	154	Propofol: 154
Pastis et al[16], 2019	RCT	310	Midazolam: 73	250	Midazolam: 24
Chen et al[17], 2022	RCT	73	Dexmedetomidine: 73	69	Dexmedetomidine: 67

RCT: Randomized controlled trial.

Table 3 The number of patients with adverse events during bronchoscopy

Ref.	Patients in each group (n)		Hypotension (n)		Hypertension (n)		Respiratory depression (n)		Hypoxemia (n)		Bradycardia (n)		Tachycardia (n)		Injection pain (n)
	Remimazolam	Control	Remimazolam	Control	Remimazolam	Control	Remimazolam	Control	Remimazolam	Control	Remimazolam	Control	Remimazolam	Control	Remimazolam	Control
Gao et al[13], 2023	30	Propofol: 30	11	Propofol: 22	1	Propofol: 2	NA	NA	1	Propofol: 2	2	Propofol: 5	6	Propofol: 9	NA	NA
Zhang et al[14], 2023	96	Propofol: 96	1	Propofol: 8	NA	NA	13	Propofol: 38	NA	NA	0	Propofol: 22	NA	NA	NA	NA
Zhou et al[15], 2022	155	Propofol: 155	22	Propofol: 49	13	Propofol: 5	9	Propofol: 8	13	Propofol: 5	NA	NA	NA	NA	1	Propofol: 26
Pastis et al[16], 2019	303	Midazolam: 69	127	Midazolam: 34	186	Midazolam: 41	7	Midazolam: 3	186	Midazolam: 41	13	Midazolam: 3	4	Midazolam: 0	2	Midazolam: 0
Chen et al[17], 2022	73	Dexmedetomidine: 73	9	Dexmedetomidine: 8	2	Dexmedetomidine: 3	2	Dexmedetomidine: 2	2	Dexmedetomidine: 3	3	Dexmedetomidine: 2	NA	NA	NA	NA

Table 4 Pooled results on the incidence of adverse events for remimazolam versus conventional sedatives

Control	Complications	Relative risk	95%CI	I2 value (%)	P value for effect
Conventional sedatives	Hypotension	0.61	(0.40, 0.95)	65.1	0.027
	Hypertension	1.11	(0.89, 1.38)	23.5	0.359
	Respiratory depression	0.50	(0.33, 0.77)	42.3	0.002
	Hypoxemia	0.74	(0.37, 1.47)	59.7	0.387
	Bradycardia	0.72	(0.33, 1.56)	0.0	0.403
	Tachycardia	0.78	(0.33, 1.85)	0.0	0.576
	Injection pain	0.17	(0.01, 5.30)	72.3	0.316

Table 5 Pooled results of subgroup analyses of adverse event rates for remimazolam vs propofol, midazolam, and dexmedetomidine

Control	Complications	Relative risk	95%CI	I2 value (%)	P value for effect
Propofol	Hypotension	0.45	(0.32, 0.64)	0.0	0.000
	Hypertension	2.00	(0.82, 4.85)	37.6	0.125
	Respiratory depression	0.48	(0.30, 0.76)	78.4	0.002
	Hypoxemia	0.36	(0.15, 0.87)	-	0.023
	Bradycardia	0.33	(0.08, 1.33)	0.0	0.119
	Tachycardia	0.67	(0.27, 1.64)	-	0.378
	Injection pain	0.04	(0.01, 0.28)	-	0.001
Midazolam	Hypotension	0.85	(0.65, 1.12)	-	0.247
	Hypertension	1.03	(0.83, 1.28)	-	0.766
	Respiratory depression	0.53	(0.14, 2.00)	-	0.350
	Hypoxemia	1.16	(0.68, 1.97)	-	0.595
	Bradycardia	0.99	(0.29, 3.37)	-	0.983
	Tachycardia	2.07	(0.11, 38.05)	-	0.624
	Injection pain	1.15	(0.06, 23.72)	-	0.927
Dexmedetomidine	Hypotension	0.61	(0.40, 0.95)	-	0.797
	Hypertension	0.67	(0.11, 3.87)	-	0.652
	Respiratory depression	1.00	(0.14, 6.91)	-	1.000
	Hypoxemia	0.80	(0.33, 1.91)	-	0.616
	Bradycardia	1.50	(0.26, 8.71)	-	0.652