Efficacy and Safety of Remimazolam in Endoscopic Sedation—A Systematic Review and Meta-Analysis

Abstract

Background: The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of remimazolam in clinical endoscopic procedure sedation.Methods: The authors searched the databases of PubMed, Embase, and Cochrane Library for studies published until January 2, 2021, that reported remimazolam sedation for endoscopic procedures. The sedative efficiency and the incidence of adverse events were assessed as outcomes. Cochrane Review Manager Software 5.3 was used to perform the statistical analyses.Results: Seven relevant studies involving a total of 1,996 patients were identified. We conducted a meta-analysis of the different controls used in the studies, that is, the placebo, midazolam, and propofol. The results demonstrated that remimazolam had a strong sedative effect, and its sedative efficiency was significantly higher than that of placebo [OR = 0.01, 95% CI: (0.00, 0.10), I2 = 30%, p <0.00001]. The sedative efficiency of remimazolam was significantly higher than that of midazolam [OR = 0.12, 95% CI: (0.08, 0.21), I2 = 0%, p < 0.00001] but lesser than that of propofol [OR = 12.22, 95% CI: (1.58, 94.47), I2 = 0%, p = 0.02]. Regarding the adverse events, remimazolam is associated with a lower incidence of hypotension than placebo and midazolam. Similarly, remimazolam was associated with a lower incidence of hypotension and hypoxemia than propofol.Conclusions: Remimazolam is a safe and effective sedative for patients undergoing endoscopic procedures. The sedative efficiency of remimazolam was significantly higher than that of midazolam but slightly lower than that of propofol. However, the respiration and circulation inhibitory effects of remimazolam were weaker than those of midazolam and propofol.

Efficacy of Remimazolam for Procedural Sedation in American Society of Anesthesiologists (ASA) I to IV Patients Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

“…While we were drafting our article, we found two recent systematic reviews and meta-analyses evaluating the efficacy and safety of remimazolam in patients undergoing endoscopy. Both the studies have highlighted that remimazolam has higher efficacy in terms of better sedation and procedural success, which is consistent with our analysis [ 16 , 17 ]. Both the studies have included dose-finding and dose-specific trials in their analysis, whereas our analysis only includes dose-specific trials of remimazolam i.e., up to 5.0 mg of a loading dose of remimazolam.…”

“…The most common adverse effects usually reported after the use of remimazolam are hypertension, hypotension, bradycardia, decreased respiratory rate, and hypoxia. However, no statistically significant difference was observed between both the intervention groups for the adverse effects as reported in the previous two meta-analyses except for the incidence of hypotension, for which remimazolam had a better outcome [ 16 - 17 ]. Other minor side effects include nausea and vomiting.…”

“…Moreover, our analysis is solely focused on colonoscopy, unlike the two meta-analyses, which have included bronchoscopy and upper gastrointestinal (GI) endoscopy too. Moreover, one study mentioned that since their analysis had both fixed-dose studies and dose-finding studies, the result might not be accurate in terms of dose to be used for the endoscopic procedure [ 17 ]. Similarly, the patients from class V and VI were not included because of the paucity of the data and were not deemed suitable for the procedure, respectively.…”

Remimazolam Inhibits Neuronal Apoptosis in Rat Brain via Slit Guidance Ligand 2/Roundabout 4 Signaling Pathway

“…Remimazolam is developed on the basis of midazolam, which has better efficacy and safety [11] , better anesthesia effect [12] and remimazolam can also act on GABA receptors to reduce neuronal excitation. There is no accumulation in the body and the retention time is shorter than that of midazolam, which can induce less movement of rats, thereby exerting a better sedative role [13,14] .…”

Review of remimazolam and sedatives in the intensive care unit

“…Remimazolam showed a lower incidence of hypotension than midazolam, and no significant differences were observed in hypoxia, bradycardia, nausea, vomiting, and injection site pain. Compared with propofol, remimazolam showed a significantly lower incidence of hypotension, hypoxemia, and pain at injection site; however, there were no differences in the incidence of bradycardia, nausea, and vomiting [ 57 , 58 ].…”