The safety and efficacy between remimazolam and propofol in intravenous anesthesia of endoscopy operation: a systematic review and meta-analysis

Background: Propofol is the most widely used intravenous anesthetic in endoscopic surgery, but is associated with several adverse reactions. Public research has shown that remimazolam, a safe general anesthetic, is increasingly being used as a substitute for propofol in clinical operations. Our meta-analysis aimed to analyze whether the adverse reaction rate of remimazolam in endoscopic surgery is acceptable and whether the surgical success rate is not lower than that of propofol. Aim: This meta-analysis examined the adverse events and efficacy of remimazolam vs. propofol during endoscopic surgery. Method: MEDLINE, EMBASE, ClinicalTrials.gov, and Google Scholar were comprehensively searched. Seven studies comparing remimazolam and propofol were included in our meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane manual were used to assess the quality of the results published in all included studies to ensure that our meta-analysis results are reliable and worthwhile. Results: Compared to propofol, the use of remimazolam reduced postoperative injection pain [Relative Risk (RR)=0.06, 95% confidence interval (CI): 0.03–0.12, P <0.00001], postoperative hypotension (RR=0.45, 95% CI: 0.28–0.73, P =0.001), and postoperative respiratory depression (RR=0.20, 95% CI: 0.08–0.47, P =0.0002); however, it also slightly reduced the success rate of the operation [Risk Difference (RD)=−0.02, 95% CI: −0.04–−0.01, P =0.0007]. There were no significant differences in the occurrence of bradycardia symptoms after the operation (RD=−0.01, 95% CI: −0.03–0.01, P =0.35), recovery time after the operation [STD Mean Difference (SMD)=0.68, 95% CI: −0.43–1.80, P =0.23] or discharge time (SMD=0.17, 95% CI: −0.58–0.23, P =0.41). We also performed a subgroup analysis of each corresponding outcome. Conclusion: Our analysis showed that remimazolam may be a safer shock option than propofol for endoscopic surgery. However, further research is required to determine their utility.