Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and meta-analysis
Propofol has a favourable efficacy profile in gastrointestinal endoscopic procedures, however adverse events remain frequent. Emerging evidence supports remimazolam use in gastrointestinal endoscopy. This systematic review and meta-analysis compares remimazolam and propofol, both combined with a sho...
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Veröffentlicht in: | British journal of anaesthesia : BJA 2024-06, Vol.132 (6), p.1219-1229 |
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description | Propofol has a favourable efficacy profile in gastrointestinal endoscopic procedures, however adverse events remain frequent. Emerging evidence supports remimazolam use in gastrointestinal endoscopy. This systematic review and meta-analysis compares remimazolam and propofol, both combined with a short-acting opioid, for sedation of adults in gastrointestinal endoscopy.
We searched MEDLINE, Embase, and Cochrane databases for randomised controlled trials comparing efficacy-, safety-, and satisfaction-related outcomes between remimazolam and propofol, both combined with short-acting opioids, for sedation of adults undergoing gastrointestinal endoscopy. We performed sensitivity analyses, subgroup assessments by type of short-acting opioid used and age range, and meta-regression analysis using mean patient age as a covariate. We used R statistical software for statistical analyses.
We included 15 trials (4516 subjects). Remimazolam was associated with a significantly lower sedation success rate (risk ratio [RR] 0.991; 95% confidence interval [CI] 0.984–0.998; high-quality evidence) and a slightly longer induction time (mean difference [MD] 9 s; 95% CI 4–13; moderate-quality evidence), whereas there was no significant difference between the sedatives in other time-related outcomes. Remimazolam was associated with significantly lower rates of respiratory depression (RR 0.41; 95% CI 0.30–0.56; high-quality evidence), hypotension (RR 0.43; 95% CI 0.35–0.51; moderate-quality evidence), hypotension requiring treatment (RR 0.25; 95% CI 0.12–0.52; high-quality evidence), and bradycardia (RR 0.42; 95% CI 0.30–0.58; high-quality evidence). There was no difference in patient (MD 0.41; 95% CI –0.07 to 0.89; moderate-quality evidence) and endoscopist satisfaction (MD –0.31; 95% CI –0.65 to 0.04; high-quality evidence) between both drugs.
Remimazolam has clinically similar efficacy and greater safety when compared with propofol for sedation in gastrointestinal endoscopies. |
doi_str_mv | 10.1016/j.bja.2024.02.005 |
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We searched MEDLINE, Embase, and Cochrane databases for randomised controlled trials comparing efficacy-, safety-, and satisfaction-related outcomes between remimazolam and propofol, both combined with short-acting opioids, for sedation of adults undergoing gastrointestinal endoscopy. We performed sensitivity analyses, subgroup assessments by type of short-acting opioid used and age range, and meta-regression analysis using mean patient age as a covariate. We used R statistical software for statistical analyses.
We included 15 trials (4516 subjects). Remimazolam was associated with a significantly lower sedation success rate (risk ratio [RR] 0.991; 95% confidence interval [CI] 0.984–0.998; high-quality evidence) and a slightly longer induction time (mean difference [MD] 9 s; 95% CI 4–13; moderate-quality evidence), whereas there was no significant difference between the sedatives in other time-related outcomes. Remimazolam was associated with significantly lower rates of respiratory depression (RR 0.41; 95% CI 0.30–0.56; high-quality evidence), hypotension (RR 0.43; 95% CI 0.35–0.51; moderate-quality evidence), hypotension requiring treatment (RR 0.25; 95% CI 0.12–0.52; high-quality evidence), and bradycardia (RR 0.42; 95% CI 0.30–0.58; high-quality evidence). There was no difference in patient (MD 0.41; 95% CI –0.07 to 0.89; moderate-quality evidence) and endoscopist satisfaction (MD –0.31; 95% CI –0.65 to 0.04; high-quality evidence) between both drugs.
Remimazolam has clinically similar efficacy and greater safety when compared with propofol for sedation in gastrointestinal endoscopies.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1016/j.bja.2024.02.005</identifier><identifier>PMID: 38443286</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>benzodiazepine ; Benzodiazepines - administration & dosage ; Benzodiazepines - adverse effects ; efficacy ; endoscopic sedation ; Endoscopy, Gastrointestinal - methods ; gastrointestinal endoscopy ; Humans ; Hypnotics and Sedatives - administration & dosage ; propofol ; Propofol - administration & dosage ; Randomized Controlled Trials as Topic ; remimazolam ; safety</subject><ispartof>British journal of anaesthesia : BJA, 2024-06, Vol.132 (6), p.1219-1229</ispartof><rights>2024 British Journal of Anaesthesia</rights><rights>Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-8df0bbdcf7c2b7183f61e767b974f6f4afa8ae31b23c7a5f423b6c97b2eea3a13</citedby><cites>FETCH-LOGICAL-c353t-8df0bbdcf7c2b7183f61e767b974f6f4afa8ae31b23c7a5f423b6c97b2eea3a13</cites><orcidid>0000-0002-6359-9167 ; 0000-0001-5500-4701 ; 0000-0001-5389-4368 ; 0000-0001-6294-9885</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38443286$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barbosa, Eduardo Cerchi</creatorcontrib><creatorcontrib>Espírito Santo, Paula Arruda</creatorcontrib><creatorcontrib>Baraldo, Stefano</creatorcontrib><creatorcontrib>Meine, Gilmara Coelho</creatorcontrib><title>Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and meta-analysis</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><description>Propofol has a favourable efficacy profile in gastrointestinal endoscopic procedures, however adverse events remain frequent. Emerging evidence supports remimazolam use in gastrointestinal endoscopy. This systematic review and meta-analysis compares remimazolam and propofol, both combined with a short-acting opioid, for sedation of adults in gastrointestinal endoscopy.
We searched MEDLINE, Embase, and Cochrane databases for randomised controlled trials comparing efficacy-, safety-, and satisfaction-related outcomes between remimazolam and propofol, both combined with short-acting opioids, for sedation of adults undergoing gastrointestinal endoscopy. We performed sensitivity analyses, subgroup assessments by type of short-acting opioid used and age range, and meta-regression analysis using mean patient age as a covariate. We used R statistical software for statistical analyses.
We included 15 trials (4516 subjects). Remimazolam was associated with a significantly lower sedation success rate (risk ratio [RR] 0.991; 95% confidence interval [CI] 0.984–0.998; high-quality evidence) and a slightly longer induction time (mean difference [MD] 9 s; 95% CI 4–13; moderate-quality evidence), whereas there was no significant difference between the sedatives in other time-related outcomes. Remimazolam was associated with significantly lower rates of respiratory depression (RR 0.41; 95% CI 0.30–0.56; high-quality evidence), hypotension (RR 0.43; 95% CI 0.35–0.51; moderate-quality evidence), hypotension requiring treatment (RR 0.25; 95% CI 0.12–0.52; high-quality evidence), and bradycardia (RR 0.42; 95% CI 0.30–0.58; high-quality evidence). There was no difference in patient (MD 0.41; 95% CI –0.07 to 0.89; moderate-quality evidence) and endoscopist satisfaction (MD –0.31; 95% CI –0.65 to 0.04; high-quality evidence) between both drugs.
Remimazolam has clinically similar efficacy and greater safety when compared with propofol for sedation in gastrointestinal endoscopies.</description><subject>benzodiazepine</subject><subject>Benzodiazepines - administration & dosage</subject><subject>Benzodiazepines - adverse effects</subject><subject>efficacy</subject><subject>endoscopic sedation</subject><subject>Endoscopy, Gastrointestinal - methods</subject><subject>gastrointestinal endoscopy</subject><subject>Humans</subject><subject>Hypnotics and Sedatives - administration & dosage</subject><subject>propofol</subject><subject>Propofol - administration & dosage</subject><subject>Randomized Controlled Trials as Topic</subject><subject>remimazolam</subject><subject>safety</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtv1DAUhS1ERYfCD2CDvGST4EcSJ7BCVXlIlSohWFvXzjXyKIkH36TV8Ovr0RSWrO7mfEfnfoy9kaKWQnbv97XbQ62EamqhaiHaZ2wnGyOrzhj5nO2EEKYSg1SX7CXRXghp1NC-YJe6bxqt-m7Hjt9xjjP8SRPM_B4zbcQPOR1SSBMPKXPCEdaYFh4X_gtozSkuK9IaF5g4LmMinw7RnyCP45aRPnDgdKQV5wJ6nvE-4gOHZeQzrlBBAY8U6RW7CDARvn66V-zn55sf11-r27sv364_3VZet3qt-jEI50YfjFfOyF6HTqLpjBtME7rQQIAeUEuntDfQhkZp1_nBOIUIGqS-Yu_OvWXh760st3Mkj9MEC6aNrBp0r_q2M0OJynPU50SUMdhDLnLy0UphT8bt3hbj9mTcCmWL8cK8farf3IzjP-Kv4hL4eA5gebKoyJZ8xKXIihn9ascU_1P_CMSylUA</recordid><startdate>202406</startdate><enddate>202406</enddate><creator>Barbosa, Eduardo Cerchi</creator><creator>Espírito Santo, Paula Arruda</creator><creator>Baraldo, Stefano</creator><creator>Meine, Gilmara Coelho</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6359-9167</orcidid><orcidid>https://orcid.org/0000-0001-5500-4701</orcidid><orcidid>https://orcid.org/0000-0001-5389-4368</orcidid><orcidid>https://orcid.org/0000-0001-6294-9885</orcidid></search><sort><creationdate>202406</creationdate><title>Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and meta-analysis</title><author>Barbosa, Eduardo Cerchi ; Espírito Santo, Paula Arruda ; Baraldo, Stefano ; Meine, Gilmara Coelho</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-8df0bbdcf7c2b7183f61e767b974f6f4afa8ae31b23c7a5f423b6c97b2eea3a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>benzodiazepine</topic><topic>Benzodiazepines - administration & dosage</topic><topic>Benzodiazepines - adverse effects</topic><topic>efficacy</topic><topic>endoscopic sedation</topic><topic>Endoscopy, Gastrointestinal - methods</topic><topic>gastrointestinal endoscopy</topic><topic>Humans</topic><topic>Hypnotics and Sedatives - administration & dosage</topic><topic>propofol</topic><topic>Propofol - administration & dosage</topic><topic>Randomized Controlled Trials as Topic</topic><topic>remimazolam</topic><topic>safety</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Barbosa, Eduardo Cerchi</creatorcontrib><creatorcontrib>Espírito Santo, Paula Arruda</creatorcontrib><creatorcontrib>Baraldo, Stefano</creatorcontrib><creatorcontrib>Meine, Gilmara Coelho</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Barbosa, Eduardo Cerchi</au><au>Espírito Santo, Paula Arruda</au><au>Baraldo, Stefano</au><au>Meine, Gilmara Coelho</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and meta-analysis</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><addtitle>Br J Anaesth</addtitle><date>2024-06</date><risdate>2024</risdate><volume>132</volume><issue>6</issue><spage>1219</spage><epage>1229</epage><pages>1219-1229</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><abstract>Propofol has a favourable efficacy profile in gastrointestinal endoscopic procedures, however adverse events remain frequent. Emerging evidence supports remimazolam use in gastrointestinal endoscopy. This systematic review and meta-analysis compares remimazolam and propofol, both combined with a short-acting opioid, for sedation of adults in gastrointestinal endoscopy.
We searched MEDLINE, Embase, and Cochrane databases for randomised controlled trials comparing efficacy-, safety-, and satisfaction-related outcomes between remimazolam and propofol, both combined with short-acting opioids, for sedation of adults undergoing gastrointestinal endoscopy. We performed sensitivity analyses, subgroup assessments by type of short-acting opioid used and age range, and meta-regression analysis using mean patient age as a covariate. We used R statistical software for statistical analyses.
We included 15 trials (4516 subjects). Remimazolam was associated with a significantly lower sedation success rate (risk ratio [RR] 0.991; 95% confidence interval [CI] 0.984–0.998; high-quality evidence) and a slightly longer induction time (mean difference [MD] 9 s; 95% CI 4–13; moderate-quality evidence), whereas there was no significant difference between the sedatives in other time-related outcomes. Remimazolam was associated with significantly lower rates of respiratory depression (RR 0.41; 95% CI 0.30–0.56; high-quality evidence), hypotension (RR 0.43; 95% CI 0.35–0.51; moderate-quality evidence), hypotension requiring treatment (RR 0.25; 95% CI 0.12–0.52; high-quality evidence), and bradycardia (RR 0.42; 95% CI 0.30–0.58; high-quality evidence). There was no difference in patient (MD 0.41; 95% CI –0.07 to 0.89; moderate-quality evidence) and endoscopist satisfaction (MD –0.31; 95% CI –0.65 to 0.04; high-quality evidence) between both drugs.
Remimazolam has clinically similar efficacy and greater safety when compared with propofol for sedation in gastrointestinal endoscopies.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>38443286</pmid><doi>10.1016/j.bja.2024.02.005</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-6359-9167</orcidid><orcidid>https://orcid.org/0000-0001-5500-4701</orcidid><orcidid>https://orcid.org/0000-0001-5389-4368</orcidid><orcidid>https://orcid.org/0000-0001-6294-9885</orcidid></addata></record> |
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subjects | benzodiazepine Benzodiazepines - administration & dosage Benzodiazepines - adverse effects efficacy endoscopic sedation Endoscopy, Gastrointestinal - methods gastrointestinal endoscopy Humans Hypnotics and Sedatives - administration & dosage propofol Propofol - administration & dosage Randomized Controlled Trials as Topic remimazolam safety |
title | Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and meta-analysis |
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