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Remimazolam versus propofol for sedation in gastrointestinal endoscopy and colonoscopy within elderly patients: a meta-analysis of randomized controlled trials

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Abstract

Purpose

Propofol has become the sedative of choice for endoscopy and colonoscopy. However, it has shown associations with various adverse effects, specifically in the geriatric population. In contrast, remimazolam is a novel benzodiazepine, demonstrating a superior clinical safety profile. Hence, this systematic review and meta-analysis aims to clarify the efficacy and safety of remimazolam versus propofol in elderly patients (≥ 60 years) undergoing gastrointestinal endoscopic and colonoscopy procedures.

Methods

Electronic databases including PubMed, Cochrane Library, ScienceDirect, and Google Scholar were explored from inception till January 7, 2024. The Cochrane Risk of Bias Tool for Randomized Controlled Trials (RoB-2) was utilized to evaluate the quality of each included study reported in this meta-analysis.

Results

Seven randomized control trials were included, resulting in the pooling of 1,466 patients (remimazolam: 731 patients; propofol: 735 patients). Propofol demonstrated a significantly lower time to loss of consciousness (P < 0.00001, 4 studies, 784 patients) and a greater sedation success after first dose (P = 0.05, 5 studies, 1,271 patients). Remimazolam reported a significantly lower risk of bradycardia (P = 0.02, 5 studies, 1,323 patients), hypoxemia (P < 0.00001, 6 studies, 1,389 patients), and pain on injection site (P < 0.00001, 5 studies, 1,184 patients). No statistically significant differences in sedation time, number of supplemental doses, procedural parameters, and other adverse outcomes were reported.

Conclusion

As per the results of our analyses, propofol demonstrated comparatively superior efficacy, however, remimazolam demonstrated comparatively superior safety. The debatable evidence generated from this meta-analysis may not currently be powerful enough to advocate for the use of remimazolam in elderly patients undergoing gastrointestinal procedures; hence, further comprehensive studies are necessary in order to arrive at a robust conclusion.

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Authors and Affiliations

  1. Department of Medicine, Dow Medical College, Karachi, Pakistan

    Wania Ahmer, Sahar Imtiaz, Khadija Ahmed, Juvairia Yousuf, Muhammad Ahmed Ali Fahim, Rahmeen Ali, Muhammad Umair Anjum & Muhammad Hasanain

  2. Department of Medicine, Dow International Medical College, Karachi, Pakistan

    Daniyal Muhammad Alam & Muhammad Omar Larik

  3. Department of Medicine, Sindh Medical College, Karachi, Pakistan

    Barka Sajid & Sunny Asnani

  4. Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan

    Marium Mansoor

  5. Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan

    Muhammad Talha Safdar

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  1. Wania Ahmer
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Contributions

Conceptualization: Wania Ahmer; Methodology: Muhammad Ahmed Ali Fahim, Marium Mansoor; Formal Analysis: Sahar Imtiaz, Daniyal Muhammad Alam, Barka Sajid; Writing — original draft: Wania Ahmer, Khadija Ahmed, Juvairia Yousuf, Sunny Asnani, Muhammad Ahmed Ali Fahim, Rahmeen Ali, Marium Mansoor, Muhammad Talha Safdar; Writing — review & editing: Muhammad Omar Larik, Muhammad Hasanain, Muhammad Umair Anjum; Supervision: Muhammad Omar Larik, Muhammad Hasanain, Muhammad Umair Anjum. All authors read and approved the final version of the manuscript.

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Correspondence to Muhammad Omar Larik.

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Ahmer, W., Imtiaz, S., Alam, D.M. et al. Remimazolam versus propofol for sedation in gastrointestinal endoscopy and colonoscopy within elderly patients: a meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 80, 493–503 (2024). https://doi.org/10.1007/s00228-024-03624-6

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