Article ; Online: Remimazolam versus propofol for sedation in gastrointestinal endoscopy and colonoscopy within elderly patients: a meta-analysis of randomized controlled trials.
European journal of clinical pharmacology
2024 Volume 80, Issue 4, Page(s) 493–503
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, ... ...
| 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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| MeSH term(s) | Humans ; Aged ; Propofol/adverse effects ; Randomized Controlled Trials as Topic ; Benzodiazepines/adverse effects ; Hypnotics and Sedatives ; Endoscopy, Gastrointestinal/methods ; Colonoscopy/methods | |||||
| Chemical Substances | Propofol (YI7VU623SF) ; remimazolam (7V4A8U16MB) ; Benzodiazepines (12794-10-4) ; Hypnotics and Sedatives | |||||
| Language | English | |||||
| Publishing date | 2024-01-23 | |||||
| Publishing country | Germany | |||||
| Document type | Meta-Analysis ; Systematic Review ; Journal Article ; Review | |||||
| ZDB-ID | 121960-1 | |||||
| ISSN | 1432-1041 ; 0031-6970 | |||||
| ISSN (online) | 1432-1041 | |||||
| ISSN | 0031-6970 | |||||
| DOI | 10.1007/s00228-024-03624-6 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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