Department of Medicine, Evangelical University of Goiás, Anápolis, Brazil.
Diagnostic Imaging and Specialized Diagnosis Unit, University Hospital of Federal University of São Carlos, São Carlos, Brazil.
Br J Anaesth. 2024 Jun;132(6):1219-1229. doi: 10.1016/j.bja.2024.02.005. Epub 2024 Mar 4.
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.
在胃肠内镜检查中，丙泊酚具有良好的疗效，但不良反应仍很常见。有新证据支持瑞马唑仑在胃肠内镜检查中的应用。本系统评价和荟萃分析比较了瑞马唑仑和丙泊酚联合短效阿片类药物在胃肠内镜检查中镇静成人的疗效、安全性和满意度相关结局。
我们检索了 MEDLINE、Embase 和 Cochrane 数据库，以比较瑞马唑仑和丙泊酚联合短效阿片类药物在胃肠内镜检查中镇静成人的疗效、安全性和满意度相关结局。我们进行了敏感性分析，根据使用的短效阿片类药物类型和年龄范围进行亚组评估，并使用平均患者年龄作为协变量进行元回归分析。我们使用 R 统计软件进行统计分析。
我们纳入了 15 项试验（4516 名受试者）。瑞马唑仑的镇静成功率显著较低（风险比 [RR] 0.991；95%置信区间 [CI] 0.984-0.998；高质量证据），诱导时间略长（平均差 [MD] 9 秒；95%CI 4-13；中等质量证据），而两种镇静剂在其他时间相关结局方面无显著差异。瑞马唑仑与呼吸抑制发生率显著降低相关（RR 0.41；95%CI 0.30-0.56；高质量证据）、低血压发生率降低（RR 0.43；95%CI 0.35-0.51；中等质量证据）、需要治疗的低血压发生率降低（RR 0.25；95%CI 0.12-0.52；高质量证据）和心动过缓发生率降低（RR 0.42；95%CI 0.30-0.58；高质量证据）。两种药物的患者（MD 0.41；95%CI -0.07 至 0.89；中等质量证据）和内镜医师满意度（MD -0.31；95%CI -0.65 至 0.04；高质量证据）无差异。
与丙泊酚相比，瑞马唑仑在胃肠内镜检查中具有相似的疗效和更高的安全性。
