Xin Yueyang, Lu Pei, Guan Shaodi, Si Shaomeng, Sun Rao, Xia Wei, Xu Hui
Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Medicina (Kaunas). 2025 Mar 5;61(3):453. doi: 10.3390/medicina61030453.
: Appropriate sedation and anesthesia are crucial for ensuring comfortable endoscopic procedures. Propofol is one of the most often used sedatives. However, its safety and adverse effects restrict its usage. Remimazolam is a relatively new intravenous benzodiazepine that offers many benefits. Our analysis aims to evaluate the effectiveness and safety of remimazolam during short endoscopic procedures. We conducted a comprehensive search of the PubMed, Web of Science, ClinicalTrials.gov, and Turning Research Into Practice databases up to 31 December 2023, for randomized controlled trials published in English. Statistical analyses were performed using Cochrane Review Manager 5.4.1 and Stata Software/MP. The success rate of sedation with remimazolam was slightly lower than that with propofol (RR: 0.99, 95% CI: 0.981.00; = 0.004; I = 42%). As for anesthetic effect-related outcomes, remimazolam did not show advantages in onset time (MD = 12.72, 95% CI: 6.5318.90, < 0.001, I = 94%), recovery time (MD = 0.86, 95% CI: -0.552.27, = 0.23, I = 98%), or intraoperative body movement (RR: 1.18, 95% CI: 0.602.32, = 0.62, I = 87%). However, compared to propofol, remimazolam significantly reduced the incidence of several adverse events, including injection pain (RR: 0.07, 95% CI: 0.030.14, < 0.001, I = 69%), intraoperative hypotension (RR: 0.38, 95% CI: 0.310.47, < 0.001, I = 65%), bradycardia (RR: 0.25, 95% CI: 0.150.45, < 0.001, I = 0%), and respiratory depression (RR: 0.34, 95% CI: 0.250.46, < 0.001, I = 50%). The incidence of postoperative nausea and vomiting (PONV) was slightly higher with remimazolam (RD: 0.01, 95% CI: 0.00~0.03, = 0.04, I = 33%). Remimazolam is a promising sedative for short endoscopic procedures due to its superior safety profile despite a slightly lower sedation success rate compared to propofol.
适当的镇静和麻醉对于确保舒适的内镜手术至关重要。丙泊酚是最常用的镇静剂之一。然而，其安全性和不良反应限制了其使用。瑞马唑仑是一种相对较新的静脉注射苯二氮䓬类药物，具有许多优点。我们的分析旨在评估瑞马唑仑在短内镜手术中的有效性和安全性。我们对截至2023年12月31日的PubMed、科学网、ClinicalTrials.gov和将研究转化为实践数据库进行了全面搜索，以查找英文发表的随机对照试验。使用Cochrane系统评价管理软件5.4.1和Stata软件/MP进行统计分析。瑞马唑仑镇静的成功率略低于丙泊酚（风险比：0.99，95%置信区间：0.981.00；P = 0.004；I² = 42%）。至于与麻醉效果相关的结果，瑞马唑仑在起效时间（平均差 = 12.72，95%置信区间：6.5318.90，P < 0.001，I² = 94%）、恢复时间（平均差 = 0.86，95%置信区间：-0.552.27，P = 0.23，I² = 98%）或术中身体移动方面（风险比：1.18，95%置信区间：0.602.32，P = 0.62，I² = 87%）未显示出优势。然而，与丙泊酚相比，瑞马唑仑显著降低了几种不良事件的发生率，包括注射痛（风险比：0.07，95%置信区间：0.030.14，P < 0.001，I² = 69%）、术中低血压（风险比：0.38，95%置信区间：0.310.47，P < 0.001，I² = 65%）、心动过缓（风险比：0.25，95%置信区间：0.150.45，P < 0.001，I² = 0%）和呼吸抑制（风险比：0.34，95%置信区间：0.250.46，P < 0.001，I² = 50%）。瑞马唑仑术后恶心呕吐（PONV）的发生率略高（风险差值：0.01，95%置信区间：0.00~0.03，P = 0.04，I² = 33%）。尽管与丙泊酚相比镇静成功率略低，但瑞马唑仑因其卓越的安全性，是短内镜手术中一种有前景的镇静剂。
