Xing Yang, Lang Zekun, Wang Xinrun, Liu Jie, Han Xiaoxia, Zhou Jia, Leng Yufang
First Medical College of Lanzhou University, Lanzhou Gansu, China.
Department of Anesthesiology, First Hospital of Lanzhou University, Lanzhou Gansu, China.
Int J Surg. 2025 Sep 1;111(9):6384-6396. doi: 10.1097/JS9.0000000000002737. Epub 2025 Jun 12.
Remimazolam is a novel, ultra-short-acting benzodiazepine. This systematic review and meta-analysis compared the anesthetic efficacy and safety of remimazolam versus propofol for procedural sedation and general anesthesia.
A comprehensive search of PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials was conducted through 26 July 2024. Randomized controlled trials comparing remimazolam and propofol for procedural sedation or general anesthesia were included. The primary outcome was the success rate of sedation or general anesthesia. Data were analyzed using fixed and random-effects models to calculate pooled risk ratios (RRs), mean differences, 95% confidence intervals (CIs), and P values.
Twenty-seven studies involving 7283 patients met the inclusion criteria. Sedation and general anesthesia success rates were comparable between remimazolam and propofol (RR: 0.99; 95% CI: 0.97-1.00; P = 0.10; N = 4858). While remimazolam had a longer time to awake, it was associated with significantly lower rates of hypotension and injection pain. Rates of nausea, vomiting, and discharge times were similar between the drugs. Subgroup analyses revealed that during procedural sedation, remimazolam resulted in longer awakening times and a reduced risk of hypoxemia. However, these effects were not observed in general anesthesia.
Remimazolam and propofol achieved comparable success rates for sedation and general anesthesia. Remimazolam reduced hypoxemia risk but prolonged awakening times during procedural sedation. It also lowered the incidence of hypotension and injection pain across both procedural sedation and general anesthesia. Additional studies are needed to further clarify its role, particularly in general anesthesia.
瑞马唑仑是一种新型超短效苯二氮䓬类药物。本系统评价和荟萃分析比较了瑞马唑仑与丙泊酚用于程序镇静和全身麻醉时的麻醉效果及安全性。
截至2024年7月26日，对PubMed、EMBASE、Web of Science和Cochrane对照试验中央注册库进行了全面检索。纳入比较瑞马唑仑和丙泊酚用于程序镇静或全身麻醉的随机对照试验。主要结局是镇静或全身麻醉的成功率。使用固定效应模型和随机效应模型分析数据，以计算合并风险比（RRs）、平均差、95%置信区间（CIs）和P值。
27项涉及7283例患者的研究符合纳入标准。瑞马唑仑和丙泊酚的镇静和全身麻醉成功率相当（RR：0.99；95%CI：0.97 - 1.00；P = 0.10；N = 4858）。虽然瑞马唑仑的苏醒时间较长，但它与显著较低的低血压和注射痛发生率相关。两种药物的恶心、呕吐发生率和出院时间相似。亚组分析显示，在程序镇静期间，瑞马唑仑导致苏醒时间延长，低氧血症风险降低。然而，在全身麻醉中未观察到这些效应。
瑞马唑仑和丙泊酚在镇静和全身麻醉方面的成功率相当。瑞马唑仑降低了低氧血症风险，但在程序镇静期间延长了苏醒时间。它还降低了程序镇静和全身麻醉中低血压和注射痛的发生率。需要进一步研究以进一步阐明其作用，特别是在全身麻醉中的作用。
