Remimazolam versus midazolam for moderate sedation in gastrointestinal endoscopy: a systematic review and meta-analysis of randomized controlled trials.
Umar Akram, Eeman Ahmad, Shahzaib Ahmed et al.
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In 30 seconds
This systematic review and meta-analysis compared remimazolam with midazolam for moderate sedation in gastrointestinal endoscopy, pooling 9 randomized controlled trials involving 1251 patients. Sedation success did not differ significantly between agents (risk ratio, 1.49; P = .08). Compared with midazolam, remimazolam was associated with shorter induction, alertness, recovery, and discharge times, greater patient satisfaction, and lower risks of hypotension and bradycardia. The authors note substantial heterogeneity across several outcomes, so these comparative findings warrant cautious interpretation.
Key findings
- Sedation success was not significantly different between remimazolam and midazolam (risk ratio, 1.49; P = .08).
- Remimazolam shortened recovery time by 15.66 minutes versus midazolam (MD, -15.66 minutes; P ≤ .001).
- Remimazolam was associated with lower risks of hypotension (OR, 0.47; P < .001) and bradycardia (OR, 0.59; P = .037).
- Patient satisfaction was higher with remimazolam (standardized MD, 0.34; P < .01); other adverse events were comparable.
Why it matters
Sedation success was comparable, while several recovery-related outcomes and two cardiovascular adverse events favored remimazolam in the pooled trials. These results inform comparisons of procedural sedation options and highlight outcomes relevant to patient experience and endoscopy-unit flow. However, heterogeneity across several outcomes limits confidence in how consistently these differences apply across settings.
What to keep in mind
Substantial heterogeneity across several outcomes, as noted by the authors, warrants cautious interpretation.