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. 2023 Feb 6:14:1101728.
doi: 10.3389/fphar.2023.1101728. eCollection 2023.

The use of remimazolam versus propofol for induction and maintenance of general anesthesia: A systematic review and meta-analysis

Ching-Chung Ko  1   2 , Kuo-Chuan Hung  3 , Amina M Illias  4   5 , Chong-Chi Chiu  6   7   8 , Chia-Hung Yu  3 , Chien-Ming Lin  3 , I-Wen Chen  9 , Cheuk-Kwan Sun  7   10
Affiliations

The use of remimazolam versus propofol for induction and maintenance of general anesthesia: A systematic review and meta-analysis

Ching-Chung Ko et al. Front Pharmacol. .

Abstract

Background: The primary objective of this study was to compare the risk of hypotension, as well as the induction and recovery characteristics between remimazolam and propofol in patients receiving surgery under general anesthesia. Methods: The Embase, Medline, Google scholar, and the Cochrane Library databases were searched from inception to March 2022 for randomized controlled trials The primary outcome was the risk of post-induction hypotension between the two agents, while the secondary outcomes included anesthetic depth, induction efficacy, time to loss of consciousness (LOC), hemodynamic profiles, time to eye opening, extubation time as well as the incidence of injection pain and postoperative nausea/vomiting (PONV). Results: Meta-analysis of eight studies published from 2020 to 2022 involving 738 patients revealed a significantly lower risk of post-induction hypotension with the use of remimazolam compared to that with propofol [risk ratio (RR) = 0.57, 95% confidence interval (CI): 0.43 to 0.75, p < 0.0001, I2 = 12%, five studies, 564 patients]. After anesthetic induction, the anesthetic depth measured by bispectral index (BIS) was lighter in the remimazolam group than that in the propofol group (MD = 9.26, 95% confidence interval: 3.06 to 15.47, p = 0.003, I2 = 94%, five studies, 490 patients). The time to loss of consciousness was also longer in the former compared to the latter (MD = 15.49 s, 95%CI: 6.53 to 24.46, p = 0.0007, I2 = 61%, three studies, 331 patients). However, the use of remimazolam correlated with a lower risk of injection pain (RR = 0.03, 95%CI: 0.01 to 0.16, p < 0.0001, I2 = 0%, three studies, 407 patients) despite comparable efficacy of anesthetic induction (RR = 0.98, 95%CI: 0.9 to 1.06, p = 0.57, I2 = 76%, two studies, 319 patients). Our results demonstrated no difference in time to eye opening, extubation time, and risk of PONV between the two groups. Conclusion: Remimazolam was associated with a lower risk of post-induction hypotension after anesthetic induction compared with propofol with similar recovery characteristics. Further studies are required to support our findings. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/; Identifier: CRD42022320658.

Keywords: anesthesia; general anesthesia (GA); hypotension; propofol; remimazolam.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram of study selection for the current meta-analysis.
FIGURE 2
FIGURE 2
Risks of bias of the included studies. Risk of bias. Green: low risk; yellow: some concern; red: high risk.
FIGURE 3
FIGURE 3
Forest plot comparing the risk of hypotension between remimazolam and control groups. M-H, Mantel-Haenszel; CI, confidence interval.
FIGURE 4
FIGURE 4
Forest plot comparing anesthetic depth between remimazolam and control groups. CI, confidence interval; IV, inverse variance.
FIGURE 5
FIGURE 5
Forest plot comparing (A) time to loss of consciousness; (B) risk of injection pain and (C) efficacy of anesthetic induction between remimazolam and control groups. CI, confidence interval; IV, inverse variance; M-H, Mantel-Haenszel.
See this image and copyright information in PMC

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