Efficacy and safety of remimazolam in bronchoscopic sedation: A meta-analysis.

ABSTRACT

BACKGROUND: Remimazolam is a new benzodiazepine used for procedural sedation and general anesthesia. Several studies have used remimazolam for bendable bronchoscopy. AIM: To assess the safety and efficacy of remimazolam for sedation in patients undergoing bendable bronchoscopy by performing a meta-analysis of randomized controlled trials (RCTs). METHODS: We searched the EMBASE, PubMed, Cochrane Library, and Web of Science databases for RCTs on bendable bronchoscopic procedural sedation with remimazolam vs conventional sedatives (CS). RESULTS: Five studies with 1080 cases were included. Remimazolam had the same sedation success rate compared with CS [relative risk (RR) 1.35, 95%CI 0.60-3.05, P = 0.474, I2 = 99.6%]. However, remimazolam was associated with a lower incidence of hypotension (RR 0.61; 95%CI 0.40-0.95, P = 0.027; I2 = 65.1%) and a lower incidence of respiratory depression (RR 0.50, 95%CI 0.33-0.77, P = 0.002, I2 = 42.3%). A subgroup analysis showed a higher success rate of sedation with remimazolam than midazolam (RR 2.45, 95%CI 1.76-3.42, P < 0.001). Compared with propofol, the incidence of hypotension (RR 0.45, 95%CI 0.32-0.64, P < 0.001, I2 = 0.0%), respiratory depression (RR 0.48, 95%CI 0.30-0.76, P = 0.002, I2 = 78.4%), hypoxemia (RR 0.36, 95%CI 0.15-0.87, P = 0.023), and injection pain (RR 0.04, 95%CI 0.01-0.28, P = 0.001) were lower. CONCLUSION: Remimazolam is safe and effective during bronchoscopy. The sedation success rate was similar to that in the CS group. However, remimazolam has a higher safety profile, with fewer inhibitory effects on respiration and circulation.