Efficacy of Remimazolam for Procedural Sedation in American Society of Anesthesiologists (ASA) I to IV Patients Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

Abstract

Remimazolam is made by combining midazolam and remifentanil as an alternative to conventional sedatives. To evaluate the efficacy of remimazolam for sedation in patients undergoing colonoscopy, we conducted a systematic review and meta-analysis of the available randomized controlled trials (RCTs) comparing remimazolam and midazolam. A search was conducted using PubMed, Cochrane Library, and clinicaltrial.gov from inception till December 26, 2021, for RCTs that investigated the efficacy of remimazolam during the above-mentioned procedure. There was no restriction of language. A quality assessment was performed using the Cochrane Risk-of-Bias tool. The data were pooled, and a meta-analysis was completed. The systemic review was conducted in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guideline statement. Three randomized controlled trials involving 539 patients were included in the meta-analysis. Compared with midazolam during colonoscopy, remimazolam results in reduced need for top-up doses (RR= 3.45, 95% CI=1.07 to 11.14; P=0.04, I 2 =84%). The need for rescue medication was reduced with remimazolam as compared to midazolam (RR=2.42, 95%CI=1.04 to 5.61; P=0.04, I 2 =96%). There was no significant difference observed between the two drugs on completion of colonoscopy and the overall procedural sedation, but the sensitivity analysis favored remimazolam over midazolam for procedural sedation (RR=4.08, 95%CI=2.35 to 7.09; P<0.00001, I 2 =39%). This analysis demonstrates the advantages of remimazolam over other agents and sets a platform for relevant future studies.

The effective dose of remimazolam in adult gastroscopy

“…Remimazolam is an ultra-short-acting benzodiazepine drug with a rapid onset and metabolism, without bioaccumulation, and antagonized by flumazenil. [ 16 17 18 ] Remimazolam can avoid adverse reactions such as propofol-induced hemodynamic fluctuations, excessive sedation, and injection pain. [ 16 17 18 29 ] It can be used safely for painless gastrointestinal endoscopy,[ 19 ] including in obese patients.…”

“…[ 16 17 18 ] Remimazolam can avoid adverse reactions such as propofol-induced hemodynamic fluctuations, excessive sedation, and injection pain. [ 16 17 18 29 ] It can be used safely for painless gastrointestinal endoscopy,[ 19 ] including in obese patients. [ 29 ]…”

“…Remimazolam is a new type of benzodiazepine[ 16 17 18 ] and was launched in China in July 2020. It has a short half-life, fast onset and metabolism, and high safety and has been used in painless gastroscopy[ 19 ] and colonoscopy.…”

Remimazolam versus propofol in combination with esketamine for surgical abortion: A double‐blind randomized controlled trial

“…This feature enables rapid metabolism even with a longer infusion, 16 thus providing more predictable sedation 17 . It has been shown to be well‐tolerated and effective for general anesthesia when used alone or in combination with analgesics, with fewer adverse events compared with propofol 18–20 and other benzodiazepines 21,22 . It does not cause respiratory depression or injection pain and has no significant impact on hemodynamics as propofol does 17,23 .…”

“… 17 It has been shown to be well‐tolerated and effective for general anesthesia when used alone or in combination with analgesics, with fewer adverse events compared with propofol 18 , 19 , 20 and other benzodiazepines. 21 , 22 It does not cause respiratory depression or injection pain and has no significant impact on hemodynamics as propofol does. 17 , 23 It was reported to reduce stress during painless gastrointestinal endoscopy as well.…”