Efficacy and safety of remimazolam vs. propofol for general anesthesia with tracheal intubation: Systematic review and meta‑analysis

Remimazolam is an ultra-short-acting intravenous benzodiazepine derivative approved for sedation during gastroscopy and colonoscopy. The present study aimed to compare the safety and efficacy of remimazolam and propofol for general anesthesia with tracheal intubation by meta-analysis. A comprehensive search was conducted in databases, including PubMed, Embase, Cochrane Library and Web of Science, to identify relevant randomized controlled trials (RCTs). The search period was from the inception of these databases until February 2024. All eligible randomized controlled trials that report at least one outcome of interest were subjected to quality assessment and data extraction by two researchers independently using Review Manager 5.4 software. Data analysis was conducted using R software. A total of 14 RCTs with 1,275 patients were included for meta-analysis. Compared with propofol, remimazolam significantly reduced incidence of hypotension [odds ratio (OR)=0.31, 95% confidence interval (CI; 0.23, 0.43), P<0.0001], bradycardia [OR=0.06, 95% CI (0.00, 1.20), P=0.06] and injection pain [OR=0.02, 95% CI (0.01, 0.08), P<0.0001] with shorter time to recovery of consciousness (ROC) [mean difference (MD)=5.47 min, 95% CI (-10.70, -0.24 min), P=0.04] but longer time to loss of consciousness [MD=37.01 sec, 95% CI (24.42, 49.60 sec), P<0.0001]. Remimazolam was a safer and more effective alternative to propofol for general anesthesia with tracheal intubation and demonstrated a lower risk of adverse events with shorter time to ROC.