Remimazolam vs. Propofol: Are we witnessing a new era in sedation safety? A comprehensive meta-analysis

A comprehensive search was conducted following PRISMA guidelines, resulting in the identification of 258 studies across electronic databases and additional sources. After removing duplicates, 197 records remained for screening. Forty-six articles were evaluated in full text, of which only eight were deemed suitable for qualitative synthesis. Five of these presented sufficient data for quantitative meta-analysis. Three studies contributed to the pooled estimate of hypotension, indicating a Risk Ratio (RR) of 1.00 (95% CI: 0.78–1.28, p = 1.00), with no significant heterogeneity (I² = 0%). For respiratory depression, two studies reported non-zero events, producing a pooled RR of 1.00 (95% CI: 0.55–1.83, p = 1.00), also with I² = 0%. Funnel plot analyses suggested a low probability of publication bias. These findings support the conclusion that Remimazolam and Propofol confer similarly low risks of hypotension and respiratory depression. Further investigations with larger samples and standardized protocols may help clarify whether patient subgroups or specific procedures might yield different outcomes.