Efficacy of remimazolam versus dexmedetomidine for procedural sedation: a systematic review and meta-analysis

Dexmedetomidine is a widely used sedative agent, owing to its stable hemodynamic profiles and minimal respiratory depression.Recently, remimazolam was approved for procedural sedation.Its pharmacokinetic properties may provide more controllable sedation with fewer adverse effects.This systematic review aims to evaluate the relative efficacy of remimazolam versus dexmedetomidine during procedural sedation.A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted to identify randomized controlled trials comparing remimazolam with dexmedetomidine for procedural sedation.Of 515 studies identified, nine met the inclusion criteria and were included in the final analysis.Compared to dexmedetomidine, remimazolam was associated with a significant shorter induction time (mean difference [MD] -3.78 min; 95% confidence interval [CI] -5.88 to -1.68; p=0.0004;I 2 =98%) and a reduced recovery time (MD -3.89 min; 95% CI -5.67 to -2.11; p<0.0001;I 2 =95%).No significant differences were observed between the two groups in the use of rescue medications or in the incidence of respiratory depression.The incidence of hypertension and bradycardia was significantly lower in the remimazolam group.In conclusion, remimazolam may be associated with shorter induction and recovery times for procedural sedation than those of dexmedetomidine, with lower risks of hypertension and bradycardia.However, given the limitations identified in the quality assessment, further well-designed, large-scale studies are necessary to validate the clinical significance of these results.