Comparison of the safety of remimazolam and propofol during general anesthesia in elderly patients: systematic review and meta-analysis

被引：0

作者：

Liu, Xianchun ^{[1
]}

Zhang, Longyi ^{[1
]}

Zhao, Li ^{[1
]}

Zhou, Xuelei ^{[1
]}

Mao, Wei ^{[1
]}

Chen, Linlin ^{[1
]}

Zhu, Hongyu ^{[1
]}

Xie, Ying ^{[1
]}

Li, Linji ^{[1
]}

机构：

[1] Nanchong Cent Hosp, Clin Med Coll 2, North Sichuan Med Coll, Dept Anesthesiol, Nanchong, Peoples R China

来源：

FRONTIERS IN MEDICINE | 2025年 / 12卷

关键词：

remimazolam; elderly patients; general anesthesia; meta-analysis; propofol; PAIN;

D O I：

10.3389/fmed.2025.1409495

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Remimazolam is a novel sedative drug approved for procedural sedation and general anesthesia. Clinical trials have already explored its use in elderly patients for general anesthesia. For elderly patients with declining physical and physiological function, anesthesia safety is crucial. Most current clinical studies compare the safety of remimazolam and propofol, though the results are inconsistent. Therefore, we conducted a meta-analysis to compare the safety of remimazolam and propofol in general anesthesia for elderly patients. Methods We systematically searched the PubMed, Cochrane Library, Embase, and Web of Science databases for all published randomized controlled trials comparing remimazolam and propofol for general anesthesia in elderly patients. We synthesized data from eligible studies using relative risk or mean difference, and analyzed differences in hemodynamic stability and adverse effects between the two drugs. Data extraction and quality assessment were performed independently by two researchers. Results Eight randomized controlled trials involving 571 participants were included. Compared to propofol, remimazolam was associated with a lower incidence of hypotension (RR = 0.51, 95% CI: [0.33, 0.81], I2 = 18%, p = 0.3 > 0.1) and bradycardia (RR = 0.56, 95% CI: [0.31, 1.02], Z = 1.88, p = 0.06 < 0.05). The mean arterial pressure after induction was higher in the remimazolam group (WMD = 3.95, 95% CI: [3.197, 9.498], Z = 3.95, p < 0.00001). The remimazolam group had a higher heart rate (HR) after induction compared to the propofol group (WMD = 7.89, 95% CI: [-2.39, 18.17], Z = 1.5, p = 0.13 > 0.05), but this result was not statistically significant. Among other secondary outcomes, the remimazolam group had lower incidences of injection site pain, nausea and vomiting, and hypoxemia compared to the propofol group, and also had a shorter extubation time. Conclusion In this meta-analysis, compared to propofol, remimazolam reduced the incidence of hypotension, bradycardia, and injection site pain during general anesthesia in elderly patients. The mean arterial pressure (MAP) and heart rate (HR) were more stable after induction. Remimazolam may be a safer sedative for elderly patients. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024516950, CRD42024516950.

引用

页数：13

共 32 条

[1] Fowler A.J., Abbott T.E.F., Prowle J., Pearse R.M., Age of patients undergoing surgery, Br J Surg, 106, pp. 1012-1018, (2019)
[2] Egawa J., Inoue S., Nishiwada T., Tojo T., Kimura M., Kawaguchi T., Et al., Effects of anesthetics on early postoperative cognitive outcome and intraoperative cerebral oxygen balance in patients undergoing lung surgery: a randomized clinical trial, Can J Anaesth, 63, pp. 1161-1169, (2016)
[3] Kabetu C.E., Gakuu L.N., Anaesthesia in the elderly with special reference to management of orthopaedic patients, East Afr Med J, 74, pp. 652-655, (1997)
[4] Marik P.E., Propofol: therapeutic indications and side-effects, Curr Pharm Des, 10, pp. 3639-3649, (2004)
[5] Jalota L., Kalira V., George E., Shi Y.Y., Hornuss C., Radke O., Et al., Prevention of pain on injection of propofol: systematic review and meta-analysis, BMJ, 342, (2011)
[6] Chan V.W., Chung F.F., Propofol infusion for induction and maintenance of anesthesia in elderly patients: recovery and hemodynamic profiles, J Clin Anesth, 8, pp. 317-323, (1996)
[7] Sneyd J.R., Rigby-Jones A.E., Remimazolam for anaesthesia or sedation, Curr Opin Anaesthesiol, 33, pp. 506-511, (2020)
[8] Doi M., Morita K., Takeda J., Sakamoto A., Yamakage M., Suzuki T., Efficacy and safety of remimazolam versus propofol for general anesthesia: a multicenter, single-blind, randomized, parallel-group, phase IIb/III trial, J Anesth, 34, pp. 543-553, (2020)
[9] Hasegawa G., Hirata N., Yoshikawa Y., Yamakage M., Differential effects of remimazolam and propofol on heart rate variability during anesthesia induction, J Anesth, 36, pp. 239-245, (2022)
[10] Page M.J., McKenzie J.E., Bossuyt P.M., Boutron I., Hoffmann T.C., Mulrow C.D., Et al., The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, BMJ, 372, (2021)

← 1 2 3 4 →