Efficacy and safety of Remimazolam in bronchoscopic sedation： A Systematic Review and Meta-Analysis

Background： Remimazolam is a new benzodiazepine sedative drug used for procedural sedation and general anesthesia. To assess the safety and efficacy of it for sedation of patients undergoing bendable bronchoscopy, this study performed a meta-analysis of existing (randomized controlled trials)RCTs of remimazolam.Methods： We searched relevant studies in databases of Embase, PubMed, Cochrane Library, etc. We searched for published randomized controlled trials on bendable bronchoscopic procedural sedation with remimazolam versus conventional sedation (CS) from the time the database was created until August 2023. The results of these randomized controlled trials are summarized in the following table. STATA 15.1 software was applied to data analyses.Results：5 studies with 1080 cases were included. The remimazolam had the same sedation success rate compared with conventional sedation (RR: 1.35, 95% Cl:0.60,3.05, P=0.474; I2=99.6%). But, remimazolam had a lower incidence of hypotension (RR: 0.61, 95% CI:0.40,0.95, P=0.027, I2=65.1%) and a lower incidence of respiratory depression (RR: 0.50, 95% Cl:0.33,0.77, P=0.002; I2=42.3%). There exists no obvious difference between the remimazolam and conventional sedation groups in the incidence of hypertension, hypoxemia, bradycardia, tachycardia, and injection pain. A subgroup analysis showed a higher success rate of sedation with remimazolam than midazolam (RR: 2.45, P=0.000). Compared with propofol, the incidence of hypotension (RR: 0.45, 95% CI:0.32,0.64, P=0.000, I2=0.0%), respiratory depression (RR: 0.48, 95% Cl:0.30,0.76, P=0.002; I2=78.4%), hypoxemia (RR:0.36, 95% CI:0.15,0.87, P=0.023) and the incidence of injection pain (RR:0.04, 95% CI:0.01,0.28, P=0.001) were lower.Conclusions： Remimazolam is safe and effective for cases with bronchoscopy. Its sedation success rate is similar to that of conventional sedatives. However, remimazolam has a higher safety profile with less inhibitory effects on respiration and circulation. More investigations are needed to verify the obtained findings.