The comparison of remimazolam and midazolam for the sedation of gastrointestinal endoscopy: a meta-analysis of randomized controlled studies

INTRODUCTION: Remimazolam and midazolam are used for the sedation of gastrointestinal endoscopy, but their efficacy remains controversial. We conduct a systematic review and meta-analysis to compare the sedation of remimazolam with midazolam for gastrointestinal endoscopy. METHODS: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched. Randomized controlled trials (RCTs) assessing the influence of remimazolam versus midazolam on gastrointestinal endoscopy were included. Two investigators independently have searched articles, extracted data, and assessed the quality of included studies. This meta-analysis was performed using the random-effect model. RESULTS: Three RCTs involving 528 patients were included in the meta-analysis. Compared with midazolam for gastrointestinal endoscopy, remimazolam was associated with higher procedure success (OR=9.78; 95% CI=1.48 to 64.71; P=0.02), lower need for rescue medication (OR=0.09; 95% CI=0.01 to 0.80; P=0.03), shorter total recall (Std. MD=0.93; 95% CI=0.15 to 1.72; P=0.02) and delayed recall (Std. MD=0.44; 95% CI=0.05 to 0.83; P=0.03), reduced incidence of hypotenson (OR=0.39; 95% CI=0.25 to 0.62; P<0.0001) and adverse events (OR=0.36; 95% CI=0.17 to 0.79; P=0.01), but had no obvious influence on fully alert (Std. MD=-0.75; 95% CI=-1.58 to 0.08; P=0.08). CONCLUSIONS: Remimazolam demonstrated better efficacy and safety for the sedation of gastrointestinal endoscopy compared to midazolam.