Low-dose midazolam and propofol use for conscious sedation during diagnostic endoscopy

Efficacy and Safety of Remimazolam in Endoscopic Sedation-A Systematic Review and Meta-Analysis

Background: The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of remimazolam in clinical endoscopic procedure sedation.

Methods: The authors searched the databases of PubMed, Embase, and Cochrane Library for studies published until January 2, 2021, that reported remimazolam sedation for endoscopic procedures. The sedative efficiency and the incidence of adverse events were assessed as outcomes. Cochrane Review Manager Software 5.3 was used to perform the statistical analyses.

Results: Seven relevant studies involving a total of 1,996 patients were identified. We conducted a meta-analysis of the different controls used in the studies, that is, the placebo, midazolam, and propofol. The results demonstrated that remimazolam had a strong sedative effect, and its sedative efficiency was significantly higher than that of placebo [OR = 0.01, 95% CI: (0.00, 0.10), I² = 30%, p <0.00001]. The sedative efficiency of remimazolam was significantly higher than that of midazolam [OR = 0.12, 95% CI: (0.08, 0.21), I² = 0%, p < 0.00001] but lesser than that of propofol [OR = 12.22, 95% CI: (1.58, 94.47), I² = 0%, p = 0.02]. Regarding the adverse events, remimazolam is associated with a lower incidence of hypotension than placebo and midazolam. Similarly, remimazolam was associated with a lower incidence of hypotension and hypoxemia than propofol.

Conclusions: Remimazolam is a safe and effective sedative for patients undergoing endoscopic procedures. The sedative efficiency of remimazolam was significantly higher than that of midazolam but slightly lower than that of propofol. However, the respiration and circulation inhibitory effects of remimazolam were weaker than those of midazolam and propofol.

Factors Affecting Recovery Time after Sedation for Upper Gastrointestinal Endoscopy

The purpose of this study was to investigate factors affecting recovery time after sedation for upper gastrointestinal endoscopy. The study population included 1310 patients in the national gastric cancer screening program who received sedation for upper gastrointestinal endoscopy from April 15, 2015 to December 31, 2018. Multivariate regression analysis was performed to identify factors related to recovery time. The mean recovery time after examination was 51.2 minutes (SD=13.3). Patients with a history of hypertension had a recovery time 2.59 minutes shorter than that of patients without hypertension (p=0.006, Bonferroni-corrected p=0.108). Patients with a history of stroke had a recovery time 9.41 minutes longer than that of patients without stroke (p=0.007, Bonferroni-corrected p=0.124). Patients who received 3 mg midazolam had a recovery time 2.99 minutes longer than that of patients received 2 mg (p=0.001, Bonferroni-corrected p=0.010), and patients who received less than 6 cc of propofol had a recovery time 2.90 minutes longer than those that of patients received 7-12 cc of propofol (p<0.001, Bonferroni-corrected p=0.005). These results suggest that receiving high doses of midazolam and having a history of stroke are associated with longer recovery times. Patients meeting these criteria should be managed carefully after sedation for upper gastrointestinal endoscopy.