Remimazolam vs. propofol for induction and maintenance of general anesthesia: A systematic review and meta-analysis of emergence agitation risk in surgical populations

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-03-22 DOI:10.1016/j.jclinane.2025.111815

Jian-li Song MD , Yong Ye BD , Ping Hou BD , Qiang Li BD, Bin Lu BD, Guan-yu Chen MD

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Abstract

Introduction

The association between remimazolam and emergence agitation (EA) remains unclear. This meta-analysis aimed to compare the relative risk of developing EA when using remimazolam vs. propofol in induction and maintenance of general anesthesia.

Method

We searched PubMed, clinicaltrials.gov, Web of Science, Cochrane Library, and Embase databases to identify studies meeting the inclusion criteria. The primary outcome was the incidence of EA. Secondary outcomes included the incidence of postoperative delirium (POD) within 7 days after surgery, emergence time, extubation time, length of post-anesthesia care unit (PACU) stay, and adverse events.

Results

A total of 19 randomized controlled trials with 3031 patients were included in the meta-analysis. There was no statistically significant difference in the incidence of EA (RR = 0.82; 95 % confidence interval [CI], 0.41–1.65; p = 0.585) between remimazolam and propofol. Likewise, there were no significant intergroup differences in POD incidence, extubation time, emergence time, or length of PACU stay. Remimazolam exhibited superior hemodynamic stability, with a significantly reduced incidence of postinduction hypotension and intraoperative hypotension compared with propofol, while maintaining comparable safety profiles in terms of postoperative nausea and vomiting (PONV), intraoperative awareness, and hypoxemia. Subgroup analysis revealed that without routine postoperative antagonist administration, remimazolam was associated with prolonged extubation and length of PACU stay relative to propofol. In contrast, following antagonizing with flumazenil, the extubation and emergence times of the remimazolam group were shorter than those of the propofol group, while comparable PACU discharge time was maintained.

Conclusion

The use of remimazolam for the induction and maintenance of general anesthesia does not lead to a higher occurrence of EA in adult patients undergoing surgery, relative to propofol. However, in patients with ASA III–IV, remimazolam may be linked to a greater risk of POD than propofol.

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雷马唑仑与异丙酚对全麻诱导和维持的影响：手术人群出现躁动风险的系统回顾和荟萃分析

雷马唑仑与突发性躁动（EA）之间的关系尚不清楚。本荟萃分析旨在比较在全麻诱导和维持中使用雷马唑仑和异丙酚时发生EA的相对风险。方法检索PubMed、clinicaltrials.gov、Web of Science、Cochrane Library和Embase数据库，确定符合纳入标准的研究。主要指标为EA发生率。次要指标包括术后7天内谵妄（POD）发生率、急诊时间、拔管时间、麻醉后护理单元（PACU）停留时间和不良事件。结果共纳入19项随机对照试验3031例患者。两组EA发病率比较，差异无统计学意义(RR = 0.82；95%置信区间[CI]， 0.41-1.65；雷马唑仑与异丙酚的差异P = 0.585)。同样，各组间POD发生率、拔管时间、急诊时间、PACU住院时间均无显著差异。雷马唑仑表现出优越的血流动力学稳定性，与异丙酚相比，其诱导后低血压和术中低血压的发生率显著降低，同时在术后恶心和呕吐（PONV）、术中意识和低氧血症方面保持相当的安全性。亚组分析显示，在没有常规术后拮抗剂的情况下，相对于异丙酚，雷马唑仑与拔管时间延长和PACU停留时间有关。相比之下，氟马西尼拮抗后，雷马唑仑组拔管和急诊时间均短于异丙酚组，PACU出院时间保持相当。结论与异丙酚相比，雷马唑仑用于全麻诱导和维持并不会导致成人手术患者EA的发生率更高。然而，在ASA III-IV型患者中，雷马唑仑可能比异丙酚与POD的风险更高有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.