Table 1.
Characteristics of included studies.
| Author, Year, Country | Participants | Sample Size/Intervention | Primary Outcome | Major Finding | ||
|---|---|---|---|---|---|---|
| Age (Year) |
Procedure | ASA | ||||
| Liu et al., 2021, China [10] | 65–75 | Colonoscopy | I–II | Remimazolam (n = 115) initial bolus 0.15 mg/kg (over 1 min), followed by 0.075 mg/kg Propofol plus etomidate (n = 117) bolus 0.1 mL/kg (over 1 min), followed by 0.05 mL/kg |
Success of the procedure | Remimazolam may have noninferior efficacy and a higher safety profile than etomidate-propofol in older colonoscopy |
| Tan et al., 2022, China [11] | >60 | Upper GI endoscopy | I–II | Remimazolam (n = 66) initial bolus 0.1 or 0.2 mg, followed by 0.05 mg/kg Propofol (n = 33) bolus 1.0–1.5 mg/kg, followed by 0.5 mg/kg |
Recovery of the cognitive domain | Remimazolam is a safe and effective sedative in older upper GI endoscopy |
| Lu et al., 2022, China [13] | 65–85 | Upper GI endoscopy | I–III | Remimazolam (n = 200) 300 mg/h, followed by 2.5 mg Propofol (n = 200) 3.0 g/h, followed by 0.5 mg/kg |
Rate of hypotension, defined as SBP ≤ 90 mmHg or a >30% decline from the baseline | Remimazolam is associated with a low rate of hypotension in older upper GI endoscopy |
| Hu et al., 2022, China [14] | ≥65 | Gastroscopy | I–III | Remimazolam (n = 173) initial bolus 0.2 mg/kg (slow IV injection, over 1 min), followed by one-third of the initial dose Propofol (n = 173) initial bolus 1.5 mg/kg (slow IV injection, over 1 min), followed by one-third of the initial dose |
Incidence of respiratory depression, defined as respiratory rate < 8/min and/or oxygen saturation <90% | The incidence of respiratory depression is significantly reduced in patients administered remimazolam compared with the patients administered propofol |
| Guo et al., 2022, China [12] | ≥65 | GI endoscopy | I–II | Remimazolam (n = 39) initial bolus 0.15 mg/kg (slow IV injection, completed in 30 s), followed by one-third of the initial dose Propofol (n = 38) initial bolus 1.5 mg/kg (slow IV injection, completed in 30 s), followed by one-third of the initial dose |
Success rate of sedation, the time to loss of consciousness, the recovery time between the remimazolam and propofol | Compared with propofol, remimazolam can be safely and effectively used in older GI endoscopy |
| Ye et al., 2023, China [16] | ≥65 | Gastroscopy | I–II | Remimazolam (n = 64) initial bolus 0.2 mg/kg, followed by 3 mg Propofol (n = 65) initial bolus 2.0 mg/kg, followed by 30 mg |
Incidence of adverse events to assess safety (hypotension, hypertension, bradycardia, tachycardia, respiratory depression, hypoxia, injection pain) | Remimazolam is safer alternative than propofol in older gastroscopy |
| Liu et al., 2023, China [15] | 60–80 | GI endoscopy | I–II | Remimazolam (n = 107) initial bolus 0.10 mg/kg, followed by 2.5 mg Propofol (n = 109) initial bolus 1.5 mg/kg, followed by 0.5 mg/kg |
Incidence of moderate hypoxemia, defined as SpO2 ≥ 85% and <90%, duration > 15 s | Remimazolam improves risk of moderate hypoxemia and hypotension in older GI endoscopy |
ASA, American Society of Anesthesiology classification; n, number; GI, gastrointestinal.