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78th Annual PostGraduate Assembly in Anesthesiology (PGA78) 2024
December 6 - 9, 2024 | New York City
4081
Comparing the efficacy of remimazolam and midazolam for procedural sedation, a meta-analysis
Poster Presenter
Part of Topic
Comparing the efficacy of remimazolam and midazolam for procedural sedation, a meta-analysis
Ian Winkeler BS1, Zhaosheng Jin MBBS2; Mingxi Zhu, MD2; Shaji Poovathoor, MD2; Sergio Bergese, MD2; Joy Schabel, MD2
1. Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794
2. Department of Anestheiology, School of Medicine, Stony Brook University, Stony Brook, NY, 11794
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In 2010, over 100,000 bronchoscopies and 7 million gastrointestinal endoscopies were performed in the U.S. These procedures are performed under moderate to deep sedation and fast turnover rates are desirable.
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Remimazolam is metabolized by liver carboxylesterase and has shorter distribution and elimination half-lives than midazolam; remimazolam may be easier to titrate to effect and achieve faster recovery times.
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In the following meta-analysis, we sought to assess the efficacy of remimazolam compared to midazolam across multiple trials and types of procedures
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We systematically searched PubMed for clinical trials as of July 7th, 2024 that compared remimazolam and midazolam for procedural sedation that met the following criteria:
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The data was analyzed using Review Manager V5.3. For continuous variables, we calculated mean differences (MD) by inverse-variance method. For dichotomous variables, we calculated the risk ratios (RRs) by Mantel-Haenszel method.
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Seven RCTs spanning three different types of procedures were included. 371 patients and 928 patients were sedated with midazolam and remimazolam, respectively.
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Pooled analysis indicated a decreased time for sedation onset (Fig 1), time to emerge from sedation (Fig 2), risk of procedure abortion (Fig 3), and need to administer rescue sedative (Fig 4) for remimazolam compared to midazolam.
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Remimazolam outperformed midazolam in all four outcomes, suggesting that remimazolam may be a suitable alternative for midazolam for these procedures.
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Though differences in risk for procedure abortion and need for rescue sedative are important, differences in only a few minutes of onset and offset time may not translate to clinical significance.
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In 5 of the 7 studies, fentanyl or alfentanil was administered prior to either remimazolam or midazolam. Sedative interactions between benzodiazepines and fentanyl may partially explain the variability between studies.