Efficacy and safety of remimazolam versus propofol in elderly patients undergoing gastrointestinal endoscopy: a systematic review and meta-analysis.

BACKGROUND

This systematic review and meta-analysis study was undertaken to compare the efficacy and safety of remimazolam versus propofol for sedation in elderly patients (≥60 years old) undergoing gastrointestinal endoscopy.

METHODS

The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ClinicalTrials.gov were used to perform a thorough literature search from their inception to December 2025. A random-effects meta-analysis was performed using RevMan. The Mantel-Haenszel method was used to pool risk ratios (RRs) along with 95% confidence intervals (95% CIs) for dichotomous outcomes. The inverse variance method was used to pool mean differences (MDs) with 95% CI.

RESULTS

This meta-analysis included 11 RCTs consisting of 2456 participants. Remimazolam significantly reduced the risk of overall adverse events (RR: 0.60, 95% CI: 0.42-0.86), injection site pain (RR: 0.20, 95% CI: 0.12-0.34), hypotension (RR: 0.46, 95% CI: 0.35-0.59), bradycardia (RR: 0.52, 95% CI: 0.34-0.77), need for vasopressors (RR: 0.39, 95% CI: 0.23-0.67), hypoxemia (RR: 0.42, 95% CI: 0.29-0.59), and respiratory depression (RR: 0.42, 95% CI: 0.29-0.62) compared with propofol. There were no statistically significant differences between remimazolam and propofol in sedation success, procedure success, procedure time, onset time, time to full alertness, time to discharge, patient satisfaction, endoscopist satisfaction, postoperative nausea and vomiting, or prolonged sedation.

CONCLUSION

Our analysis suggests that remimazolam is safer compared to propofol for sedation in endoscopic procedures.