Hemodynamic and Postoperative Benefits of Remimazolam Over Sevoflurane: A Comparative Meta-Analysis.

OBJECTIVE

To compare remimazolam and sevoflurane in terms of intraoperative hemodynamics, postoperative recovery, and complications during elective surgical procedures.

DESIGN

A systematic review and meta-analysis conducted according to the PRISMA guidelines.

SETTING

Elective surgeries performed across various healthcare institutions, as reported in studies retrieved from PubMed, Cochrane, Scopus, and Embase databases.

PARTICIPANTS

A total of 10 studies (6 randomized controlled trials and 4 retrospective studies) involving 864 patients undergoing elective surgical procedures (431 receiving sevoflurane and 433 receiving remimazolam) were included.

INTERVENTIONS: Administration of either remimazolam or sevoflurane for maintenance of general anesthesia.

MEASUREMENTS AND MAIN

RESULTS

Primary outcomes assessed were intraoperative mean arterial pressure (MAP), heart rate (HR), extubation time, quality of recovery (QoR-15), incidence of hypotension, and postoperative nausea and vomiting (PONV). The risk of bias was evaluated using the Newcastle-Ottawa Scale and the Detsky Quality Assessment Scale. Statistical analysis was performed with RevMan 5.4. Remimazolam was associated with higher intraoperative MAP both before (p = 0.05) and after intubation (p = 0.04) and incision (p < 0.0001). The incidence rates of intraoperative hypotension and use of rescue antihypotensive agents were significantly lower in the remimazolam group (p < 0.00001). Additionally, PONV and the requirement for rescue antiemetics were significantly reduced with remimazolam (p = 0.0005 and p = 0.01, respectively). There were no significant differences between the groups in terms of extubation time, QoR-15 scores, and postoperative pain scores.

CONCLUSIONS

Compared to sevoflurane, remimazolam appears to provide more stable intraoperative hemodynamics, a lower risk of hypotension requiring intervention, and faster recovery with fewer PONV episodes. Given the heterogeneity of the included studies, the inclusion of retrospective data, and the overall low to moderate certainty of evidence, these findings should be interpreted with caution. Further high-quality randomized trials are needed to confirm these results.