Adverse Drug Events Observed with the Newly Approved Remimazolam in Comparison to Propofol for General Anesthesia in Patients Undergoing Surgery: A Meta-analysis

Developments in anesthetic pharmacology have been aiming at minimizing physiological disturbance in addition to maintaining and improving titrateability, recovery profile, and patient experience. Remimazolam, a GABA_Alpha receptor agonist, is a new intravenous anesthetic agent which has recently been approved for use. This analysis aimed to systematically compare the adverse drug events reported with the newly approved remimazolam in comparison to propofol for general anesthesia (GA) in patients undergoing surgery.

Electronic databases were searched from 15 May to 20 December 2023 for relevant publications which compared the outcomes reported with the newly approved remimazolam versus propofol in patients undergoing surgery. Relevant reported adverse drug events were the endpoints of this study. The statistical analysis was carried out using the latest version of the RevMan software. Data analysis was represented by risk ratio (RR) with 95% confidence intervals (CI).

Sixteen studies with a total number of 1897 participants were included in this analysis; 1104 participants received remimazolam and 793 participants received propofol. The risks for hypotension (RR 0.50, 95% CI 0.43–0.58; P = 0.00001), hypoxemia (RR 0.43, 95% CI 0.19–0.99; P = 0.05), bradycardia (RR 0.53, 95% CI 0.36–0.78; P = 0.001), pain at injection site (RR 0.07, 95% CI 0.01–0.56; P = 0.01), and total adverse events (RR 0.33, 95% CI 0.24–0.47; P = 0.00001) were significantly lower with remimazolam. However, no significant differences were observed in terms of postoperative nausea and vomiting (RR 0.98, 95% CI 0.66–1.46; P = 0.93), dizziness (RR 0.42, 95% CI 0.11–1.57; P = 0.20), psychiatric symptoms (RR 1.09, 95% CI 0.45–2.67; P = 0.85), and respiratory depression (RR 0.81, 95% CI 0.24–2.76; P = 0.74).

Our current analysis showed that the newly approved remimazolam was apparently associated with significantly fewer adverse drug events in comparison to propofol for GA in patients undergoing surgery. Therefore, this new drug should be further studied and more research with larger population sizes should be carried out to confirm this hypothesis.