Remimazolam vs. propofol for total intravenous anesthesia: a systematic review of hemodynamic stability and recovery profiles

Abstract

Remimazolam is an ultra-short-acting benzodiazepine that has been developed as a new option for total intravenous anesthesia (TIVA) and might have benefits in terms of hemodynamic stability and recovery profiles. The purpose of this systematic review was to compare the hemodynamic stability and recovery between remimazolam and propofol in adult TIVA patients. The PubMed/MEDLINE, Embase, CENTRAL, and Web of Science databases were searched using the PubMed/MEDLINE, Embase, CENTRAL, and Web of Science search engines, respectively, to find randomized controlled trials (RCTs) published in the past 5 years that compared remimazolam-based TIVA with propofol-based TIVA. Outcomes were hemodynamic parameters, recovery quality, and adverse events. Cochrane RoB 2 was used to evaluate risk of bias. Total 11 RCTs including a wide range of surgical populations were included. Remimazolam was consistently shown to be more hemodynamically stable, with significantly fewer incidences of hypotension (such as during induction (6.7% vs. 28.9%)) and lower vasopressor use. The quality of recovery (QoR-15) score was not inferior to those with propofol. Recovery profiles were variable: some studies suggested that extubation was slower with remimazolam, whereas others indicated that recovery was quicker with flumazenil. Incidence of PONV was similar, and pain at injection was significantly less with remimazolam. Remimazolam was more hemodynamically stable than propofol during TIVA and produced a comparable quality of recovery. Flumazenil might help to rapidly restore consciousness. Remimazolam can be used in patients who are at risk of developing hemodynamic instability.