(1159) Remimazolam Compared With Conventional Sedatives During Flexible Bronchoscopy: A Meta-Analysis

Introduction: Remimazolam is a novel ultra-short-acting benzodiazepine used as a sedative. Recent trials have evaluated its use for procedural sedation during short procedures. We aim to assess remimazolam's clinical effects and safety when used as a sedative during flexible bronchoscopy.

Methods: On July 15, 2024, we searched the following databases: PubMed, Embase, Scopus, and Cochrane. Our inclusion criteria consisted of clinical trials that evaluated the use of remimazolam as a sedative in patients undergoing routine flexible bronchoscopy compared to conventional sedatives. Our outcomes included procedure success, induction time, time to full awakening, operator satisfaction score, and safety data such as hypotension, hypertension, bradycardia, respiratory depression, hypoxia, hypoxemia, nausea, and vomiting. We used RevMan with a random-effects model, using the standard mean difference (SMD) and the odds ratio (OR) with a 95% confidence interval.

Results: Out of the 63 articles we obtained, only 11 papers were included, with a total of 1,614 patients (922 in remimazolam vs 692 conventional sedatives). In terms of procedure success, had higher odds of success compared to conventional sedatives with an odds ratio of 2.40 (95% CI: 1.08 to 5.30, p = 0.03). There was no statistically significant difference between remimazolam and conventional sedatives in terms of induction time (SMD: 0.10, 95% CI: -0.56 to 0.76, p = 0.76). The same can be said for the time to full awakening, with the following values: SMD: -0.48 (95% CI: -1.15 to 0.18, p = 0.15). The operator satisfaction score was similar, with no significant difference between remimazolam and conventional sedatives (SMD: -0.17, 95% CI: -0.66 to 0.32, p = 0.49). Hypotension, hypertension, respiratory depression, hypoxemia, hypoxia, nausea, and vomiting did not show any statistically significant differences between remimazolam and conventional sedatives; all had p-values above 0.05. Bradycardia was the only significant finding, and it was less frequent in the remimazolam group, with an odds ratio (OR) of 0.51 (95% CI: 0.28 to 0.95, p = 0.03).

Conclusions: Remimazolam had outcomes similar to those of conventional sedatives. It also had a safety profile comparable to conventional sedatives, making it suitable for sedation during flexible bronchoscopy.