Comparing the safety and efficacy of remimazolam-based total intravenous anesthesia versus volatile agent-based anesthesia: a meta-analysis of randomized controlled trials
Background Remimazolam is a novel short-acting benzodiazepine that has recently been used for general anesthesia. This study compared the safety and efficacy of remimazolam-based total intravenous anesthesia (TIVA) and volatile agent-based anesthesia in adults undergoing general anesthesia. Methods...
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Korean Society of Anesthesiologists
2025-02-01
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| Series: | Korean Journal of Anesthesiology |
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| author | Ji-In Park Hyo-Seok Na Keum-O Lee Jung-Hee Ryu Hyun-Jung Shin |
| author_facet | Ji-In Park Hyo-Seok Na Keum-O Lee Jung-Hee Ryu Hyun-Jung Shin |
| author_sort | Ji-In Park |
| collection | DOAJ |
| description | Background Remimazolam is a novel short-acting benzodiazepine that has recently been used for general anesthesia. This study compared the safety and efficacy of remimazolam-based total intravenous anesthesia (TIVA) and volatile agent-based anesthesia in adults undergoing general anesthesia. Methods We searched electronic databases including PubMed, Embase, CENTRAL, and Scopus for relevant studies. The primary outcome was the proportion of patients who experienced hypotension during surgery. Secondary outcomes included incidence of bradycardia, extubation time, duration in the post-anesthesia care unit hospital stay, and incidence of postoperative nausea and/or vomiting (PONV). We estimated the relative risk (RR) and mean difference with 95% CIs using a random-effects model. Results A total of 969 patients from 12 randomized controlled trials were included. The incidence of hypotension was 14% and 34% in the remimazolam and volatile agent groups, respectively. Remimazolam significantly lowered the incidence of hypotension (RR: 0.43, 95% CI [0.29–0.63], P = 0.0000, I2 = 26%). The remimazolam group had a PONV incidence of 13%, compared to 28% in the volatile agent group, indicating a significant difference (RR: 0.51, 95% CI [0.37–0.72], P = 0.0001, I2 = 15%). No significant differences were observed in the other outcomes. Conclusions Remimazolam-based TIVA demonstrated favorable hemodynamic effects, with a lower incidence of hypotension and similar bradycardia rates, compared to volatile agent-based anesthesia. Furthermore, the reduction in PONV supports the use of remimazolam-based TIVA as a valuable method for general anesthesia. |
| format | Article |
| id | doaj-art-0a2dce422e434dd1a9889d9a420463f2 |
| institution | Kabale University |
| issn | 2005-6419 2005-7563 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Korean Journal of Anesthesiology |
| spelling | doaj-art-0a2dce422e434dd1a9889d9a420463f22025-02-03T08:32:46ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632025-02-01781486010.4097/kja.244449024Comparing the safety and efficacy of remimazolam-based total intravenous anesthesia versus volatile agent-based anesthesia: a meta-analysis of randomized controlled trialsJi-In Park0Hyo-Seok Na1Keum-O Lee2Jung-Hee Ryu3Hyun-Jung Shin4 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, KoreaBackground Remimazolam is a novel short-acting benzodiazepine that has recently been used for general anesthesia. This study compared the safety and efficacy of remimazolam-based total intravenous anesthesia (TIVA) and volatile agent-based anesthesia in adults undergoing general anesthesia. Methods We searched electronic databases including PubMed, Embase, CENTRAL, and Scopus for relevant studies. The primary outcome was the proportion of patients who experienced hypotension during surgery. Secondary outcomes included incidence of bradycardia, extubation time, duration in the post-anesthesia care unit hospital stay, and incidence of postoperative nausea and/or vomiting (PONV). We estimated the relative risk (RR) and mean difference with 95% CIs using a random-effects model. Results A total of 969 patients from 12 randomized controlled trials were included. The incidence of hypotension was 14% and 34% in the remimazolam and volatile agent groups, respectively. Remimazolam significantly lowered the incidence of hypotension (RR: 0.43, 95% CI [0.29–0.63], P = 0.0000, I2 = 26%). The remimazolam group had a PONV incidence of 13%, compared to 28% in the volatile agent group, indicating a significant difference (RR: 0.51, 95% CI [0.37–0.72], P = 0.0001, I2 = 15%). No significant differences were observed in the other outcomes. Conclusions Remimazolam-based TIVA demonstrated favorable hemodynamic effects, with a lower incidence of hypotension and similar bradycardia rates, compared to volatile agent-based anesthesia. Furthermore, the reduction in PONV supports the use of remimazolam-based TIVA as a valuable method for general anesthesia.http://ekja.org/upload/pdf/kja-24444.pdfanesthesia, generalanesthesia, inhalationanesthesia, intravenouspostoperative nausea and vomitingremimazolamsafety |
| spellingShingle | Ji-In Park Hyo-Seok Na Keum-O Lee Jung-Hee Ryu Hyun-Jung Shin Comparing the safety and efficacy of remimazolam-based total intravenous anesthesia versus volatile agent-based anesthesia: a meta-analysis of randomized controlled trials Korean Journal of Anesthesiology anesthesia, general anesthesia, inhalation anesthesia, intravenous postoperative nausea and vomiting remimazolam safety |
| title | Comparing the safety and efficacy of remimazolam-based total intravenous anesthesia versus volatile agent-based anesthesia: a meta-analysis of randomized controlled trials |
| title_full | Comparing the safety and efficacy of remimazolam-based total intravenous anesthesia versus volatile agent-based anesthesia: a meta-analysis of randomized controlled trials |
| title_fullStr | Comparing the safety and efficacy of remimazolam-based total intravenous anesthesia versus volatile agent-based anesthesia: a meta-analysis of randomized controlled trials |
| title_full_unstemmed | Comparing the safety and efficacy of remimazolam-based total intravenous anesthesia versus volatile agent-based anesthesia: a meta-analysis of randomized controlled trials |
| title_short | Comparing the safety and efficacy of remimazolam-based total intravenous anesthesia versus volatile agent-based anesthesia: a meta-analysis of randomized controlled trials |
| title_sort | comparing the safety and efficacy of remimazolam based total intravenous anesthesia versus volatile agent based anesthesia a meta analysis of randomized controlled trials |
| topic | anesthesia, general anesthesia, inhalation anesthesia, intravenous postoperative nausea and vomiting remimazolam safety |
| url | http://ekja.org/upload/pdf/kja-24444.pdf |
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