OBJECTIVE To systematically evaluate the efficacy and safety of the sedative effect of remimazolam in endoscopy and to compare it with propofol and midazolam.METHODS Search PubMed,Embase,Cochrane Library,Wanfang database,CNKI and other databases to collect the literature of randomized controlled trials of remimazolam for sedation in endoscopy.The search period was from 2018 0nwards when remimazolam was approved for clinical trials until April 2022.The search strategy included the following variable keywords:remimazolam,gastroscopy,bronchoscopy,and colonoscopy.The quality of the included literature was assessed and the collected data were subjected to meta-analysis by RevMan 5.4 software.RESULTS Ten relevant RCTs involving midazolam and propofol,involving a total of 2 076 patients were included in the analysis.The results showed that the sedative effect of remimazolam was significantly higher than that of midazolam[OR=0.03,95％CI(0.02,0.05),I2=0％,P＜0.000 01];but lower than that of propofol[OR=11.32,95％CI(2.12,60.56),I2=0％,P=0.005].The onset time of remimazolam was longer than that of propofol,but shorter than that of midazolam;the recovery time was faster than that of propofol and midazolam.Compared with midazolam,there was no significant difference in the incidence of adverse reactions.Compared with propofol,remimazolam was associated with lower rates of hypotension,slowed heart rate,hypoxemia,and injection pain,but higher risk ratio of nausea,with no difference invomiting.CONCLUSION The sedative effect and onset of action of remimazolam are better than midazolam but less than propofol when used for endoscopy.Wake-up time is faster than that of propofol and midazolam.The incidence of respiratory and circulatory depression is lower with remimazolam than with propofol,and there are no significant differences in adverse effects compared with midazolam.
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