Key result
Remimazolam did not significantly reduce the incidence of intraoperative hypotension compared to dexmedetomidine in middle-aged and elderly patients undergoing general anesthesia (RR 0.78).
Why the study?
The study was conducted to compare the effects of remimazolam and dexmedetomidine on the incidence of hypotension and to evaluate their safety profiles in middle-aged and elderly patients undergoing general anesthesia.
Does remimazolam reduce intraoperative hypotension compared to dexmedetomidine in middle-aged and elderly patients undergoing general anesthesia?
Meta-Analysis (n=741)
Does remimazolam reduce intraoperative hypotension compared to dexmedetomidine in middle-aged and elderly patients undergoing general anesthesia?
Effect estimate: RR 0.78 (95% CI 0.36–1.68)
p-value: p=0.53
In middle-aged and elderly patients undergoing general anesthesia, remimazolam and dexmedetomidine result in similar rates of intraoperative hypotension, but remimazolam is associated with less bradycardia and more tachycardia.
Remimazolam confers no hypotension advantage over dexmedetomidine; reinforces comparable primary risk but distinct heart rate effects in elderly anesthesia.
BACKGROUND: The objective of this study is to compare the effects of remimazolam and dexmedetomidine on the incidence of hypotension in middle-aged and elderly patients undergoing general anesthesia, and to evaluate the safety profiles of both medications. METHODS: We systematically searched PubMed, Cochrane Library, EMBASE, and Web of Science from inception to July 2024 for randomized controlled trials comparing remimazolam versus dexmedetomidine in patients aged ≥ 45 years undergoing general anesthesia. Two investigators independently screened studies, extracted data, and assessed risk of bias using the Cochrane RoB 2 tool. Meta-analyses employed random-effects models to calculate risk ratios (RR) with 95% confidence intervals. The primary outcome was intraoperative hypotension incidence; secondary outcomes included bradycardia, tachycardia, hypertension, and postoperative nausea and vomiting. RESULTS: This meta-analysis included 8 randomized controlled trials with 741 patients (384 remimazolam; 357 dexmedetomidine). There was no statistically significant difference in intraoperative hypotension between groups (RR 0.78, 95% CI 0.36-1.68, P = 0.53, I²=71%). Remimazolam showed a significant reduction in bradycardia risk compared to dexmedetomidine (RR 0.41, 95% CI 0.23-0.73, P = 0.002, I²=0%). However, remimazolam had a higher risk of tachycardia (RR 3.41, 95% CI 1.47-7.90, P = 0.004, I²=0%). There was no significant difference in intraoperative hypertension (RR 0.85, 95% CI 0.38-1.90, P = 0.69, I²=0%) or postoperative nausea and vomiting(RR 0.98, 95% CI 0.30-3.23, P = 0.97, I²=0%). CONCLUSIONS: Remimazolam and dexmedetomidine did not differ significantly in intraoperative hypotension, intraoperative hypertension, or postoperative nausea and vomiting in middle-aged and elderly patients. Remimazolam reduced the incidence of bradycardia. In contrast, dexmedetomidine had an advantage in reducing intraoperative tachycardia. These findings support individualized anesthetic selection based on patients' specific cardiovascular risk profiles.
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Wang et al. (2025) conducted a meta-analysis in Middle-aged and elderly patients undergoing general anesthesia (n=741). Remimazolam vs. Dexmedetomidine was evaluated on Intraoperative hypotension incidence (RR 0.78, 95% CI 0.36–1.68, p=0.53). Remimazolam did not significantly reduce the incidence of intraoperative hypotension compared to dexmedetomidine in middle-aged and elderly patients undergoing general anesthesia (RR 0.78).
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