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February 6, 2023Frontiers in PharmacologyOpen Access

The use of remimazolam versus propofol for induction and maintenance of general anesthesia: A systematic review and meta-analysis

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Key result

Remimazolam significantly reduced the risk of post-induction hypotension compared to propofol (RR 0.57) in patients undergoing surgery under general anesthesia.

Why the study?

To compare the risk of hypotension, as well as induction and recovery characteristics, between remimazolam and propofol in patients undergoing surgery under general anesthesia.

Does remimazolam reduce post-induction hypotension compared to propofol in adult patients receiving surgery under general anesthesia?

Population

738 patients receiving surgery under general anesthesia across eight studies

Comparison

Remimazolam vs propofol

Design

Systematic review and meta-analysis of randomized controlled trials

Authors

CKChing‐Chung KoNational Sun Yat-sen UniversityKHKuo‐Chuan HungTainan University of TechnologyAIAmina M. IlliasChang Gung University

Discussion

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Overview

Remimazolam may lower post-induction hypotension risk versus propofol; extends RCT evidence for safer general anesthesia induction.

Study Design

Type

Meta-Analysis (n=738)

Structured PICO

Does remimazolam reduce post-induction hypotension compared to propofol in adult patients receiving surgery under general anesthesia?

P
Population
738 adult patients undergoing surgery under general anesthesia across 8 randomized controlled trials.
I
Intervention
Remimazolam administered as an agent for anesthetic induction or maintenance of general anesthesia (various doses including bolus 0.2-0.3 mg/kg or continuous infusion 12 mg/kg/h).
C
Comparator
Propofol as an induction agent (maximal dosage up to 2.5 mg/kg).
O
Outcome
Risk of post-induction hypotensionsafety

Main Result

Relative Risk: 0.57 (95% CI 0.43–0.75)

Absolute Event Rate: 27.4% vs 42.4%

p-value: p=<0.0001

Remimazolam provides a safer hemodynamic profile with a significantly lower risk of post-induction hypotension and injection pain compared to propofol, while maintaining similar recovery characteristics.

Limitations

  • Heterogeneity in the dosage of remimazolam, administration technique, and ASA-PS across the included studies
  • Unable to analyze the risk of respiratory depression following surgery
  • Recruitment of only Asian populations (Japan and China) limits applicability to other ethnic or geographical backgrounds
  • Assessment of prognostic impact on a mixed patient population may not be reliable
  • Variation in the definition of hypotension across the included trials
  • Relatively small sample size
  • Outcomes on hemodynamic profiles (heart rate and MBP) and extubation time were not stable on sensitivity analysis
  • Five trials had 'some concerns' for overall risk of bias due to lack of information about allocation concealment or trial registration

Cite This Study

Ko et al. (2023) conducted a meta-analysis in General anesthesia (n=738). Remimazolam vs. Propofol was evaluated on Risk of post-induction hypotension (RR 0.57, 95% CI 0.43 to 0.75, p=<0.0001). Remimazolam significantly reduced the risk of post-induction hypotension compared to propofol (RR 0.57) in patients undergoing surgery under general anesthesia.

synapsesocial.com/papers/6a7a5cdf756812e395898cd6https://doi.org/10.3389/fphar.2023.1101728
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Remimazolam Versus Propofol for Anesthesia in Intracranial Neurosurgeries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials2026
  2. 2Comparison of hypotension incidence between remimazolam and propofol in patients with hypertension undergoing neurosurgery: prospective, randomized, single-blind trial2024 · 18 citations
  3. 3Hypotension after General Anesthesia Induction with Remimazolam or Propofol in Geriatric Patients Undergoing Sevoflurane Anesthesia with Remifentanil2025
  4. 4Comparative Analysis of the Hemodynamic Effects of Remimazolam and Propofol During General Anesthesia: A Retrospective Study2024 · 7 citations
  5. 5Comparison of Remimazolam and Propofol on Post-Induction Hypotension in Elderly Hypertensive Patients: A Randomized Controlled Trial2025 · 8 citations