SYSTEMATIC REVIEW article
Front. Med.
Sec. Obstetrics and Gynecology
This article is part of the Research TopicReviews in Obstetrics and Gynecology 2025View all 4 articles
Safety and Efficacy of Remimazolam versus Propofol Sedation in Gynecological Procedures: A Meta-Analysis of East Asian Randomized Trials
Provisionally accepted
- Jiaxing Hospital Affiliated to Zhejiang Chinese Medical University, Jiaxing, China
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Abstract Background and aim: Hysteroscopy necessitates appropriate sedation to ensure patient comfort and operative success. The relative safety profile of remimazolam compared to propofol in this context is unclear. This study evaluates the safety of remimazolam in comparison to propofol for sedation during hysteroscopy and other gynecological procedures. Methods: We systematically searched MEDLINE (PubMed), Embase, and Scopus from inception until September 2024. We included randomized controlled trials (RCTs) that compared remimazolam and propofol for sedation in hysteroscopy procedures. The analyses were conducted using a random-effects model by PRISMA guidelines. The main outcome was the incidence of total adverse events. Secondary outcomes comprised respiratory depression, hypotension, bradycardia, emergence time, and recovery time. Results: Thirteen RCTs comprising 1765 patients (remimazolam: n=1026; propofol: n=739) met the inclusion criteria. The overall incidence of adverse events was significantly lower with remimazolam compared to propofol. Remimazolam was associated with lower risks of respiratory depression (OR, 0.25; 95% CI, 0.17-0.39; P<0.00001) and hypotension (OR, 0.30; 95% CI: 0.21–0.42; P < 0.00001). No significant difference was observed in bradycardia (OR, 0.53; 95% CI, 0.28-1.02; P=0.06). Recovery time (mean difference [MD], 0.18 minutes; 95% CI, -0.3, 0.65) and operation time (MD, 0.02 minutes; 95% CI, -1.0, 1.03) were almost similar for both groups. Conclusions:In patients undergoing gynecological procedures, remimazolam demonstrated a superior safety profile compared to propofol, with significantly lower rates of overall adverse events, respiratory depression, and hypotension. More studies are required to confirm these results.
Keywords: sedation, Hysteroscopy, Remimazolam, Propofol, Gynecological surgery, Anesthesia
Received: 09 Sep 2025; Accepted: 06 Nov 2025.
Copyright: © 2025 Jin, Shao, Lai and Xiaomin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yang Xiaomin, yang_xiaomin@hotmail.com
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