Comparative effects of remimazolam and propofol on hemodynamic stability during sedation for painless gastroscopy: a randomized clinical trial

Citation (Vancouver):

Gong F, Gui Q, Lan L, Zhou G, Wen Q, Wei Y, Li X, Cao X. Comparative effects of remimazolam and propofol on hemodynamic stability during sedation for painless gastroscopy: a randomized clinical trial. BMC Anesthesiol. 2025;25:587. doi:10.1186/s12871-025-03484-2.

Study at a glance

- Design and setting: Single-centre, prospective, randomized, single-blind parallel-group trial (n=300) in adults undergoing painless gastroscopy in China.

- Population: Low-risk outpatients, 18–65 years, BMI 18–30 kg/m², ASA I–II; all received topical lidocaine, butorphanol, and nasal oxygen.

- Interventions: Remimazolam tosilate 0.2 mg/kg IV (0.1 mg/kg top-ups; propofol rescue allowed) versus propofol 2 mg/kg IV (0.5 mg/kg top-ups) for gastroscopy sedation.

- Primary hemodynamics: Remimazolam maintained higher MAP at the start and end of endoscopy (T1 MD ≈ +7.5 mmHg, T2 MD ≈ +5.0 mmHg; both statistically significant) with similar or slightly higher cardiac output (no clear difference at T1; small increase at T2).

- Safety: Compared with propofol, remimazolam markedly reduced hypotension (37/150 vs 8/150), bradycardia (22/150 vs 0/150), hypoxia (8/150 vs 0/150), and injection pain (38/150 vs 10/150).

- Recovery profile: Endoscopy duration was similar (~5 min), but remimazolam had slower onset and longer recovery (time to MOAA/S 5 median 10 vs 6 minutes).

- Risk of bias and certainty: Overall RoB 2 judgment “some concerns” (mainly unclear allocation concealment and reporting of prespecified analyses); GRADE certainty for key hemodynamic and safety outcomes rated moderate.