Remimazolam Versus Propofol During Hysteroscopy: A Systematic Review And Meta-Analysis of Nine Randomized Controlled Trials
In brief
Remimazolam cuts low oxygen or respiratory events by 74% during hysteroscopy
In a meta-analysis of nine randomized trials involving 1,164 patients, remimazolam was linked to fewer low-oxygen or respiratory events, low blood pressure, and injection pain than propofol. Sedation success and procedure outcomes were similar, but hiccups were more common; the findings suggest a safety trade-off that needs consideration in practice.
- Journal
- Clinical therapeutics (Q1)
- Published
- 3 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Alaa Boudjelal, Sarah Altaweel, Raniya Simeen, Turki Yaslam Alnaqeeb, Jamal Bassam Al-Ashgar, Jood Alotaibi, et al.
- PMID
- 42829312
- DOI
- 10.1016/j.clinthera.2026.09.004
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 5 October 2026): Systematic review, RMZ vs propofol safety in hysteroscopy
Abstract
PURPOSE: To compare the efficacy and safety of remimazolam (RMZ) versus propofol during hysteroscopy. METHODS: A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, Google Scholar, EMBASE, CENTRAL, Scopus, and Web of Science until February 2025. We pooled dichotomous outcomes and continuous outcomes using relative risk (RR) and standardized mean difference, respectively, with a 95% confidence interval (CI). FINDINGS: Nine RCTs and 1164 patients were included. RMZ was significantly associated with decreased incidence of injection pain (RR = 0.07; with 95% CI, [0.02, 0.20]; P = 0.001), hypotension (RR = 0.33; with 95% CI, [0.22, 0.50]; P = 0.001), and low SpO₂/respiratory depression (RR = 0.26; with 95% CI, [0.18, 0.38]; P = 0.001). However, RMZ was significantly associated with an increased incidence of hiccough (RR = 10.37; with 95% CI, [2.94, 36.62]; P = 0.001), with no significant difference between both groups regarding bradycardia (RR = 0.32; with 95% CI, [0.08, 1.18]; P = 0.09), and body movement (RR = 1.17; with 95% CI, [0.95, 1.44]; P = 0.15). Additionally, there was no significant difference between the 2 groups regarding sedation success (P = 0.83), recovery duration (P = 0.05), and total procedural duration (P = 0.07). IMPLICATIONS: RMZ may provide a safer alternative to propofol during hysteroscopy, with similar procedural outcomes and fewer injection-related and cardiorespiratory adverse events.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.