{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T23:03:01Z","timestamp":1791068581045,"version":"4.1.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background and Aim<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirteen RCTs comprising 1765 patients (remimazolam:\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f1,026; propofol:\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f739) 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\u20130.39;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f\u202f0.00001) and hypotension (OR, 0.30; 95% CI: 0.21\u20130.42;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f\u202f0.00001). No significant difference was observed in bradycardia (OR, 0.53; 95% CI, 0.28\u20131.02;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.06). Recovery time [mean difference (MD), 0.18\u202fmin; 95% CI, \u22120.3, 0.65] and operation time (MD, 0.02\u202fmin; 95% CI, \u22121.0, 1.03) were almost similar for both groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review registration<\/jats:title>\n                    <jats:p>\n                      <jats:uri>https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:uri>\n                      , identifier CRD42024614416\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1701785","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T06:33:40Z","timestamp":1764138820000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Safety and efficacy of remimazolam versus propofol sedation in gynecological procedures: a meta-analysis of East Asian randomized trials"],"prefix":"10.3389","volume":"12","author":[{"given":"Ou","family":"Jin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanqi","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XiaoMin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1034\/j.1600-0412.2003.00191.x","article-title":"A systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women","volume":"82","author":"Farquhar","year":"2003","journal-title":"Acta Obstet Gynecol Scand"},{"key":"ref2","first-page":"126","article-title":"Modern operative hysteroscopy","volume":"68","author":"Centini","year":"2016","journal-title":"Minerva Ginecol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"513","DOI":"10.2165\/00003495-199550030-00008","article-title":"Propofol an update of its use in anaesthesia and conscious sedation","volume":"50","author":"Bryson","year":"1995","journal-title":"Drugs"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"4506","DOI":"10.26355\/eurrev_202004_21033","article-title":"Safety and efficacy of propofol alone or in combination with other agents for sedation of patients undergoing colonoscopy: an updated meta-analysis","volume":"24","author":"Zhang","year":"2020","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1016\/j.bja.2024.02.005","article-title":"Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and meta-analysis","volume":"132","author":"Barbosa","year":"2024","journal-title":"Br J Anaesth"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1186\/s12871-021-01373-y","article-title":"Efficacy and safety of remimazolam besylate versus propofol during hysteroscopy: single-Centre randomized controlled trial","volume":"21","author":"Zhang","year":"2021","journal-title":"BMC Anesthesiol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1007\/s40122-023-00483-4","article-title":"Remimazolam compared to Propofol during hysteroscopy: a safety and efficacy analysis","volume":"12","author":"Fan","year":"2023","journal-title":"Pain Ther"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1007\/s40265-021-01544-8","article-title":"Remimazolam: a review in procedural sedation","volume":"81","author":"Lee","year":"2021","journal-title":"Drugs"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"96877","DOI":"10.5492\/wjccm.v13.i3.96877","article-title":"Remimazolam in intensive care unit: Potential applications and considerations","volume":"13","author":"Elmati","year":"2024","journal-title":"World J Crit Care Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.23736\/S0375-9393.22.16817-3","article-title":"Remimazolam versus propofol for procedural sedation and anesthesia: a systemic review and meta-analysis","volume":"88","author":"Zhang","year":"2022","journal-title":"Minerva Anestesiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.17085\/apm.21115","article-title":"Remimazolam: pharmacological characteristics and clinical applications in anesthesiology","volume":"17","author":"Kim","year":"2022","journal-title":"Anesth Pain Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1002\/phar.1806","article-title":"Remimazolam: pharmacologic considerations and clinical role in anesthesiology","volume":"36","author":"Wesolowski","year":"2016","journal-title":"Pharmacotherapy"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"3957","DOI":"10.2147\/DDDT.S384155","article-title":"Remimazolam: an updated review of a new sedative and Anaesthetic","volume":"16","author":"Hu","year":"2022","journal-title":"Drug Des Devel Ther"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"3566","DOI":"10.1097\/JS9.0000000000000638","article-title":"The safety and efficacy between remimazolam and propofol in intravenous anesthesia of endoscopy operation: a systematic review and meta-analysis","volume":"109","author":"Zhao","year":"2023","journal-title":"Int J Surg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.chest.2018.09.015","article-title":"Safety and efficacy of remimazolam compared with placebo and midazolam for moderate sedation during bronchoscopy","volume":"155","author":"Pastis","year":"2019","journal-title":"Chest"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1111\/biom.12817","article-title":"Quantifying publication bias in meta-analysis","volume":"74","author":"Lin","year":"2018","journal-title":"Biometrics"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e37627","DOI":"10.1097\/MD.0000000000037627","article-title":"Effectiveness and safety of remimazolam combined with alfentanil in hysteroscopic examination: a prospective, randomized, single-blind trial","volume":"103","author":"Huang","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"5402","DOI":"10.3390\/jcm12165402","article-title":"Remimazolam\u2019s effects on postoperative nausea and vomiting are similar to those of Propofol after laparoscopic gynecological surgery: a randomized controlled trial","volume":"12","author":"Matsumoto","year":"2023","journal-title":"J Clin Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1186\/s12871-024-02746-9","article-title":"Comparison of hypotension between propofol and remimazolam-propofol combinations sedation for day-surgery hysteroscopy: a prospective, randomized, controlled trial","volume":"24","author":"Tan","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.2147\/DDDT.S405057","article-title":"Cardiopulmonary adverse events of Remimazolam versus Propofol during cervical Conization: a randomized controlled trial","volume":"17","author":"Wang","year":"2023","journal-title":"Drug Des Devel Ther"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"4615","DOI":"10.2147\/DDDT.S483029","article-title":"Comparing Remimazolam and Propofol for postoperative anesthesia satisfaction in outpatient gynecological surgery: a randomized clinical trial","volume":"18","author":"Wang","year":"2024","journal-title":"Drug Des Devel Ther"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1409233","DOI":"10.3389\/fmed.2024.1409233","article-title":"Clinical study on the safety and efficacy of remimazolam in hysteroscopic surgery under general anesthesia in elderly patients","volume":"11","author":"Xie","year":"2024","journal-title":"Front Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1606","DOI":"10.1111\/cts.13572","article-title":"Remimazolam versus propofol in combination with esketamine for surgical abortion: a double-blind randomized controlled trial","volume":"16","author":"Yue","year":"2023","journal-title":"Clin Transl Sci"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"4101","DOI":"10.2147\/DDDT.S390403","article-title":"Remimazolam Tosylate combined with low-dose Propofol improves sedation and safety in hysteroscopy","volume":"16","author":"Zhang","year":"2022","journal-title":"Drug Des Devel Ther"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1213\/ANE.0000000000006921","article-title":"Effect of remimazolam supplementation on propofol requirements during hysteroscopy: a double-blind, dose-response study","volume":"139","author":"Zhou","year":"2024","journal-title":"Anesth Analg"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1111\/jcpt.13525","article-title":"Efficacy and safety of remimazolam tosylate in hysteroscopy: a randomized, single-blind, parallel controlled trial","volume":"47","author":"Zhang","year":"2022","journal-title":"J Clin Pharm Ther"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"101377","DOI":"10.1016\/j.accpm.2024.101377","article-title":"Comparison of the bispectral indices of patients receiving remimazolam and propofol for general anesthesia: a randomized crossover trial","volume":"43","author":"Yang","year":"2024","journal-title":"Anaesth Crit Care Pain Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1007\/s00228-024-03624-6","article-title":"Remimazolam versus propofol for sedation in gastrointestinal endoscopy and colonoscopy within elderly patients: a meta-analysis of randomized controlled trials","volume":"80","author":"Ahmer","year":"2024","journal-title":"Eur J Clin Pharmacol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"143","DOI":"10.2147\/DDDT.S392569","article-title":"Effect of Remimazolam on postoperative delirium in older adult patients undergoing orthopedic surgery: a prospective randomized controlled clinical trial","volume":"17","author":"Yang","year":"2023","journal-title":"Drug Des Devel Ther"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1097\/ALN.0000000000005077","article-title":"Effect of Remimazolam on emergence delirium in children undergoing laparoscopic surgery: a double-blinded randomized trial","volume":"141","author":"Cai","year":"2024","journal-title":"Anesthesiology"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"257","DOI":"10.3390\/jcm12010257","article-title":"Comparison of remimazolam-flumazenil versus propofol for rigid bronchoscopy: a prospective randomized controlled trial","volume":"12","author":"Pan","year":"2022","journal-title":"J Clin Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1701785\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T06:33:41Z","timestamp":1764138821000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1701785\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,26]]},"references-count":34,"alternative-id":["10.3389\/fmed.2025.1701785"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1701785","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,26]]},"article-number":"1701785"}}