{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:03:39Z","timestamp":1785420219112,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deanship of Scientific Research at Imam Mohammad Ibn Saud Islamic University","award":["IMSIU-DDRSP2601"],"award-info":[{"award-number":["IMSIU-DDRSP2601"]}]},{"award":["IMSIU-DDRSP2601"],"award-info":[{"award-number":["IMSIU-DDRSP2601"]}],"id":[{"id":"https:\/\/ror.org\/05gxjyb39","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceutics"],"abstract":"<jats:p>Background: Propofol is widely used for anesthesia in colorectal cancer surgery, but is frequently associated with hypotension and respiratory depression. Remimazolam, a novel ultra-short\u2013acting benzodiazepine, may offer improved hemodynamic stability with similar anesthetic depth and recovery characteristics. However, evidence directly comparing remimazolam and propofol in the setting of colon cancer surgery remains limited. Therefore, the aim of this study was to systematically evaluate the efficacy, safety, perioperative hemodynamic stability, and recovery outcomes of remimazolam versus propofol in older adults undergoing colon cancer surgery. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials and comparative cohort studies evaluating remimazolam versus propofol in adult patients undergoing colon or colorectal cancer surgery. PubMed, Scopus, and Web of Science were searched from the start of each database to October 2025. Outcomes included perioperative hemodynamics (MAP and HR), recovery parameters, intraoperative remifentanil consumption, anesthesia duration, and adverse events. Random-effect models were used to calculate pooled mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs). Results: Six studies involving 542 patients (remimazolam n = 276; propofol n = 266) were included. Remimazolam produced significantly higher perioperative MAP (overall MD = 2.86 mmHg, 95% CI 1.52\u20134.21; p &lt; 0.0001) and slightly higher HR (MD = 2.30 bpm, 0.08\u20134.52; p = 0.04). Differences were largest immediately after incision and at the end of surgery. No significant differences were found in PACU stay, overall recovery duration, remifentanil consumption, or anesthesia duration. Postoperative nausea and vomiting were comparable (RR = 0.93; p = 0.86), while respiratory depression was numerically lower with remimazolam (RR = 0.49; p = 0.17). Conclusions: Remimazolam provides anesthetic efficacy comparable to propofol in colon cancer surgery while offering modest, but clinically meaningful improvements in intraoperative hemodynamic stability. Recovery times, opioid requirements, and adverse-event rates were similar between agents. Remimazolam may be particularly advantageous for elderly or hemodynamically vulnerable patients undergoing major colorectal procedures. Larger, high-quality trials are warranted to clarify long-term and oncologic outcomes.<\/jats:p>","DOI":"10.3390\/pharmaceutics18040448","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T08:58:48Z","timestamp":1775465928000},"page":"448","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Remimazolam Versus Propofol for General Anesthesia in Older Adults Undergoing Colon Cancer Surgery: A Systematic Review and Meta-Analysis of Comparative Studies"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8467-8000","authenticated-orcid":false,"given":"Khalid I.","family":"AlHussaini","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11564, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim Abdullah","family":"Abalhassan","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, King Abdulaziz Medical City, Ministry of National Guard\u2014Health Affairs, Riyadh 11564, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"Toraih","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Perfusion, College of Health Professions, Upstate Medical University, Syracuse, NY 13210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah Ibrahim","family":"Alhussaini","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, King Abdulaziz Medical City, Ministry of National Guard\u2014Health Affairs, Riyadh 11564, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"998","DOI":"10.2174\/18735592MTEx9NTk2y","article-title":"Colorectal Cancer Epidemiology: Recent Trends and Impact on Outcomes","volume":"22","author":"Baidoun","year":"2021","journal-title":"Curr. Drug Targets"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/S2468-1253(21)00426-X","article-title":"The rising tide of early-onset colorectal cancer: A comprehensive review of epidemiology, clinical features, biology, risk factors, prevention, and early detection","volume":"7","author":"Patel","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.canlet.2021.09.034","article-title":"Incidence, mortality, survival, risk factor and screening of colorectal cancer: A comparison among China, Europe, and northern America","volume":"522","author":"Li","year":"2021","journal-title":"Cancer Lett."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.soc.2021.12.001","article-title":"Colorectal Cancer: Preoperative Evaluation and Staging","volume":"31","author":"Mahmoud","year":"2022","journal-title":"Surg. Oncol. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3111","DOI":"10.3390\/curroncol30030236","article-title":"Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going?","volume":"30","author":"Tsalikidis","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s00423-023-03201-y","article-title":"Colorectal cancer surgery in octogenarians: Real-world long-term results","volume":"409","author":"Willemsen","year":"2023","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1097\/ACO.0000000000000352","article-title":"Practical considerations in the management of sedation for colonoscopy","volume":"29","author":"Tetzlaff","year":"2016","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2781","DOI":"10.1007\/s10620-020-06044-5","article-title":"Recent Developments in Drugs for GI Endoscopy Sedation","volume":"65","author":"Goudra","year":"2020","journal-title":"Dig. Dis. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.cgh.2009.07.008","article-title":"Incidence of sedation-related complications with propofol use during advanced endoscopic procedures","volume":"8","author":"Hovis","year":"2010","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Li, M., Ke, W., and Zhuang, S. (2022). Effect of intravenous lidocaine on propofol consumption in elderly patients undergoing colonoscopy: A double-blinded, randomized, controlled trial. BMC Anesth., 22, (In English).","DOI":"10.1186\/s12871-022-01601-z"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1097\/00000542-200510000-00026","article-title":"Propofol: The challenges of formulation","volume":"103","author":"Baker","year":"2005","journal-title":"Anesthesiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1007\/s00540-022-03079-y","article-title":"A population pharmacokinetic model of remimazolam for general anesthesia and consideration of remimazolam dose in clinical practice","volume":"36","author":"Masui","year":"2022","journal-title":"J. Anesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.tips.2018.03.006","article-title":"The Benzodiazepine Binding Sites of GABA(A) Receptors","volume":"39","author":"Sigel","year":"2018","journal-title":"Trends Pharmacol. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1213\/ANE.0b013e31823acb95","article-title":"Remimazolam: New beginnings or just a me-too?","volume":"115","author":"Sneyd","year":"2012","journal-title":"Anesth. Analg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/ACO.0000000000000877","article-title":"Remimazolam for anaesthesia or sedation","volume":"33","author":"Sneyd","year":"2020","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_16","doi-asserted-by":"crossref","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":"ref_17","first-page":"4594","article-title":"The efficacy and safety of remimazolam tosylate versus propofol in patients undergoing colonoscopy: A multicentered, randomized, positive-controlled, phase III clinical trial","volume":"12","author":"Chen","year":"2020","journal-title":"Am. J. Transl. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1111\/jgh.15188","article-title":"Remimazolam tosilate in upper gastrointestinal endoscopy: A multicenter, randomized, non-inferiority, phase III trial","volume":"36","author":"Chen","year":"2021","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","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":"ref_20","doi-asserted-by":"crossref","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":"ref_21","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur. J. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e943784","DOI":"10.12659\/MSM.943784","article-title":"Comparison of Remimazolam and Propofol on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer: A Single-Center Prospective Randomized Controlled Study","volume":"30","author":"Liu","year":"2024","journal-title":"Med. Sci. Monit."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"5507","DOI":"10.2147\/DDDT.S502910","article-title":"Dose-Dependent Effects of Remimazolam on Early Perioperative Neurocognitive Disorders in Elderly Colorectal Cancer Patients Undergoing Laparoscopic Surgery","volume":"19","author":"Liu","year":"2025","journal-title":"Drug Des. Devel Ther."},{"key":"ref_24","first-page":"1","article-title":"Effects of General Anesthesia Induced by Remimazolam and Propofol on Adverse and Inflammatory Reactions in Patients After Colorectal Cancer Surgery: A Retrospective Study","volume":"86","author":"Wang","year":"2025","journal-title":"Br. J. Hosp. Med."},{"key":"ref_25","first-page":"41","article-title":"Effect of Remimazolam on Cellular Immune Response and Postoperative Recovery in Patients Undergoing Laparoscopic Colorectal Cancer Surgery","volume":"24","author":"Wu","year":"2025","journal-title":"Iran. J. Allergy Asthma Immunol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jatmed.2025.05.001","article-title":"Efficacy and safety of continuous infusion of remimazolam for sedation in elderly patients undergoing colonoscopic polypectomy: A non-inferiority prospective controlled clinical trial","volume":"4","author":"Tian","year":"2025","journal-title":"J. Anesth. Transl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Xin, Y., Chu, T., Wang, J., and Xu, A. (2022). Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: A prospective, randomized, controlled clinical trial. BMC Anesth., 22, (In English).","DOI":"10.1186\/s12871-022-01805-3"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"So, K.Y., Park, J., and Kim, S.H. (2023). Safety and efficacy of remimazolam for general anesthesia in elderly patients undergoing laparoscopic cholecystectomy: A randomized controlled trial. Front. Med., 10, (In English).","DOI":"10.3389\/fmed.2023.1265860"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Liu, X., Zhang, L., Zhao, L., Zhou, X., Mao, W., Chen, L., Zhu, H., Xie, Y., and Li, L. (2025). Comparison of the safety of remimazolam and propofol during general anesthesia in elderly patients: Systematic review and meta-analysis. Front. Med., 12, (In English).","DOI":"10.3389\/fmed.2025.1409495"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"66","DOI":"10.7555\/JBR.37.20230110","article-title":"Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial","volume":"38","author":"He","year":"2023","journal-title":"J. Biomed. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"6423","DOI":"10.2147\/DDDT.S532746","article-title":"Effect of Remimazolam versus Propofol on Hemodynamics in Elderly Hypertensive Patients Undergoing Gastroenteroscopy: A Multicenter, Randomized Controlled Clinical Trial","volume":"19","author":"Gu","year":"2025","journal-title":"Drug Des. Devel Ther."},{"key":"ref_32","unstructured":"Staheli, B., and Rondeau, B. (2021). Anesthetic Considerations in the Geriatric Population, StatPearls Publishing."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"An, X., Shen, T., Yin, X., Xu, J., Zhang, Y., and Wang, T. (2024). The safety of remimazolam versus propofol in gastroscopic sedation: A meta-analysis. BMC Anesth., 24, (In English).","DOI":"10.1186\/s12871-024-02422-y"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1007\/s00101-024-01454-w","article-title":"Effect of remimazolam for general anesthesia on postoperative nausea and vomiting: A systematic review and meta-analysis","volume":"73","author":"Kim","year":"2024","journal-title":"Anaesthesiologie"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"13","DOI":"10.3892\/br.2024.1891","article-title":"Efficacy and safety of remimazolam vs. propofol for general anesthesia with tracheal intubation: Systematic review and meta-analysis","volume":"22","author":"Luo","year":"2025","journal-title":"Biomed. Rep."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Huang, J., Xiao, Z., Lao, J., Pan, L., Chen, Z., and Lin, Z. (2025). Comparison of the effects of remimazolam and propofol on postoperative delirium in elderly surgical patients: A meta-analysis. BMC Anesth., 25, (In English).","DOI":"10.1186\/s12871-025-03197-6"}],"container-title":["Pharmaceutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4923\/18\/4\/448\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T09:00:54Z","timestamp":1775466054000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4923\/18\/4\/448"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,6]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["pharmaceutics18040448"],"URL":"https:\/\/doi.org\/10.3390\/pharmaceutics18040448","relation":{},"ISSN":["1999-4923"],"issn-type":[{"value":"1999-4923","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,6]]}}}