{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T23:02:59Z","timestamp":1791068579135,"version":"4.1.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"\n Background and Aims:<\/jats:title>\n Laparoscopic cholecystectomy (LC) presents anaesthetic challenges such as haemodynamic instability and postoperative complications. Remimazolam (RMZ), a novel ultra-short acting benzodiazepine, has emerged as a promising alternative to the standard propofol, with a potentially superior safety profile. This study aimed to compare the efficacy and safety of RMZ with propofol for anaesthesia during LC.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A systematic review and meta-analysis were conducted to synthesise evidence from randomised controlled trials (RCTs). A search of PubMed, Web of Science, Scopus, and Google Scholar through May 2025 was conducted. We pooled dichotomous outcomes using risk ratios (RRs) and continuous outcomes using mean differences (MDs), and 95% confidence intervals (CIs).<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Six RCTs involving 452 patients were included in the analysis. Compared to the control group, RMZ was associated with a significantly longer anaesthesia onset time (MD: 13.26, 95% CI: 0.47, 26.05,\n P<\/jats:italic>\n = 0.04), recovery time (MD: 2.72, 95% CI: 0.44, 5.01,\n P<\/jats:italic>\n = 0.02), and postanaesthesia care unit (PACU) stay (MD: 5.54, 95% CI: 0.86, 10.22,\n P<\/jats:italic>\n = 0.02). However, RMZ significantly reduced the incidence of injection pain (RR: 0.03, 95% CI: 0.01, 0.15,\n P<\/jats:italic>\n < 0.001), and no significant differences were observed in surgery duration (\n P<\/jats:italic>\n = 0.30), extubation time (\n P<\/jats:italic>\n = 0.14), or the incidence of hypotension (\n P<\/jats:italic>\n = 0.15), bradycardia (\n P<\/jats:italic>\n = 0.13), or postoperative nausea and vomiting (\n P<\/jats:italic>\n = 0.67).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n With uncertain evidence, RMZ significantly prolonged anaesthesia onset time, recovery time, and time to PACU discharge compared to control in patients undergoing LC. Still, RMZ improved patient comfort through significantly decreased incidence of injection pain and is associated with a comparable haemodynamic safety profile to propofol.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ija.ija_908_25","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T10:00:20Z","timestamp":1767348020000},"page":"79-91","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Safety and efficacy of remimazolam in general anaesthesia during laparoscopic cholecystectomy: A systematic review and meta-analysis of randomised controlled trials"],"prefix":"10.4103","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2514-0689","authenticated-orcid":false,"given":"Mohamed","family":"Abuelazm","sequence":"first","affiliation":[{"name":"Primary Care Physician, Faculty of Medicine, Tanta University, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4407-9392","authenticated-orcid":false,"given":"Shroog","family":"Alanazi","sequence":"additional","affiliation":[{"name":"Intern, College of Medicine, University of Hail, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9252-1190","authenticated-orcid":false,"given":"Rayyan","family":"Altemani","sequence":"additional","affiliation":[{"name":"Resident, Internal Medicine, University of Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5537-5710","authenticated-orcid":false,"given":"Salman","family":"Aljaber","sequence":"additional","affiliation":[{"name":"Intern, College of Medicine, Qassim University, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9136-8980","authenticated-orcid":false,"given":"Abdullah","family":"Almosa","sequence":"additional","affiliation":[{"name":"Intern, College of Medicine, Almaarefa University, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9916-6291","authenticated-orcid":false,"given":"Ali","family":"Aljuraifani","sequence":"additional","affiliation":[{"name":"Intern, College of Medicine, Qassim University, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8231-5316","authenticated-orcid":false,"given":"Mamdouh","family":"Alrugaibah","sequence":"additional","affiliation":[{"name":"Intern, College of Medicine, Qassim University, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0772-644X","authenticated-orcid":false,"given":"Mohammed","family":"Albalawi","sequence":"additional","affiliation":[{"name":"Intern, College of Medicine, Jouf University, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4494-8874","authenticated-orcid":false,"given":"Fahad","family":"Alwisiydi","sequence":"additional","affiliation":[{"name":"Intern, College of Medicine, Almaarefa University, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4391-3022","authenticated-orcid":false,"given":"Rayan","family":"Muawad","sequence":"additional","affiliation":[{"name":"Consultant, Pediatric Anaesthesia Department, King Abdullah Specialist Children Hospital, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"R1-20260102","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1186\/s12871-024-02614-6","article-title":"Comparison of remimazolam tosilate and propofol during induction and maintenance of general anesthesia in patients undergoing laparoscopic cholecystectomy: A prospective, single center, randomised controlled trial","volume":"24","author":"Luo","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"R2-20260102","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s40001-025-02381-1","article-title":"Effect of remimazolam combined with estazolam on anxiety levels and postoperative gastrointestinal function recovery in patients undergoing laparoscopic cholecystectomy surgery","volume":"30","author":"Mao","year":"2025","journal-title":"Eur J Med Res"},{"key":"R3-20260102","first-page":"807","article-title":"[TIVA with propofol-remifentanil or balanced anesthesia with sevoflurane-fentanyl in laparoscopic operations. Hemodynamics, awakening and adverse effects]","volume":"48","author":"Juckenhofel","year":"1999","journal-title":"Anaesthesist"},{"key":"R4-20260102","doi-asserted-by":"crossref","first-page":"252","DOI":"10.17085\/apm.22252","article-title":"Comparison of remimazolam-remifentanil and propofol-remifentanil during laparoscopic cholecystectomy","volume":"18","author":"Lee","year":"2023","journal-title":"Anesth Pain Med"},{"key":"R5-20260102","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.bja.2018.12.025","article-title":"Propofol infusion syndrome: A structured literature review and analysis of published case reports","volume":"122","author":"Hemphill","year":"2019","journal-title":"Br J Anaesth"},{"key":"R6-20260102","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fmed.2023.1265860","article-title":"Safety and efficacy of remimazolam for general anesthesia in elderly patients undergoing laparoscopic cholecystectomy: A randomised controlled trial","volume":"10","author":"So","year":"2023","journal-title":"Front Med"},{"key":"R7-20260102","doi-asserted-by":"crossref","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":"R8-20260102","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.bpa.2018.06.007","article-title":"New benzodiazepines for sedation","volume":"32","author":"Cornett","year":"2018","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"R9-20260102","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1097\/ALN.0000000000003103","article-title":"Pharmacokinetics and pharmacodynamics of remimazolam (CNS 7056) after continuous infusion in healthy male volunteers part i. pharmacokinetics and clinical pharmacodynamics","volume":"132","author":"Sch\u00fcttler","year":"2020","journal-title":"Anesthesiology"},{"key":"R10-20260102","first-page":"9","article-title":"Effect of remimazolam induction on hemodynamics in patients undergoing valve replacement surgery: A randomised, double-blind, controlled trial","author":"Liu","year":"2021","journal-title":"Pharmacol Res Perspect"},{"key":"R11-20260102","doi-asserted-by":"crossref","first-page":"553","DOI":"10.23736\/S0375-9393.23.17034-9","article-title":"Comparison of remimazolam and propofol about safety outcome indicators during general anesthesia in surgical patients: A systematic review and meta-analysis","volume":"89","author":"Wu","year":"2023","journal-title":"Minerva Anestesiol"},{"key":"R12-20260102","doi-asserted-by":"crossref","first-page":"6386606","DOI":"10.1155\/2022\/6386606","article-title":"Remimazolam requires less vasopressor support during induction and maintenance of general anesthesia in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: A retrospective analysis from a single center","volume":"2022","author":"Miyoshi","year":"2022","journal-title":"Biomed Res Int"},{"key":"R13-20260102","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1007\/s00540-020-02788-6","article-title":"Efficacy and safety of remimazolam versus propofol for general anesthesia: A multicenter, single-blind, randomised, parallel-group, phase IIb\/III trial","volume":"34","author":"Doi","year":"2020","journal-title":"J Anesth"},{"key":"R14-20260102","doi-asserted-by":"crossref","DOI":"10.1213\/ANE.0000000000007516","article-title":"Electroencephalogram correlates of delayed emergence after remimazolam-induced anesthesia compared to propofol","author":"Lee","year":"2025","journal-title":"Anesth Analg"},{"key":"R15-20260102","doi-asserted-by":"crossref","first-page":"441","DOI":"10.4097\/kja.23939","article-title":"The incidences of nausea and vomiting after general anesthesia with remimazolam versus sevoflurane: A prospective randomised controlled trial","volume":"77","author":"Yoo","year":"2024","journal-title":"Korean J Anesthesiol"},{"key":"R16-20260102","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13643-021-01626-4","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"10","author":"Page","year":"2021","journal-title":"Syst Rev"},{"key":"R17-20260102","article-title":"Cochrane Handbook for Systematic Reviews of Interventions","year":"2023"},{"key":"R18-20260102","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"R19-20260102","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":"R20-20260102","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1136\/bmj.39490.551019.BE","article-title":"Rating quality of evidence and strength of recommendations: What is \u201cquality of evidence\u201d and why is it important to clinicians?","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ Br Med J"},{"key":"R21-20260102","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"Rating Quality of Evidence and Strength of Recommendations: GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"R22-20260102","doi-asserted-by":"crossref","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":"R24-20260102","doi-asserted-by":"crossref","first-page":"307","DOI":"10.4097\/kja.22297","article-title":"Remimazolam \u2013 current knowledge on a new intravenous benzodiazepine anesthetic agent","volume":"75","author":"Kim","year":"2022","journal-title":"Korean J Anesthesiol"},{"key":"R25-20260102","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1007\/s40262-018-0672-3","article-title":"Clinical pharmacokinetics and pharmacodynamics of propofol","volume":"57","author":"Sahinovic","year":"2018","journal-title":"Clin Pharmacokinet"},{"key":"R26-20260102","doi-asserted-by":"crossref","first-page":"3691","DOI":"10.2147\/DDDT.S512431","article-title":"The recovery of ciprofol, remimazolam and remimazolam-flumazenil for general anesthesia undergoing fundus surgery: A single-center, prospective, randomized, controlled clinical study","volume":"19","author":"Zhang","year":"2025","journal-title":"Drug Des Devel Ther"},{"key":"R27-20260102","doi-asserted-by":"crossref","first-page":"12660","DOI":"10.1038\/s41598-024-63578-8","article-title":"Remimazolam-flumazenil provides fast recovery from general anesthesia compared to propofol during radiofrequency catheter ablation of atrial fibrillation","volume":"14","author":"Lee","year":"2024","journal-title":"Sci Rep"},{"key":"R28-20260102","doi-asserted-by":"crossref","first-page":"583","DOI":"10.2147\/IJGM.S345390","article-title":"Efficacy and safety of remimazolam tosilate versus propofol for general anaesthesia in cirrhotic patients undergoing endoscopic variceal ligation","volume":"15","author":"Shi","year":"2022","journal-title":"Int J Gen Med"},{"key":"R29-20260102","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/s40981-022-00576-7","article-title":"Long-term delayed emergence after remimazolam-based general anesthesia: A case report","volume":"8","author":"Takemori","year":"2022","journal-title":"JA Clin Reports"},{"key":"R30-20260102","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/s12871-023-02172-3","article-title":"Comparison of bispectral index and patient state index as measures of sedation depth during surgeries using remimazolam tosilate","volume":"23","author":"Zhao","year":"2023","journal-title":"BMC Anesthesiol"},{"key":"R31-20260102","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1097\/ALN.0000000000004904","article-title":"Electroencephalographic features of elderly patients during anesthesia induction with remimazolam: A substudy of a randomized controlled trial","volume":"141","author":"Kim","year":"2024","journal-title":"Anesthesiology"},{"key":"R32-20260102","first-page":"101377","article-title":"Comparison of the bispectral indices of patients receiving remimazolam and propofol for general anaesthesia: A randomised crossover trial","volume":"43","author":"Yang","year":"2024","journal-title":"Anaesth Crit Care Pain Med"},{"key":"R33-20260102","doi-asserted-by":"crossref","first-page":"E761","DOI":"10.36076\/ppj.2023.26.E761","article-title":"Hemodynamic influences of remimazolam versus propofol during the induction period of general anesthesia: A systematic review and meta-analysis of randomized controlled trials","volume":"26","author":"Peng","year":"2023","journal-title":"Pain Physician"},{"key":"R34-20260102","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1097\/EJA.0000000000002042","article-title":"Remimazolam vs. propofol for general anaesthesia in elderly patients: A meta-analysis with trial sequential analysis","volume":"41","author":"Pereira","year":"2024","journal-title":"Eur J Anaesthesiol"},{"key":"R35-20260102","first-page":"22","article-title":"Application effects of remimazolam and propofol on elderly patients undergoing hip replacement","author":"Zhang","year":"2022","journal-title":"BMC Anesthesiol"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_908_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:55:52Z","timestamp":1786647352000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_908_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_908_25","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-07-12","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}