JMIR Publications

ABSTRACT

Background:

Post-induction hypotension (PIHO) is a hemodynamic abnormality commonly observed during the induction of general anesthesia. Previous studies have found that etomidate is considered a safer drug for the induction of anesthesia because it has only minor adverse effects on the cardiovascular and pulmonary systems. Remimazolam is a innovative benzodiazepine. Recent evidence found that remimazolam has minimal inhibitory effects on circulation and respiration. However, the efficacy and safety of remimazolam versus etomidate in the induction of anesthesia are unclear.

Objective:

To compare the efficacy and safety of remimazolam versus etomidate for general anesthesia.

Methods:

We plan to search the Web of Science, Cochrane Library, EMBASE, and PubMed from the date of their creation until December 31, 2023. The language limit is English only. The search terms that will be employed are "randomized controlled trials," "etomidate," and remimazolam." The incidence of PIHO was the primary outcome measure. Secondary outcomes included depth of anesthesia after induction, sedation success rate, time to loss of consciousness (LOC), hemodynamic profiles, recovery time, the incidence of injection pain, and postoperative nausea and vomiting. Reviews, meta-analyses, case studies, abstracts from conferences, and comments will not be accepted. The heterogeneity of the results will be evaluated by sensitivity and subgroup analysis. RevMan software and Stata software will be used for data analysis. We will evaluate the quality of included studies using the Cochrane Collaboration's risk of bias tool. The confidence of the evidence will be assessed through the Grading of Recommendations, Assessments, Developments, and Evaluations (GRADE).

Results:

Our study will conclude which drug has more stable hemodynamics and lower incidence of PIHO by comparing the use of etomidate and remimazolam in the induction of general anesthesia. The results of this systematic review and meta-analysis will be publicly available and published in a peer-reviewed journal.

Conclusions:

This is the first meta-analysis comparing remimazolam with etomidate for general anesthesia. The results of this study will provide data guidance for future anesthesia induction drugs. Clinical Trial: PROSPERO Registration Number: CRD42023463120.