The pooled result favored remimazolam, but its precision varied substantially across outcomes.
Three randomized trials involving 528 patients compared remimazolam with midazolam for gastrointestinal endoscopy. Procedure success favored remimazolam, with an odds ratio of 9.78 and a confidence interval from 1.48 to 64.71. Rescue medication and hypotension also favored remimazolam. The analysis did not establish a statistically clear difference in time to full alertness.
Only three trials were available, two with small samples. Differences in doses and protocols complicate pooling. A large odds ratio with a wide interval is not a precise prediction for a particular patient, and a nonsignificant recovery endpoint does not establish equivalence.
For testimony, identify the endpoint behind each claim of superiority. Procedure completion, recall, blood pressure and recovery measure different things. Explain both the direction of the pooled finding and the uncertainty around its magnitude.
Source: Publication PMC9652671. The case-review applications above are interpretive analysis.
Related reading: Adult Status-Epilepticus Meta-Analysis Favored Lorazepam With Very Low Certainty.