Safety and efficacy of remimazolam in general anaesthesia during laparoscopic cholecystectomy: A systematic review and meta-analysis of randomised controlled trials

Background and Aims: 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. Methods: 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). Results: 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, P = 0.04), recovery time (MD: 2.72, 95% CI: 0.44, 5.01, P = 0.02), and postanaesthesia care unit (PACU) stay (MD: 5.54, 95% CI: 0.86, 10.22, P = 0.02). However, RMZ significantly reduced the incidence of injection pain (RR: 0.03, 95% CI: 0.01, 0.15, P < 0.001), and no significant differences were observed in surgery duration ( P = 0.30), extubation time ( P = 0.14), or the incidence of hypotension ( P = 0.15), bradycardia ( P = 0.13), or postoperative nausea and vomiting ( P = 0.67). Conclusion: 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.