Efficacy and Safety Profile of Remimazolam for Sedation in Adults Undergoing Short Surgical Procedures

Abstract

Sedation for short-term procedures is increasingly being used in clinical practice. Selection of appropriate drugs is important for effective and safe sedation; however, an ideal sedative remains unavailable. Remimazolam is a novel, ultrafast-acting benzodiazepine with a shorter duration of action than other agents in this class. It is currently expected to become a popular agent for short-term procedural sedation. Remimazolam shows higher clearance, a smaller volume of distribution, and a shorter half-life than midazolam. It showed dose-dependent sedative action, with onset of sedation within 60s of administration. The results of clinical trials indicate that remimazolam is more useful than midazolam for short procedural sedation such as in patients who undergo colonoscopy and that its safety profile is comparable with that of midazolam. Anesthesia-induced vascular pain is lesser and reduction in blood pressure is lesser with remimazolam than with propofol. Moreover, the availability of flumazenil (a benzodiazepine antagonist) is a specific advantage of remimazolam. These characteristics and the results of clinical trials suggest that remimazolam will be a safer alternative to previous sedative drugs for sedation during the short surgical procedures. Although short-acting agents are useful, they might lead to immediate hyper-sedation. Remimazolam is a promising agent for short-term procedural sedation; however, clinicians should be mindful of the risks of this agent.

Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

“…Patients in the AR2 and AR3 groups took more extended intervals. However, the subsequent addition of remimazolam was performed at an interval of 5-8 min for all remimazolam groups, which was consistent with the context-sensitive half time of remimazolam [43]. Besides, the duration of surgery among the groups did not differ significantly.…”

Total intravenous anesthesia induced and maintained by a combination of remimazolam and remifentanil without a neuromuscular blocking agent: a prospective, observational pilot study

“…As reported previously [ 1 ], vascular pain during remimazolam injection did not occur in our patients. In addition, except for three patients, all patients recovered from anesthesia without the use of an antagonist and there was no incidence of immediate PONV in the PACU.…”

“…In terms of the postoperative recovery profile, the median recovery time from discontinuation of remimazolam to extubation was approximately 7 min without flumazenil, which almost coincides with the CSHT of remimazolam [ 1 ]. The relatively constant CSHT of remimazolam allows for no cumulative effect, even after a prolonged continuous infusion [ 2 ].…”

“…Remimazolam is a recently developed intravenous anesthetic agent with a more rapid onset of action and faster recovery than other benzodiazepines, including midazolam [ 1 , 2 ]. Remimazolam is rapidly hydrolyzed into an inactive metabolite (CNS7054) by tissue esterases, which shows lower affinity at the benzodiazepine site of GABA A receptor [ 3 ].…”

“…Despite its various advantages, owing to its recent development, few studies have explored the efficacy and safety profile of remimazolam as a general anesthetic [ 8 – 10 ] and sedative agent for medical or surgical procedures [ 1 , 11 – 13 ]. In addition, to the best of our knowledge, no studies have reported the appropriate use of remimazolam for general anesthesia without using a neuromuscular blocking agent (NMBA).…”