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.