Profile of Remimazolam in Anesthesiology: A Narrative Review of Clinical Research Progress

Abstract

Remimazolam is a novel short-acting γ-aminobutyric acid (GABA) receptor agonist with typical characteristics of benzodiazepine sedative drugs, nonorgan-dependent metabolism, long-term infusion without accumulation, and no injection pain. It is quite different from the other current sedative drugs and has broad prospects for application. It has been established that the metabolites of remimazolam are inactive, and the interactions with other drugs are weak with slight cardiopulmonary suppressive effects, showing good effectiveness and safety. During the 2-year period that it has been on the market, remimazolam has been used in multiple clinical scenarios, such as the induction and maintenance of general anesthesia and sedation in outpatient minor procedures or examinations. However, it's use has also prompted widespread concern around the world. Therefore, given its short-and rapid-acting, controllable characteristics remimazolam deserves in-depth study in order for it to be used in fast-track surgery, comfort diagnosis and treatment. Notably, such agents might be of great significance, especially in elderly individuals, patients with critical diseases or patients with liver and kidney insufficiency. The current study reviews recent clinical studies (2015-2022) on remimazolam and summarizes the characteristics of its applications. Specifically, the use of remimazolam in some specific populations are described. This study attempts to provide scientific support for the clinical application of this novel sedative drug in the field of anesthesia.

Anesthetic Concerns in Psychiatric Disease

“…It has smaller effects on the respiratory and circulatory systems than propofol and midazolam, and may be a potentially safer option for pediatric, geriatric, and obese populations and those with multiple comorbidities. However, additional work is needed to determine safety of long-term use and use in ICU sedation, and to determine optimal dosing for specific indications [44,45].…”

Remimazolam for sedation: A protocol for a systematic review with meta‐analysis, trial sequential analysis, and GRADE approach

“…7 During drug synthesis, a methyl-propionate side chain is added. 8 This developmental strategy originates from remifentanil and has resulted in an intravenous analgesic with a fast onset, short duration of action, and a subsequent rapid recovery. 9 As a result, remimazolam shares characteristics with both midazolam and remifentanil and can be described as a benzodiazepine with a very short-acting pharmacodynamic effect.…”

“…9 As a result, remimazolam shares characteristics with both midazolam and remifentanil and can be described as a benzodiazepine with a very short-acting pharmacodynamic effect. 8 Remimazolam, like other benzodiazepines, is a GABA A γ-aminobutyric acid receptor agonist. 10,11 Remimazolam was first approved for procedural sedation for gastroscopy in China in December 2019.…”

“…Remimazolam is a benzodiazepine derived from midazolam 7 . During drug synthesis, a methyl‐propionate side chain is added 8 . This developmental strategy originates from remifentanil and has resulted in an intravenous analgesic with a fast onset, short duration of action, and a subsequent rapid recovery 9 .…”

“…This developmental strategy originates from remifentanil and has resulted in an intravenous analgesic with a fast onset, short duration of action, and a subsequent rapid recovery 9 . As a result, remimazolam shares characteristics with both midazolam and remifentanil and can be described as a benzodiazepine with a very short‐acting pharmacodynamic effect 8 . Remimazolam, like other benzodiazepines, is a GABA A γ‐aminobutyric acid receptor agonist 10,11 .…”