Published online Jul 16, 2024. doi: 10.4253/wjge.v16.i7.385
Revised: May 5, 2024
Accepted: June 4, 2024
Published online: July 16, 2024
Processing time: 99 Days and 9.8 Hours
Worldwide, a majority of routine endoscopic procedures are performed under some form of sedation to maximize patient comfort. Propofol, benzodiazepines and opioids continue to be widely used. However, in recent years, Remimazolam is gaining immense popularity for procedural sedation in gastrointestinal (GI) endoscopy. It is an ultra-short-acting benzodiazepine sedative which was approved by the Food and Drug Administration in July 2020 for use in procedural sedation. Remimazolam has shown a favorable pharmacokinetic and pharmacodynamic profile in terms of its non-specific metabolism by tissue esterase, volume of distribution, total body clearance, and negligible drug-drug interactions. It also has satisfactory efficacy and has achieved high rates of successful sedation in GI endoscopy. Furthermore, studies have demonstrated that the efficacy of Remimazolam is non-inferior to Propofol, which is currently a gold standard for procedural sedation in most parts of the world. However, the use of Propofol is associated with hemodynamic instability and respiratory depression. In contrast, Remimazolam has lower incidence of these adverse effects intra-procedurally and hence, may provide a safer alternative to Propofol in procedural sedation. In this comprehensive narrative review, highlight the pharmacologic characteristics, efficacy, and safety of Remimazolam for procedural sedation. We also discuss the potential of Remimazolam as a suitable alternative and how it can shape the future of procedural sedation in gastroenterology.
Core Tip: Procedural sedation is a key component of diagnostic and therapeutic gastrointestinal (GI) procedures. It maximizes patient comfort and improves procedural outcomes. Propofol is currently a gold standard for procedural sedation in most parts of the world. However, in recent years, Remimazolam, an ultra-short acting benzodiazepine sedative, is gaining popularity among anesthesiologists and endoscopists for its favorable pharmacology, efficacy, and safety profile. In contrast to other sedatives, particularly Propofol, Remimazolam has lower incidence of intra-procedural hemodynamic instability and respiratory depression. This comprehensive review highlights how Remimazolam can shape the future of GI endoscopy.