Remimazolam

Several studies have suggested that remimazolam causes less respiratory depression than propofol. A prior ERCP study found hypoxaemia in 9.6% of remimazolam patients compared to 15.7% of propofol patients, a statistically significant difference. A meta-analysis of upper gastrointestinal endoscopy found remimazolam associated with significantly lower hypoxaemia incidence but also significantly lower overall procedural success rate compared to propofol. In subgroup analyses restricted to elderly patients from a prior meta-analysis, procedural success did not differ significantly between remimazolam and propofol. The remimazolam induction dose is specified at 0.1 mg/kg bolus per the Japanese package insert, which pharmacodynamic studies show produces a shorter time to loss of responsiveness than continuous-infusion induction. Remimazolam is a novel ultrashort-acting benzodiazepine characterized by rapid onset, predictable offset, and reversibility with flumazenil. Some data indicate remimazolam has a lower procedural success rate than propofol, and the overall evidence base remains limited.