Efficacy of Remimazolam besylate for intravenous sedation in dental procedures for patients with cognitive disabilities: a prospective single-arm observational study.

Comparative study on the efficacy and safety of remimazolam versus midazolam for sedation during ERCP-related procedures in the elderly.

OBJECTIVES Benzodiazepine agonists, commonly used sedatives for endoscopic retrograde cholangiopancreatography (ERCP) in Japan, may cause prolonged sedation, particularly in elderly patients. Although remimazolam, an ultra-short-acting benzodiazepine, has been approved for endoscopic sedation, its efficacy and safety in elderly patients remain unclear. We compared remimazolam and midazolam for sedation during ERCP-related procedures in patients aged ≥75 years. MATERIALS AND METHODS This retrospective study included 208 patients aged ≥75 years: remimazolam group (R group, n = 106) and midazolam group (M group, n = 102). The primary outcome was the time to recovery (Aldrete score ≥9). Secondary outcomes included sedation success rate, number of doses, total doses administered, incidence of agitation requiring procedure interruption, procedure time, flumazenil use, and sedation-related adverse events. RESULTS Recovery time was significantly shorter in the R group (median, 2 vs. 4 min, p <.01). Flumazenil use was significantly lower (4.7% vs. 28.4%, p <.01). The total number of doses administered was significantly higher in the R group (median, 3 vs. 2 times, p < .01). No significant differences were observed in sedation success rate, agitation requiring procedure interruption, procedure time, and sedation-related adverse events. CONCLUSIONS Remimazolam significantly shortened recovery time and reduced flumazenil use in elderly patients, which may reduce staff workload after ERCP; larger studies are needed to establish comparative safety.

The median effective dose (ED50) of remimazolam combined with esketamine for conscious sedation in patients with dental anxiety undergoing outpatient dental surgery: a prospective, dose-finding study.

BACKGROUND Dental anxiety presents a significant barrier to treatment. Conscious sedation is widely used to alleviate anxiety. Although remimazolam has demonstrated its efficacy and advantages for outpatient dental procedures, research on the effective dose of remimazolam combined with esketamine remains limited. Thus, the purpose of our research was to estimate the effective dose of remimazolam with esketamine for conscious sedation in patients with dental anxiety undergoing outpatient dental surgery. METHODS The study enrolled outpatients with dental anxiety aged 18-65 years who received dental operations and were classified under ASA grades I-II. Using the modified Dixon up-and-down method, each patient was first administered by infusing esketamine 0.1 mg/kg, followed by an assigned dose of remimazolam. The initial dose of remimazolam was 0.1 mg/kg, with a dose gradient of 0.01 mg/kg. Sedation success was defined as achieving a MOAA/S score of 3-4 within 5 min after the initial loading dose, without requiring additional remimazolam. The primary outcome was the ED50 of remimazolam and its 95% confidence interval (CI). Secondary outcomes included security indicators, patient satisfaction and memory of the procedure, dentist satisfaction, duration of treatment, and discharge time. RESULTS The study achieved 10 transition points (from sedation success to failure) with a total enrollment of 32 individuals. The ED50 and ED95 of remimazolam with 0.1 mg/kg esketamine, for conscious sedation during outpatient dental surgery, were 0.069 mg/kg (95% CI: 0.050-0.080 mg/kg) and 0.099 mg/kg (95% CI: 0.085-0.200 mg/kg), respectively. No circulatory and respiratory adverse events requiring intervention were observed during anesthesia induction. CONCLUSIONS For outpatient dental procedures in patients with dental anxiety, the ED50 and ED95 of remimazolam with esketamine for conscious sedation were 0.069 mg/kg and 0.099 mg/kg, respectively. The ED50 provides a preliminary reference for initial dose selection in this clinical setting. However, the wide confidence interval of the ED95 limits its clinical utility and requires validation in larger studies. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry (ChiCTR2500104775; first registered on 23/06/2025).

Safety and Efficacy of Remimazolam Combined with Esketamine for Anesthesia in Elderly Patients Undergoing ERCP: A Randomized Controlled Trial.

Objective Older adults undergoing ERCP are particularly susceptible to sedation-related respiratory and circulatory adverse events. This trial compared the safety and efficacy of remimazolam-esketamine with propofol-fentanyl, with identical standardized nasopharyngeal airway-assisted respiratory management in both groups. Patients and Methods This single-center, prospective, randomized, parallel-group superiority trial enrolled 160 patients aged 60-80 years with American Society of Anesthesiologists physical status I-III who were scheduled for elective ERCP. Participants were randomly assigned 1:1 to remimazolam-esketamine (RE group; n=80) or propofol-fentanyl (PF group; n=80). Both groups received identical nasopharyngeal airway placement, oxygen delivery, capnography, and rescue algorithms; the randomized intervention was the anesthetic drug regimen. The primary outcome was composite sedation-related adverse events (SRAEs), comprising prespecified hypotension, bradycardia, hypoxemia, or respiratory depression from anesthesia induction to endoscope withdrawal. Analyses followed the intention-to-treat principle. Results Composite SRAEs occurred in 14 of 80 patients (17.5%) in the RE group and 28 of 80 patients (35.0%) in the PF group (RR, 0.50; 95% CI, 0.29-0.88; risk difference, -17.5 percentage points; 95% CI, -30.9 to -4.1; P=0.016). The adjusted RR was 0.49 (95% CI, 0.31-0.78; P=0.003). Anesthetic regimen success was similar between groups (97.5% vs 98.8%). Induction was modestly longer with RE, whereas eye-opening and modified Aldrete recovery time were slightly shorter. Conclusion In this selected population of older patients undergoing ERCP, the remimazolam-esketamine regimen was associated with fewer composite SRAEs than propofol-fentanyl while achieving a similar anesthetic regimen success rate. Induction was modestly longer. Tachycardia, hypertension, and psychotomimetic symptoms were numerically more frequent with RE, but event counts were small and estimates were imprecise. Multicenter studies are required to confirm generalizability.

Clinical Performance of Nitrous Oxide Inhalation versus Intravenous Sedation in Outpatient Dental Surgery: Efficacy and Safety Outcomes

Intravenous sedation is optimal for profound anxiolysis in complex cases, while nitrous oxide is ideal for routine procedures, prioritizing rapid recovery and fewer side effects.

EFFICACY OF DEXMEDETOMIDINE VERSUS MIDAZOLAM FOR SEDATION IN PATIENTS UNDERGOING REGIONAL ANESTHESIA: A RANDOMIZED CONTROLLED STUDY

Objectives: The objective of the study was to assess the effectiveness and safety of dexmedetomidine versus midazolam for sedation during regional anesthesia surgery. Methods: This prospective randomized comparative interventional study was conducted in the Department of Anesthesiology at a tertiary care hospital from January 2025 to January 2026. 100 adult patients undergoing elective surgeries under regional anesthesia were randomly divided into two groups: Group D (dexmedetomidine, n=50) and Group M (midazolam, n=50). Richmond agitation sedation scale (RASS) was used to evaluate sedation. Intraoperative monitoring of hemodynamic parameters, such as mean arterial pressure and heart rate, was performed. Recovery characteristics, patient satisfaction, requirement for rescue sedation and adverse effects were also assessed. Results: The mean intraoperative RASS score was significantly lower in the Group D than in the Group M (−2.8±0.5 vs. −2.5±0.7; p=0.02). The time required to reach the target sedation level was significantly greater in Group D (9.4±2.6 min vs. 7.8±2.4 min; p=0.003). The scores of patient satisfaction with dexmedetomidine use were significantly greater than with midazolam use (8.5±1.0 vs. 7.9±1.2; p=0.01). Dexmedetomidine was associated with more adverse effects of bradycardia (p=0.08) and hypotension (p=0.46), whereas midazolam was associated with more adverse effects of excessive sedation (p=0.14) and restlessness (p=0.09). Conclusion: Dexmedetomidine and midazolam were both found to be effective sedatives for patients undergoing regional anesthetic. Dexmedetomidine was found to be a more effective sedative, well tolerated, more patient-satisfying and more stable for intraoperative hemodynamic despite its comparatively slower onset of sedation than midazolam.

Sedation Dose of Remimazolam for Older Adults Undergoing Hip Arthroplasty with Neuraxial Anesthesia and Its Impact on Postoperative Delirium.