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Remimazolam in pediatric anesthesia: a systematic review for clinical decision-making

Yi Zhang1, Qiuxiang Chen2, Linyun Wang3

  • 1Department of Anesthesiology, Maternal and Child Health Hospital of Wanzhou District, Chongqing, China.

Frontiers in Pediatrics
|October 9, 2025
PubMed
Abstract

Insights

Remimazolam offers improved hemodynamic stability and reduced emergence delirium in pediatric anesthesia. However, safety data in infants and long-term neurodevelopmental effects are still needed for broader use.

Area of Science:

  • Anesthesiology
  • Pharmacology
  • Pediatric Medicine

Background:

  • The use of remimazolam in pediatric anesthesia is an emerging area.
  • Evidence from 2024-2025 was systematically reviewed to guide its clinical application.

Purpose of the Study:

  • To establish a clinical decision-making framework for remimazolam use in pediatric anesthesia.
  • To synthesize current evidence on remimazolam's efficacy and safety in pediatric patients.

Main Methods:

  • A systematic literature search was conducted following PRISMA guidelines.
  • 23 studies, including 15 randomized controlled trials with 2,847 pediatric patients, were included for narrative synthesis.

Main Results:

  • Remimazolam showed superior hemodynamic stability compared to propofol, with significantly fewer cardiovascular complications (RR 0.30).
  • It reduced emergence delirium by 61% (RR 0.39) compared to standard agents.
  • The CES1 G143E polymorphism impacts remimazolam clearance, and limitations include lack of infant data and unknown long-term safety.

Conclusions:

  • Remimazolam is a valuable anesthetic agent with advantages in hemodynamic stability and reduced emergence delirium.
  • Its use is supported in specific scenarios, but it is not a replacement for all established anesthetics.
  • Further research is required regarding safety in infants and long-term neurodevelopmental outcomes before widespread adoption.
Keywords:
emergence deliriumhemodynamic stabilityindividualized medicationpediatric anesthesiapharmacogeneticsremimazolamsystematic review

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