Remimazolam as a Novel Option for Procedural Sedation: A Narrative Review

Procedural sedation (PS) is a widely used practice designed to relieve anxiety, induce amnesia, and improve patient comfort during diagnostic and therapeutic procedures, particularly those that may cause discomfort. The choice of sedative agent plays a critical role in determining the depth of sedation, recovery time, and risk of adverse effects. Traditionally, midazolam, a benzodiazepine (BDZ), has been the agent of choice for PS due to its rapid onset and relatively short duration of action. However, midazolam's active metabolites can result in prolonged sedation, posing a risk of delayed recovery and increased complications. These drawbacks have sparked interest in the development of alternatives that offer a more favorable pharmacokinetic profile. Remimazolam, a novel ultra-short-acting BDZ, has emerged as a potential solution. Unlike midazolam, remimazolam has a rapid onset of action, a very short duration of effect, and no active metabolites, which significantly reduces the risk of prolonged sedation and enhances patient safety. Its unique pharmacological properties make it a promising candidate for PS, particularly in outpatient and short-duration procedures where rapid recovery is critical. This narrative review aims to evaluate the available literature on remimazolam as an agent for PS, with a focus on its pharmacology, safety profile, and clinical efficacy. A comprehensive literature search was conducted on PubMed and Google Scholar, focusing on studies published between 2015 and 2025. The review encompasses original research articles, clinical trials, systematic reviews, and preclinical studies that compare remimazolam with other sedatives, including midazolam, propofol, and ketamine. The findings from these studies were synthesized to highlight the advantages of remimazolam, including its rapid onset, short duration, and safety profile. Emphasis was placed on clinical studies assessing its efficacy in various procedural contexts, identifying gaps in the current evidence, and suggesting directions for future research.