Remimazolam in obstetric anaesthesia: a focused review

Remimazolam is an ultra-short-acting intravenous benzodiazepine approved for procedural sedation and general anaesthesia. Its favourable pharmacokinetic profile, including rapid onset, short context-sensitive half-time, and minimal cardiovascular depression, makes it a potential agent for obstetric anaesthesia, where maternal stability and fetal safety are paramount. This focused review evaluates the pharmacologic profile, clinical applications, safety considerations, and emerging reports of the use of remimazolam in obstetric settings. Remimazolam has been reported to provide favurable anxiolysis during neuraxial placement. There has been reported use of remimazolam in high-risk obstetric populations including those with maternal cardiac disease, providing effective sedation, stable haemodynamics, high patient satisfaction and favorable maternal-fetal outcomes. The availability of flumazenil as a reversal agent adds a safety margin. While preliminary findings are encouraging, the current evidence is limited by the small cohorts evaluated in studies. Larger prospective studies are needed to validate its efficacy, confirm maternal and neonatal safety, and support guideline development for obstetric use.