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The Effect of Remimazolam Administration on Emergence Delirium in Children After General Anesthesia: A Systematic

Ji-Na Kim1, Hyo-Seok Na1,2, Hyun-Jung Shin1,2

  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea.

Paediatric Anaesthesia
|March 6, 2026
PubMed

Insights

Remimazolam significantly reduces emergence delirium in children after anesthesia. This ultra-short-acting benzodiazepine also lowered bradycardia and improved recovery compared to propofol, without impacting overall stability.

Area of Science:

  • Anesthesiology and Perioperative Medicine
  • Pediatric Critical Care

Background:

  • Emergence delirium is a common complication in pediatric patients post-general anesthesia.
  • Remimazolam, an ultra-short-acting benzodiazepine, is a newer agent in pediatric anesthesia.
  • Its efficacy in preventing emergence delirium requires thorough investigation.

Purpose of the Study:

  • To systematically review and meta-analyze the impact of remimazolam on emergence delirium in pediatric patients.
  • To evaluate the incidence and severity of emergence delirium.
  • To assess secondary outcomes including hemodynamic stability and recovery parameters.

Main Methods:

  • A comprehensive literature search was conducted across major databases (PubMed, EMBASE, CENTRAL, Scopus, Web of Science, Google Scholar).
  • Ten randomized controlled trials (RCTs) involving 1231 children were included in the meta-analysis.
  • Random-effects models were used to calculate relative risks and mean differences for primary and secondary outcomes.

Main Results:

  • Remimazolam significantly reduced the incidence of emergence delirium (RR 0.38) and its severity (MD -1.70).
  • A notable decrease in bradycardia (RR 0.39) was observed.
  • While overall hypotension incidence did not differ, remimazolam showed lower rates than propofol in subgroup analysis. Extubation time was comparable overall but shorter versus propofol.

Conclusions:

  • Remimazolam demonstrates potential in mitigating emergence delirium in pediatric patients undergoing general anesthesia.
  • The agent appears to maintain hemodynamic stability and does not prolong recovery time.
  • Further research may solidify remimazolam's role in pediatric anesthesia protocols.
Abstract

Keywords:
childrenemergence agitationemergence deliriumgeneral anesthesiameta‐analysisremimazolam

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