Remimazolam in anesthesia and sedation: A narrative review

Remimazolam, an innovative sedative, provides a rapid onset and quick recovery by being rapidly hydrolyzed into pharmacologically inactive CNS7054 via ubiquitous nonspecific esterases. Its pharmacokinetic characteristics (high clearance rate, small steady-state volume of distribution, short terminal half-life, and no tissue accumulation) further lay the foundation for clinical application. Compared with traditional sedative drugs, the prominent innovations of this drug are reflected in three aspects: first, it has less impact on the respiratory and circulatory systems, with stable hemodynamics and a low incidence of discomfort at the administration site; second, its sedative effect can be specifically antagonized by flumazenil, allowing for more flexible safety regulation; third, it shows excellent safety and effectiveness in special populations such as elderly patients and those with comorbid cardiovascular diseases. Clinical evidence shows that remimazolam is more effective than similar drugs in scenarios such as gastrointestinal endoscopy, operating rooms, and ICUs. Its reliable performance in special populations further supports its value as a sedative that combines innovation with clinical practicality and holds broad application prospects. This review aims to systematically elaborate on the pharmacological properties and clinical application value of remimazolam, a new benzodiazepine derivative, and provide references for its standardized use in various diagnostic and therapeutic scenarios and special populations.