Related Experiment Video

Updated: Jun 28, 2026

Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
07:54

Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea

Published on: December 6, 2016

Remimazolam versus midazolam for moderate sedation in gastrointestinal endoscopy: a systematic review and

Umar Akram1, Eeman Ahmad2, Shahzaib Ahmed2

  • 1Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan.

Gastrointestinal Endoscopy
|June 26, 2026
PubMed
Abstract

Insights

Remimazolam offers comparable sedation success to midazolam for GI endoscopy but with faster recovery and higher patient satisfaction. This ultra-short-acting benzodiazepine may be a safer alternative, reducing hypotension and bradycardia risks.

Area of Science:

  • Pharmacology and Gastroenterology
  • Clinical Trial Analysis
  • Procedural Sedation

Background:

  • Midazolam is a common agent for gastrointestinal (GI) endoscopy sedation, but can cause delayed recovery and adverse effects.
  • Remimazolam, an ultra-short-acting benzodiazepine, offers potential for rapid onset and recovery.
  • Comparing remimazolam and midazolam is crucial for optimizing procedural sedation in GI endoscopy.

Purpose of the Study:

  • To systematically review and compare the efficacy and safety of remimazolam versus midazolam for sedation during GI endoscopy.
  • To evaluate key outcomes including sedation success, induction and recovery times, patient satisfaction, and adverse events.

Main Methods:

  • A systematic literature search was performed across major databases (PubMed, Cochrane CENTRAL, Google Scholar, clinicaltrials.gov) up to March 2026.
  • Included studies were randomized controlled trials (RCTs) directly comparing remimazolam and midazolam for GI endoscopy sedation.
  • Meta-analysis was conducted using R studio to synthesize data from 9 RCTs involving 1,251 patients.

Main Results:

  • No significant difference in sedation success rates was found between remimazolam and midazolam (p=0.08).
  • Remimazolam significantly reduced induction time (p=0.04), time to full alertness (p=0.012), recovery time (p<0.001), and discharge time (p=0.04).
  • Remimazolam was associated with higher patient satisfaction (p<0.01) and significantly lower risks of hypotension (p<0.001) and bradycardia (p=0.037).

Conclusions:

  • Remimazolam provides comparable sedation success to midazolam for GI endoscopy but offers faster recovery and improved patient experience.
  • Remimazolam demonstrates a favorable safety profile, with reduced risks of hypotension and bradycardia compared to midazolam.
  • Remimazolam represents a potentially safer and more efficient alternative for procedural sedation in GI endoscopy, though heterogeneity requires cautious interpretation.

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