Comparative study on the efficacy and safety of remimazolam versus midazolam for sedation during ERCP-related procedures in the elderly.

Efficacy and Safety of Remimazolam versus Midazolam for Sedation during Endoscopic Ultrasound-Guided Tissue Acquisition in Patients with Solid Pancreatic Lesions.

OBJECTIVES Remimazolam is an ultra-short-acting benzodiazepine with a shorter pharmacokinetic half-life than midazolam. This study compared the efficacy and safety of remimazolam and midazolam for sedation during endoscopic ultrasound-guided tissue acquisition (EUS-TA) in patients with solid pancreatic lesions. METHODS AND PATIENTS We retrospectively reviewed patients who underwent EUS-TA under remimazolam (August 2025-February 2026) or midazolam (January 2025-July 2025). The primary outcome was the time from procedure completion to patient awakening. Secondary outcomes included sedation success rate, time to sedation onset, total dose and number of doses, agitation requiring procedure interruption, flumazenil use, and sedation-related adverse events. RESULTS A total of 101 patients received remimazolam and 105 received midazolam. Median time from procedure completion to patient awakening was significantly shorter with remimazolam (2 min; interquartile range [IQR] 2-3) than with midazolam (4 min; IQR 3-5; P<0.01). The median total number of doses was higher with remimazolam (P<0.01), while flumazenil administration was significantly lower (P<0.01). Sedation success rate, time to sedation onset, agitation requiring procedure interruption, and adverse event rates did not differ significantly. CONCLUSION Remimazolam was associated with faster recovery and reduced flumazenil use, suggesting improved efficiency and safety in post-procedural monitoring, along with decreased staff workload after EUS-TA.

Safety and Efficacy of Remimazolam Combined with Esketamine for Anesthesia in Elderly Patients Undergoing ERCP: A Randomized Controlled Trial

In this selected population of older patients undergoing ERCP, the remimazolam-esketamine regimen was associated with fewer composite SRAEs than propofol-fentanyl while achieving a similar anesthetic regimen success rate.

EFFICACY OF DEXMEDETOMIDINE VERSUS MIDAZOLAM FOR SEDATION IN PATIENTS UNDERGOING REGIONAL ANESTHESIA: A RANDOMIZED CONTROLLED STUDY

Objectives: The objective of the study was to assess the effectiveness and safety of dexmedetomidine versus midazolam for sedation during regional anesthesia surgery. Methods: This prospective randomized comparative interventional study was conducted in the Department of Anesthesiology at a tertiary care hospital from January 2025 to January 2026. 100 adult patients undergoing elective surgeries under regional anesthesia were randomly divided into two groups: Group D (dexmedetomidine, n=50) and Group M (midazolam, n=50). Richmond agitation sedation scale (RASS) was used to evaluate sedation. Intraoperative monitoring of hemodynamic parameters, such as mean arterial pressure and heart rate, was performed. Recovery characteristics, patient satisfaction, requirement for rescue sedation and adverse effects were also assessed. Results: The mean intraoperative RASS score was significantly lower in the Group D than in the Group M (−2.8±0.5 vs. −2.5±0.7; p=0.02). The time required to reach the target sedation level was significantly greater in Group D (9.4±2.6 min vs. 7.8±2.4 min; p=0.003). The scores of patient satisfaction with dexmedetomidine use were significantly greater than with midazolam use (8.5±1.0 vs. 7.9±1.2; p=0.01). Dexmedetomidine was associated with more adverse effects of bradycardia (p=0.08) and hypotension (p=0.46), whereas midazolam was associated with more adverse effects of excessive sedation (p=0.14) and restlessness (p=0.09). Conclusion: Dexmedetomidine and midazolam were both found to be effective sedatives for patients undergoing regional anesthetic. Dexmedetomidine was found to be a more effective sedative, well tolerated, more patient-satisfying and more stable for intraoperative hemodynamic despite its comparatively slower onset of sedation than midazolam.

The median effective dose (ED50) of remimazolam combined with esketamine for conscious sedation in patients with dental anxiety undergoing outpatient dental surgery: a prospective, dose-finding study.

The ED50 provides a preliminary reference for initial dose selection in this clinical setting and requires validation in larger studies, but the wide confidence interval of the ED95 limits its clinical utility and requires validation in larger studies.

Efficacy and safety of remifentanil and fentanyl in adult endoscopic interventions: a systematic review and meta-analysis of randomized controlled trials

Despite the growing interest in remifentanil for endoscopic procedures, available data are conflicting. Objective. To evaluate efficacy and safety of remifentanil and fentanyl for analgesia in adults undergoing endoscopic procedures. Material and methods. Nine biomedical databases were screened regarding randomized controlled trials (RCTs) involving remifentanil or fentanyl as components of analgesia for endoscopic procedures under spontaneous breathing in adults. Primary endpoints included procedural measures (time to induction, recovery and complete recovery, achievement of discharge criteria), incidence of intraoperative respiratory depression and postoperative pain. The review was conducted in accordance with the PRISMA 2020 guidelines. Results. Meta-analysis included 16 RCTs (1.242 patients). Remifentanil provided faster induction (MD –1.47 min, 95% CI –2.27 to –0.68, p=0.0003) and awakening (MD –2.98 min, 95% CI –4.25 to –1.72, p<0.00001) compared to fentanyl. Remifentanil provided earlier complete recovery (MD –5.64 min, 95% CI –7.67 to –3.61, p<0.00001) and complete recovery for discharge (MD –22.24 min, 95% CI –26.91 to –17.57, p<0.00001). Remifentanil was associated with a trend towards higher risk of respiratory depression compared to fentanyl, but the difference was insignificant (RR=1.25; 95% CI 0.89 to 1.75; p=0.19). Both opioids had equivalent profiles in terms of blood pressure control, bradycardia risk, and postoperative pain. Conclusion. Remifentanil significantly reduces time to induction, recovery and complete recovery, as well as achievement of discharge criteria in endoscopic procedures in adults. However, these results are preliminary due to low certainty of evidence (GRADE ). When using remifentanil, strict monitoring of gas exchange and readiness for mechanical ventilation are necessary. Further randomized controlled trials are needed to determine optimal dose of remifentanil, especially in high-risk patients.

Efficacy and safety of oliceridine versus sufentanil in perioperative anesthesia and analgesia: a systematic review and meta-analysis with trial sequential analysis