Remimazolam for sedation in gastrointestinal endoscopy: A comprehensive review

Dushyant Singh Dahiya, Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, MO 66160, United States.
Ganesh Kumar, Department of Internal Medicine, Chandka Medical College, Sindh 77280, Pakistan.
Syeda Parsa, Department of Internal Medicine, Chandka Medical College, Sindh 77280, Pakistan.
Manesh Kumar Gangwani, Department of Gastroenterology and Hepatology, University of Arkansas For Medical Sciences, Little Rock, AR 72205, United States.
Hassam Ali, Division of Gastroenterology, Hepatology and Nutrition, East Carolina University/Brody School of Medicine, Greenville, NC 27858, United States.
Amir Humza Sohail, Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87106, United States.
Saqr Alsakarneh, Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, United States.
Umar Hayat, Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, PA 18711, United States.
Sheza Malik, Rochester Regional HealthFollow
Yash R. Shah, Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, United States.
Bhanu Siva Pinnam, Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States.
Sahib Singh, Department of Internal Medicine, Sinai hospital, Baltimore, MD 21215, United States.
Islam Mohamed, Department of Hepatology, University of Missouri, Columbia, MO 65211, United States.
Adishwar Rao, Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States.
Saurabh Chandan, Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE 68131, United States.
Mohammad Al-Haddad, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States.

Department

Internal Medicine

Document Type

Article

Publication Title

World Journal of Gastrointestinal Endoscopy

Abstract

Worldwide, a majority of routine endoscopic procedures are performed under some form of sedation to maximize patient comfort. Propofol, benzodiazepines and opioids continue to be widely used. However, in recent years, Remimazolam is gaining immense popularity for procedural sedation in gastrointestinal (GI) endoscopy. It is an ultra-short-acting benzodiazepine sedative which was approved by the Food and Drug Administration in July 2020 for use in procedural sedation. Remimazolam has shown a favorable pharmacokinetic and pharmacodynamic profile in terms of its non-specific metabolism by tissue esterase, volume of distribution, total body clearance, and negligible drug-drug interactions. It also has satisfactory efficacy and has achieved high rates of successful sedation in GI endoscopy. Furthermore, studies have demonstrated that the efficacy of Remimazolam is non-inferior to Propofol, which is currently a gold standard for procedural sedation in most parts of the world. However, the use of Propofol is associated with hemodynamic instability and respiratory depression. In contrast, Remimazolam has lower incidence of these adverse effects intra-procedurally and hence, may provide a safer alternative to Propofol in procedural sedation. In this comprehensive narrative review, highlight the pharmacologic characteristics, efficacy, and safety of Remimazolam for procedural sedation. We also discuss the potential of Remimazolam as a suitable alternative and how it can shape the future of procedural sedation in gastroenterology.

First Page

385

Last Page

395

DOI

10.4253/wjge.v16.i7.385

Volume

16

Issue

7

Publication Date

7-16-2024

PubMed ID

39072252

Link to Full Text

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