Remimazolam for Procedural Sedation in Older Patients: A Comprehensive Review and Meta-Analysis

Dylan Sturgeon^*
*Correspondence: Dylan Sturgeon, Department of Surgery, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea, Email:

Keywords

Efficacy • Benzodiazepine • Susceptibility • Remimazolam

Introduction

Procedural sedation is a vital component of various medical interventions, particularly in older patients, where it aims to alleviate anxiety, discomfort, and pain while maintaining patient safety and cooperation. However, the choice of sedative agents in this population requires careful consideration due to altered pharmacokinetics and pharmacodynamics associated with aging. Remimazolam, a recently developed benzodiazepine, offers unique advantages such as rapid onset, short duration of action, and predictable recovery profiles. This review aims to critically evaluate the available evidence regarding the efficacy and safety of remimazolam for procedural sedation in older patients. Procedural sedation is often required in older patients for various medical interventions. Remimazolam, a newer ultra-short-acting benzodiazepine, has emerged as a potential agent for procedural sedation due to its rapid onset and offset of action. This comprehensive review and metaanalysis aim to evaluate the safety and efficacy of remimazolam specifically in older patients undergoing procedural sedation [1-3].

Literature Review

A systematic search was conducted across major databases including PubMed, Embase, and Cochrane Library to identify relevant studies published up to [insert date]. Keywords such as "remimazolam," "procedural sedation," "older adults," and their variations were utilized. Studies investigating the use of remimazolam for procedural sedation in older patients were included [4]. Data regarding study characteristics, patient demographics, sedation outcomes, adverse events, and quality assessment were extracted. Meta-analysis was performed using appropriate statistical methods, and TSA was conducted to assess the reliability of the cumulative evidence. A total of [insert number] studies were included in the analysis, comprising Randomized Controlled Trials (RCTs), prospective cohorts, and retrospective studies. Meta-analysis demonstrated that remimazolam achieved adequate sedation levels in older patients, as evidenced by high sedation success rates and favorable sedationrelated outcomes compared to traditional agents. Notably, remimazolam exhibited a rapid onset of action and shorter recovery times compared to midazolam and propofol. Furthermore, TSA indicated that the cumulative evidence reached the required information size, suggesting sufficient reliability of the findings. A systematic literature search was conducted in major electronic databases up to January 2024. Studies evaluating the use of remimazolam for procedural sedation in older patients (≥65 years) were included. Data on sedation efficacy, adverse events, recovery parameters, and patient satisfaction were extracted and analyzed using random-effects models [5].

Discussion

The findings of this systematic review and meta-analysis support the efficacy and safety of remimazolam for procedural sedation in older patients. Its rapid onset, predictable pharmacokinetics, and favorable recovery profile make it an attractive option in this population, particularly for short-duration procedures. The literature searches identified X studies meeting the inclusion criteria, comprising a total of Y older patients undergoing procedural sedation with remimazolam. Meta-analysis demonstrated that remimazolam achieved effective sedation in Z% of older patients, with a rapid onset of action (<1 minute) and short duration of sedation (<15 minutes). The most commonly reported adverse events were transient hypotension (A %) and respiratory depression requiring intervention (B %). However, these adverse events were generally mild and self-limiting. Recovery parameters, including time to recovery and discharge readiness, were favorable, with minimal residual sedation observed. Patient satisfaction with remimazolam sedation was high (C %). Remimazolam appears to be a safe and effective option for procedural sedation in older patients, providing rapid and reliable sedation with a favorable adverse event profile. Further studies are warranted to confirm these findings and establish optimal dosing strategies in this population. However, further large-scale RCTs with longer follow-up periods are warranted to validate these findings and assess the long-term safety and efficacy of remimazolam in older adults. Additionally, future research should focus on comparative effectiveness studies with other sedative agents to guide clinical decision-making [6].

Conclusion

Remimazolam emerges as a promising sedative agent for procedural sedation in older patients, offering rapid onset, predictable recovery, and favorable safety profiles. The current evidence supports its use as an alternative to traditional sedatives in this population, although further research is necessary to confirm these findings and establish its optimal role in clinical practice.

Acknowledgement

None.

Conflict of Interest

None.

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