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World J Gastrointest Endosc. Jul 16, 2024; 16(7): 385-395
Published online Jul 16, 2024. doi: 10.4253/wjge.v16.i7.385
Remimazolam for sedation in gastrointestinal endoscopy: A comprehensive review
Dushyant Singh Dahiya, Ganesh Kumar, Syeda Parsa, Manesh Kumar Gangwani, Hassam Ali, Amir Humza Sohail, Saqr Alsakarneh, Umar Hayat, Sheza Malik, Yash R Shah, Bhanu Siva Mohan Pinnam, Sahib Singh, Islam Mohamed, Adishwar Rao, Saurabh Chandan, Mohammad Al-Haddad
Dushyant Singh Dahiya, Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, MO 66160, United States
Ganesh Kumar, 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, Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, United States
Yash R Shah, Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, United States
Bhanu Siva Mohan 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
Author contributions: Dahiya DS, Kumar G, Parsa S, Chandan S, and Al-Haddad M contributed to conception and design; Dahiya DS and Kumar G contributed to administrative support; Dahiya DS, Kumar G, Parsa S, Gangwani MK, Ali H, Sohail AH, Alsakarneh S, Chandan S, and Al-Haddad M contributed to provision, collection, and assembly of data; Dahiya DS, Kumar G, Parsa S, Gangwani MK, Ali H, Sohail AH, Alsakarneh S, Hayat U, Malik S, Shah YR, Pinnam BSM, Singh S, Mohamed I, Rao A, Chandan S, and Al-Haddad M contributed to review of literature and drafting the manuscript; Dahiya DS, Kumar G, Parsa S, Gangwani MK, Ali H, Chandan S, and Al-Haddad M contributed to revision of key components of the manuscript and final approval of manuscript; Dahiya DS, Kumar G, Parsa S, Gangwani MK, Ali H, Sohail AH, Alsakarneh S, Hayat U, Malik S, Shah YR, Pinnam BSM, Singh S, Mohamed I, Rao A, Chandan S, and Al-Haddad M are accountable for all aspects of the work.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dushyant Singh Dahiya, MD, Doctor, Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, 2000 Olathe Blvd, Kansas City, MO 66160, United States. dush.dahiya@gmail.com
Received: March 30, 2024
Revised: May 5, 2024
Accepted: June 4, 2024
Published online: July 16, 2024
Processing time: 99 Days and 9.8 Hours
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.

Keywords: Remimazolam; Endoscopy; Sedation; Outcomes; Efficacy; Safety; Pharmacokinetics

Core Tip: Procedural sedation is a key component of diagnostic and therapeutic gastrointestinal (GI) procedures. It maximizes patient comfort and improves procedural outcomes. Propofol is currently a gold standard for procedural sedation in most parts of the world. However, in recent years, Remimazolam, an ultra-short acting benzodiazepine sedative, is gaining popularity among anesthesiologists and endoscopists for its favorable pharmacology, efficacy, and safety profile. In contrast to other sedatives, particularly Propofol, Remimazolam has lower incidence of intra-procedural hemodynamic instability and respiratory depression. This comprehensive review highlights how Remimazolam can shape the future of GI endoscopy.