Remimazolam in intensive care unit: Potential applications and considerations

Abstract

This manuscript explores the potential use of Remimazolam in the intensive care unit (ICU) and critical care units, considering its pharmacological characteristics, clinical applications, advantages, and comparative effectiveness over current sedatives and anesthetics. We reviewed existing PubMed and Google Scholar literature to find relevant studies on Remimazolam in ICU. We created search criteria using a combination of free text words, including Remimazolam, critical care, intensive care, sedation, anesthesia, pharmacokinetics, and pharmacodynamics. Relevant articles published in the English language were analyzed and incorporated. Remimazolam is an ultra-short-acting benzodiazepine derivative promising for sedation and anesthesia. It is a safer option for hemodynamically unstable, elderly, or liver or kidney issues. It also has comparable deep sedation properties to propofol in the ICU. Furthermore, it reduces post-procedural delirium and patient comfort and reduces the need for additional sedatives in pediatric patients. In conclusion, Remimazolam is an excellent alternative to current sedatives and anesthetics in the ICU. Its cost is comparable to that of current medications. Further research on its long-term safety in the ICU and its broader application and incorporation into routine use is necessary.

Keywords: Remimazolam; Intensive care; Critical care; Anesthesia; Sedation; Mechanical ventilation; Benzodiazepine

Core Tip: Remimazolam, an ultra-short-acting benzodiazepine, offers rapid onset, stable hemodynamics, and organ-independent metabolism, ideal for intensive care unit sedation and procedural anesthesia. Its advantages over traditional sedatives like midazolam and propofol include faster recovery, reduced hemodynamic instability, and a favorable safety profile. Remimazolam is effective for sedation in hemodynamically unstable patients and those with hepatic or renal impairment, highlighting its potential for broader clinical application. Further research is necessary to establish guidelines for its routine use.