SYSTEMATIC REVIEW article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1581280
The Comparison of Remimazolam and Midazolam in Bronchoscopic Sedation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Provisionally accepted
- 1Medical Research Club, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine., Jerusalem, Palestine
- 2Thoracic Surgery Unit, Al-Ahly Hospital, Hebron, West Bank, Palestine
- 3Al-Quds University, Jerusalem, Jerusalem, Palestine
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Effective sedation is critical for bronchoscopy, ensuring patient comfort and procedural success. Midazolam, though widely used, has limitations such as longer induction and recovery times. Remimazolam, a novel ultra-short-acting benzodiazepine, offers rapid onset, faster recovery, and a safer profile, making it a potential alternative.A systematic review and meta-analysis of four randomized controlled trials (RCTs) involving 630 patients compared remimazolam with midazolam for bronchoscopy sedation. Primary outcomes included induction time, recovery time, and rescue sedation rates. Secondary outcomes assessed procedural duration and adverse events. Randomeffects models were used for analysis, and evidence quality was graded using GRADE criteria.Remimazolam reduced induction time by 3.2 minutes (95% CI: -5.51 to -0.91, p = 0.006) and recovery time (SMD: -0.976, 95% CI: -1.48 to -0.47, p < 0.001) compared to midazolam. Patients receiving remimazolam required less rescue sedation (OR: 0.223, 95% CI: 0.107 to 0.467, p < 0.001). No significant differences were observed in bronchoscopy duration or the incidence of intraoperative and postoperative complications, including hypoxia, hypotension, and nausea.3Remimazolam may reduce induction and recovery times and decrease the need for rescue sedation compared to midazolam. However, due to high heterogeneity and the limited number of studies, these findings should be interpreted with caution. Due to the limited number of studies and observed heterogeneity, further high-quality trials are necessary to confirm these findings.PROSPERO registration number CRD42024623846.
Keywords: Grading of Recommendations, assessment, development, and Evaluation Randomized Controlled Trial Bronchoscopy, Remimazolam, Midazolam, sedation, Systematic review
Received: 21 Feb 2025; Accepted: 24 Jun 2025.
Copyright: © 2025 AbuJwa'id, Deeb, Amro and Abu Asbeh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Alhareth M. Amro, Medical Research Club, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine., Jerusalem, Palestine
Yousef Abu Asbeh, Thoracic Surgery Unit, Al-Ahly Hospital, Hebron, West Bank, Palestine
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