SYSTEMATIC REVIEW article
Front. Pediatr.
Sec. Obstetric and Pediatric Pharmacology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1662752
This article is part of the Research TopicInsights in Obstetric and Pediatric Pharmacology: 2025View all 3 articles
Remimazolam in Pediatric Anesthesia: A Systematic Review for Clinical Decision-Making
Provisionally accepted
- 1Wanzhou District maternal and Child Health hospital of Chongqing, Chongqing, China
- 2People's Hospital of Fengjie, Chongqing, China
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Abstract Background: Remimazolam's role in pediatric anesthesia is evolving. We systematically reviewed 2024–2025 evidence to establish a clinical decision-making framework for its use. Methods: Following PRISMA guidelines, a systematic search identified 23 studies (15 RCTs) involving 2,847 pediatric patients for narrative synthesis. Results: Remimazolam demonstrated superior hemodynamic stability versus propofol (cardiovascular complications: RR 0.30, 95% CI 0.20-0.46) and reduced emergence delirium by 61% (RR 0.39, 95% CI 0.21-0.70). The CES1 G143E polymorphism was identified as a genetic basis for prolonged sedation, reducing drug clearance >90%. Critical limitations include a 15% re-sedation rate post-flumazenil, a complete lack of data in infants <1 year, and unknown long-term neurodevelopmental safety. Conclusion: Remimazolam represents a valuable anesthetic tool with specific advantages in pediatric anesthesia. While it demonstrates superior hemodynamic stability and reduced emergence delirium compared to standard agents, it is not a universal replacement for established anesthetics. Current evidence supports its use in specific clinical scenarios, particularly for preventing post-sevoflurane emergence delirium and in hemodynamically unstable patients. However, the absence of infant and long-term neurodevelopmental safety data necessitates continued research before widespread adoption.
Keywords: Remimazolam, pediatric anesthesia, Systematic review, emergence delirium, Hemodynamic stability, Pharmacogenetics, Individualized medication
Received: 09 Jul 2025; Accepted: 08 Sep 2025.
Copyright: © 2025 Zhang, Chen, Wang, Zeng, Cui¹, Guo, Xiang and Mo. 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: Yunbo Mo, Wanzhou District maternal and Child Health hospital of Chongqing, Chongqing, China
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