Authors: Obara, Shinju MD; Brandenburg, Jacob MD, MBA
Anesthesia & Analgesia 141(1):p 86-89, July 2025. | DOI: 10.1213/ANE.0000000000007481
This editorial discusses the clinical adoption of remimazolam, an ultrashort-acting intravenous benzodiazepine anesthetic, across different global regions. Since its approval in 2020, remimazolam has gained attention for its lower risk of circulatory depression, rapid recovery profile, and availability of a reversal agent. However, translating trial findings into routine clinical use remains challenging due to regional variations in guidelines, approved indications, and administration techniques.
As of March 2024, remimazolam besylate is approved for both general anesthesia and procedural sedation in Europe, South Korea, and Taiwan. In Japan, its use is confined to infusion for induction and maintenance of general anesthesia. In China and the United States, it is limited to procedural sedation. These differences result in varying dosage recommendations and applications, particularly in high-risk situations like ERCP where circulatory depression is a concern.
The editorial highlights a study by Xiao et al. which provides insights into the hemodynamic advantages of remimazolam compared to propofol. Xiao’s methodology closely followed Japan’s national induction dosing standards, revealing that remimazolam was associated with fewer hypotensive episodes. The authors emphasize the need for region-specific protocols to optimize remimazolam’s application and suggest that broader international collaboration is required to establish consistent best practices.
References:
Obara S, Brandenburg J. 2025.
Anesthesia & Analgesia 141(1):p 86-89. doi:10.1213/ANE.0000000000007481
Thank you to the International Anesthesia Research Society for allowing us to share this article and highlight their journal.