Author: Abramovich I et al.
Current Opinion in Anesthesiology 38(5):547–552, October 2025. doi:10.1097/ACO.0000000000001524
This review examines remimazolam—an ultrashort-acting benzodiazepine—in neuroanesthesia. Across recent RCTs and case reports, remimazolam generally produced fewer hypotensive episodes, reduced vasopressor requirements, and allowed faster emergence, especially when flumazenil was used. However, higher BIS values at comparable sedation levels raise monitoring accuracy questions. Evidence gaps remain around long-term safety, standardized dosing, tolerance potential, and performance across diverse neuro cases and comorbidities. Until larger multicenter trials with uniform methods are available, careful dosing and vigilant monitoring are advised to balance hemodynamics, depth of anesthesia, and timely recovery.
What You Should Know
• Promising hemodynamic profile: fewer hypotension events and less vasopressor use vs some alternatives.
• Rapid recovery possible, particularly with flumazenil reversal.
• BIS may read higher at similar sedation—interpret monitoring cautiously.
• Key unknowns: long-term safety, standardized dosing, tolerance risk, generalizability across populations.
• Use judiciously with close monitoring until stronger multicenter evidence emerges.
Thank you to Current Opinion in Anesthesiology for making this work available.