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. 2025 Jul 8:12:1581280.
doi: 10.3389/fmed.2025.1581280. eCollection 2025.

The comparison of remimazolam and midazolam in bronchoscopic sedation: a systematic review and meta-analysis of randomized controlled trials

Yahya Kayed AbuJwaid #  1 , Salahaldeen Deeb #  1 , Alhareth M Amro #  1 , Yousef Abu Asbeh  1   2
Affiliations

The comparison of remimazolam and midazolam in bronchoscopic sedation: a systematic review and meta-analysis of randomized controlled trials

Yahya Kayed AbuJwaid et al. Front Med (Lausanne). .

Abstract

Background: 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.

Study design and methods: 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. Random-effects models were used for analysis, and evidence quality was graded using GRADE criteria.

Results: Remimazolam reduced induction time by 3.2 min (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.

Conclusion: Remimazolam 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.

Clinical trial registration: Clinicaltrial.gov, identifier: CRD42024623846.

Keywords: bronchoscopy; meta-analysis; midazolam; remimazolam; sedation; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study searching and selection process.
Figure 2
Figure 2
(A) Traffic light plot representing the risk of bias across the studies, (B) Summary plot representing the total risk of bias in each domain.
Figure 3
Figure 3
Forest plot for comparison of induction time, recovery time, and administration of rescue sedation between remimazolam and midazolam.
See this image and copyright information in PMC

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