Role of remimazolam in gastrointestinal endoscopy: American Society for Gastrointestinal Endoscopy clinical practice update.

Abstract

This clinical practice update provides evidence-based recommendations on the use of remimazolam, a novel ultra-short-acting benzodiazepine, for procedural sedation during GI endoscopy. Remimazolam was approved by the Food and Drug Administration in July 2020 for use in procedural sedation. It offers rapid onset, short duration of action, and organ-independent metabolism, making it an alternative to traditional sedatives such as midazolam and propofol. This update synthesizes data from randomized controlled trials, meta-analyses, and real-world studies, addressing efficacy, safety, dosing, and patient selection. It aims to assist clinicians in optimizing sedation while minimizing risks, particularly in high-risk populations. Previous guidelines, such as the 2018 American Society for Gastrointestinal Endoscopy guidelines on sedation and anesthesia in GI endoscopy, focused on midazolam and propofol but did not include remimazolam. This update incorporates emerging evidence to guide the integration of remimazolam into practice.