ByFavo (remimazolam) / PAION, Cosmo Pharma, Mundipharma, Pharmascience, Eagle Pharma - LARVOL DELTA

Bispectral index during remimazolam versus propofol sedation at matched depths: a randomized, double-blind crossover trial in healthy volunteers. (PubMed, Ann Med) - P4 | "Spectral data were not recorded, so the basis of this offset is undetermined, and the cognitive findings were exploratory. Whether this offset warrants agent-specific reference values requires validation in clinical populations."

Clinical • Journal • Anesthesia

Remimazolam attenuates myocardial ischemia/reperfusion injury by inhibiting ferroptosis involving the AKT/SLC7A11/GPX4 axis. (PubMed, Int J Mol Med) - "In the OGD/R model using H9C2 cells, RMZ normalized Fe2+, GSH and GSH/oxidized GSH levels, decreased peroxidase activity and reduced OGD/R‑induced ferroptosis, which was associated with the restoration of the protein kinase B (AKT)/solute carrier family 7 member 11 (SLC7A11)/glutathione peroxidase 4 (GPX4) axis. These findings demonstrated that RMZ protects against MIRI by inhibiting ferroptosis that involves the activation of the AKT/SLC7A11/GPX4 signaling cascade, highlighting its therapeutic potential for improving cardiac outcomes following reperfusion injury."

Journal • Anesthesia • Cardiovascular • Myocardial Ischemia • Reperfusion Injury • GPX4 • SLC7A11

Efficacy and Safety of Remimazolam Versus Propofol for Sedation During Endoscopic Retrograde Cholangiopancreatography: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis (ACG 2026) - "Ten randomized controlled trials including 1,711 patients were analyzed. RMZ significantly reduced hypotension (RR 0.41, 95% CI 0.33â0.52; p< 0.001), hypoxia (RR 0.51, 95% CI 0.37â0.71; p< 0.001), and bradycardia (RR 0.40, 95% CI 0.27â0.58; p< 0.001) compared with propofol. TSA confirmed these findings as conclusive."

Retrospective data • Review • Cardiovascular • CNS Disorders • Depression • Hypotension

Remimazolam, Midazolam, or Propofol for Colonoscopy Sedation: Comparative Safety and Recovery Outcomes (ACG 2026) - "A total of 146 patients were included; 42 received remimazolam, 52 received midazolam, and 52 received propofol. Time from procedure end to safe discharge did not differ significantly across groups, 134.61 ± 49.43 minutes for remimazolam, 141.92 ± 33.04 minutes for midazolam, and 143.20 ± 41.51 minutes for propofol (p=0.55). Immediate post-procedure average Neuro Level of Consciousness (LOC) score for remimazolam was 1.49 ± 0.51, 1.33 ± 0.48 for midazolam, and 1.27 ± 0.43 for propofol (p=0.076)."

Clinical

Comparison of Remimazolam and Midazolam for Sedation in Upper Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (ACG 2026) - "Four randomized trials involving 337 participants were included. Total procedure time did not differ significantly between groups (MD = â5.67 min; 95% CI: â12.04 to 0.69; I² = 98%; P = 0.08). Remimazolam demonstrated a significantly higher sedation success rate than midazolam (OR = 5.20; 95% CI: 1.34â20.22; I² = 48%; P = 0.02)."

Retrospective data • Review • Hypotension

Remimazolam-Fentanyl Versus Midazolam-Fentanyl for Moderate Sedation in Outpatient Gastrointestinal Endoscopy: A Retrospective Cohort Study (ACG 2026) - "Of 3,986 procedures (650 EGD, 3,336 colonoscopy), sedation duration was 23% shorter with RF for EGD (10 vs 13 min, p< 0.001) and 14% shorter for colonoscopy (24 vs 28 min, p< 0.001). Phase II recovery was 5â6 minutes shorter (p< 0.001) (Figure 2), despite lower fentanyl doses. Hypercapnia was significantly lower with RF (8.5% vs 18.9%, OR 0.40, p< 0.001); bradycardia (OR 0.56) and hypoxemia (OR 0.66) were also lower."

Retrospective data • Cardiovascular

Efficacy and Safety of Remimazolam Versus Propofol for Sedation in Patients Undergoing Colonoscopy: A Systematic Review and Meta-Analysis (ACG 2026) - "This systematic review and meta-analysis included a total of 1846 patients. No significant differences were observed between remimazolam and propofol regarding induction time (MD: 13.78 s, 95% CI: -8.78 to 36.35; p = 0.23), patient satisfaction (RR = 1.03, 95% CI: 0.98â1.10; p = 0.2526), or endoscopist satisfaction (RR = 0.98, 95% CI: 0.94â1.03; p = 0.4304). However, MOAA/S scores were significantly higher in the remimazolam group (MD: 0.80, 95% CI: 0.21 to 1.39; p = 0.007)."

Retrospective data • Review • Cardiovascular

Efficacy and Safety of Remimazolam Sedation in Outpatient Endoscopic Ultrasonography: A Multicenter Randomized Controlled Trial (clinicaltrials.gov) - P=N/A | N=220 | Recruiting | Sponsor: Clinical Research Center, Yokohama Rosai Hospital, Japan Organization of Occupational Health and Safety | Not yet recruiting ➔ Recruiting

Enrollment open • Anesthesia • Hepatology

Evaluation of the effect of remimazolam on A-delta fiber-selective nociceptive evoked potentials. (clinicaltrials.gov) - P=N/A | N=20 | Completed | Sponsor: Shinshu University | Active, not recruiting ➔ Completed

Trial completion • Anesthesia

Hemodynamic Safety of Remimazolam versus Propofol in Elderly Patients Undergoing Upper Gastrointestinal Endoscopy and Colonoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (ACG 2026) - "Ten high-quality randomized controlled trials met inclusion criteria, encompassing 1,994 patients (997 in each treatment group). Remimazolam was associated with significantly lower incidence of hypotension compared with propofol (RR 0.48, 95% CI: 0.38-0.61; P < 0.00001; I² = 52%). Secondary outcomes including bradycardia, respiratory depression, and injection site pain were also significantly reduced in the remimazolam group."

Retrospective data • Review • Cardiovascular • CNS Disorders • Depression • Gastrointestinal Disorder • Hypotension • Inflammatory Bowel Disease

Propofol-Based Sedation Versus Conventional Sedation in Upper Gastrointestinal Endoscopy Followed by Colonoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (ACG 2026) - "Newer agents such as ciprofol and remimazolam have emerged as alternatives. Seven RCTs involving 2,188 participants were included. In the primary analysis, no significant differences were observed in endoscopist satisfaction (p = 0.13), sedation efficacy (p = 0.80), recovery time (p = 0.88), bradycardia (p = 0.18), or respiratory depression (p = 0.06). However, propofol-based sedation was associated with a statistically significant increased risk of hypoxemia (p = 0.007) and hypotension (p = 0.008)."

Retrospective data • Review • Cardiovascular • CNS Disorders • Depression • Hypotension

Clinical Efficacy and Safety of Remimazolam Versus Midazolam for Upper Gastrointestinal Endoscopic Procedures: A Systematic Review and Meta-Analysis (ACG 2026) - "Seven studies (4 RCTs, 3 cohorts) including 771 patients (418 remimazolam, 353 midazolam) were analyzed. Remimazolam significantly shortened recovery time (MD â16.22 min; 95% CI â26.08 to â6.35; p = 0.0013; I² = 97.7%) and discharge readiness (MD â24.55 min; 95% CI â38.82 to â10.28; p = 0.0007; I² = 99.0%) compared with midazolam. Induction time (MD â4.06 min; p = 0.1112; I² = 98.8%) and procedure duration (MD â0.09 min; p = 0.6536; I² = 0%) showed no significant differences."

Retrospective data • Review • CNS Disorders • Depression • Hypotension

Nalbuphine With Remimazolam Versus Nalbuphine With Propofol for Knee Arthroscopy (clinicaltrials.gov) - P4 | N=100 | Completed | Sponsor: Wuhan Fourth Hospital

New P4 trial • Orthopedics

Remimazolam improves survival and attenuates glycocalyx-related injury after hemorrhagic shock in rats. (PubMed, Exp Anim) - "Remimazolam administration was associated with improved survival, lower tumor necrosis factor-α levels, reduced circulating glycocalyx shedding, and a pattern suggestive of partial structural glycocalyx preservation in this rat model of hemorrhagic shock. Flumazenil co-administration attenuated several remimazolam-associated findings; however, a specific mechanism was not established."

Journal • Preclinical • Hematological Disorders • Oncology • SDC1 • TNFA

Remimazolam-Based Anesthesia Without Neuromuscular Blockade for Laparoscopic Surgery in a Patient With Immune-Mediated Necrotizing Myopathy: A Case Report. (PubMed, Case Rep Anesthesiol) - "A 44-year-old woman with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibody-positive immune-mediated necrotizing myopathy and marked preexisting muscle weakness underwent laparoscopic myomectomy under total intravenous anesthesia with remimazolam and remifentanil without neuromuscular blocking agents. In this patient with immune-mediated necrotizing myopathy and marked preexisting muscle weakness, laparoscopic surgery was completed without neuromuscular blocking agents under remimazolam-based total intravenous anesthesia, with low-dose rocuronium available as rescue treatment. Tracheal intubation was smooth, surgical conditions were acceptable, and postoperative respiratory recovery was uncomplicated."

Journal • Anesthesia • Myositis

Patient-controlled Remimazolam Sedation Under Spinal Anesthesia (clinicaltrials.gov) - P=N/A | N=104 | Not yet recruiting | Sponsor: Seoul National University Hospital | Initiation date: Jul 2026 ➔ Oct 2026

Trial initiation date • Anesthesia • Orthopedics

Brain Activity and Changes in Consciousness During General Anesthesia (clinicaltrials.gov) - P4 | N=320 | Not yet recruiting | Sponsor: Beijing Chao Yang Hospital

New P4 trial • Anesthesia

Remimazolam versus Midazolam for Sedation in Upper Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis (IASGO 2026) - "Safety outcomes were comparable, with no significant differences in hypoxemia (OR 0.98, 95%CI 0.36 to 2.64), hypotension (OR 0.59, 95% CI 0.32 to 1.10), bradycardia (OR 0.51, 95% CI 0.22 to 1.16), or nausea (OR 0.76, 95% CI 0.03 to 18.91).Conclusions : Remimazolam is associated with faster recovery, higher sedation success, and reducedneed for flumazenil rescue, with a safety profile comparable to midazolam. These findings supportremimazolam as an effective alternative for sedation in upper gastrointestinal endoscopy."

Retrospective data • Review • Cardiovascular • Hypotension

Dose-Response Relationship of Single Intravenous Remimazolam on Bispectral Index and Cardiorespiratory Effects. (PubMed, Drug Des Devel Ther) - "Sensitivity analysis after excluding one patient who received ciprofol rescue was consistent with the primary analysis. The extremely wide confidence interval for the ED90 estimated using the BIS ≤ 60 threshold suggests that this endpoint may not be suitable for pharmacodynamic evaluation of single-dose remimazolam. The ED estimates obtained with the BIS ≤ 65 threshold are from a post hoc exploratory analysis and await prospective validation in future studies incorporating clinical sedation assessments, such as the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale."

Clinical • Journal • Anesthesia • Cardiovascular • Cough • Pain • Respiratory Diseases

The Use of Remimazolam for TEE (clinicaltrials.gov) - P4 | N=210 | Not yet recruiting | Sponsor: Icahn School of Medicine at Mount Sinai

New P4 trial • Anesthesia • Heart Failure

Precision Sedation for Gastrointestinal Endoscopy in Older Adults: Brain Vulnerability and Recovery. (PubMed, Drug Des Devel Ther) - "Remimazolam and ciprofol may offer greater hemodynamic or respiratory stability in selected patients, while dexmedetomidine and combination regimens can reduce exposure to other sedatives but introduce their own limitations. In older adults, sedation should therefore aim for the minimum effective depth while avoiding excessive drug exposure and promptly correcting respiratory and circulatory disturbances. Further endoscopy-specific studies are needed to determine whether these strategies improve cognitive and functional recovery."

Journal • Review • Alzheimer's Disease • Anesthesia • CNS Disorders • Cognitive Disorders • Depression • Hypotension • Psychiatry

An evaluation of the relationship between BIS and MOAA/S during remimazolam-sufentanil induction: a prospective observational study. (PubMed, Front Med (Lausanne)) - "All participants received intravenous sufentanil (0.1 μg/kg), followed by remimazolam infusion (0.16 mg/kg in elderly patients; 0.22 mg/kg in non-elderly patients). Overall agreement between BIS and MOAA/S was slight (κappa = 0.175). Bispectral Index and MOAA/S exhibit a complex non-linear relationship and slight concordance during induction with remimazolam-sufentanil."

Journal • Observational data • Anesthesia

Remimazolam for Reducing Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Gastrectomy (clinicaltrials.gov) - P=N/A | N=147 | Completed | Sponsor: The First Affiliated Hospital with Nanjing Medical University | Not yet recruiting ➔ Completed | Trial completion date: Dec 2026 ➔ Aug 2026 | Trial primary completion date: Dec 2026 ➔ Jul 2026

Trial completion • Trial completion date • Trial primary completion date • CNS Disorders • Gastric Cancer • Geriatric Disorders • Oncology • Solid Tumor

Optimising Patient-Centred Sedation for Drug-Induced Sleep Endoscopy in Obstructive Sleep Apnoea: A Randomised Controlled Trial of Remimazolam–Propofol (ERS 2026) - "Background: Propofol and midazolam are widely used for procedural sedation. Remimazolam combined with propofol provides safe, effective, and physiologically representative sedation for DISE. It shortens induction and recovery times, improves procedural conditions, and enhances airway assessment accuracy, supporting reliable DISE-guided decision-making and personalized OSA management."

Clinical • Obstructive Sleep Apnea • Respiratory Diseases • Sleep Apnea • Sleep Disorder

In reply: what is the main cause of hypotension after induction of anesthesia with remimazolam in elderly patients? (PubMed, J Anesth) - No abstract available

Journal • Anesthesia • Hypotension