Comparison of the safety and efficacy of remimazolam versus propofol for sedation in patients undergoing fiberoptic bronchoscopy with preserved spontaneous breathing: a retrospective analysis

Background and Objectives Adequate sedation with preserved spontaneous breathing and stable hemodynamics is critical for the success and safety of fiberoptic bronchoscopy (FOB). Remimazolam, a novel ultra-short-acting benzodiazepine with rapid metabolism and favorable sedative profiles, has shown promising sedative effects for procedural sedation. However, comparative data on its application in FOB with preserved spontaneous breathing remain limited. This retrospective study aimed to compare the safety and efficacy of remimazolam and propofol for sedation in patients undergoing FOB with preserved spontaneous breathing. Materials and Methods A retrospective chart review was conducted from October 2024 to October 2025. All patients undergoing FOB with preserved spontaneous breathing were enrolled. Patients were divided into two groups based on the sedative used: remimazolam (Group R) and propofol (Group P). The primary outcome was the sedation success rate. Secondary outcomes included hemodynamic parameters, incidence of adverse events, anesthesia-related times, satisfaction scores of endoscopists and patients. Results Thirty-six patients in group R and Forty in group P were collected in this retrospective study. Sedation success rate was 100% in both groups. Oxygen saturation (SpO 2 ) levels were higher in group R at beginning of the bronchoscopy, 5, 10, and 15 min after the start of bronchoscopy ( P = 0.012, 0.001, 0.017, and 0.006, respectively). Group R had a lower incidence of hypoxemia (16.67% vs . 35.0%, P = 0.034), injection pain (0% vs . 17.5%, P = 0.008), and hypotension (5.56% vs . 22.5%, P = 0.036). Recovery time was shorter in group R ( P = 0.017). Onset time, and satisfaction scores were comparable in the two groups. Conclusion Our study uncovered remimazolam demonstrates a comparable success rate to propofol and exhibits favorable safety profiles, including reduced hypoxemia, injection pain, and hypotension during FOB with preserved spontaneous breathing. However, the shorter recovery time in Group R was confounded by the routine use of flumazenil, and the findings are limited by the retrospective design, small sample size and exclusive enrollment of ASA I–II patients, requiring validation in larger, prospective studies.