Rethinking remimazolam: reconciling regulatory positioning with clinical reality

Goyal and colleagues share a large United States health system's experience of 9431 cases of real-world remimazolam use, offering insight into current practice patterns, recovery times, and accurate adverse event rates. The authors report rapid recovery after remimazolam, including shorter time to post-anaesthesia care unit discharge readiness and faster return to baseline on the Richmond Agitation–Sedation Scale following flumazenil administration, with a critical event rate of 0.7%. Interesting practice patterns were observed, including frequent co-administration with other anaesthetics rather than as a sole agent. Although only licensed for procedural sedation in the United States, the authors reported extensive use of remimazolam to induce anaesthesia, especially for patients with an American Society of Anesthesiologists physical status of 3–5. This editorial highlights the disconnect between the development of remimazolam and its practical clinical use, as well as the work still needed to clarify the agent's optimal role.