Remimazolam for sedation in flexible bronchoscopy: A systematic review and meta-analysis of randomised controlled trials

Background Remimazolam is a novel benzodiazepine increasingly used for procedural sedation and general anaesthesia. Its role in clinical use in flexible bronchoscopy remains under investigation.Aim To evaluate the efficacy and safety of remimazolam in adults undergoing flexible bronchoscopy.Methods This meta-analysis followed PRISMA and Cochrane guidelines. A systematic search of PubMed, Scopus, and the Cochrane Library identified randomised controlled trials (RCT)comparing remimazolam with other sedatives.Results Fifteen RCTs including 2,243 patients were analysed. Procedural success was higher with remimazolam compared with overall sedatives (RR = 1.10; 95% CI: 1.02–1.19; p = 0.02). Remimazolam significantly reduced the risk of respiratory depression (risk ratio RR = 0.42; 95% CI: 0.25–0.69; p = 0.0007), hypoxaemia (RR 0.61, 95% CI 0.39–0.95; p = 0.03), hypotension (RR = 0.52; 95% CI: 0.35–0.77; p = 0.001), and bradycardia (RR = 0.38; 95% CI: 0.21–0.69; p = 0.002). Compared with midazolam, remimazolam had a faster onset, though not statistically significant. Compared with dexmedetomidine, it showed significantly faster onset (MD = –2.16 min, 95% CI: −2.65 to −1.67; p < 0.00001) and shorter recovery (MD =–1.84 min; 95% CI: −3.31 to −0.37; p = 0.01). Compared with propofol, it had lower rates of hypotension, hypoxaemia, and injection pain.Conclusion Remimazolam is a safe and effective alternative for bronchoscopy sedation, offering improved cardiopulmonary safety and favourable procedural characteristics.