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Remimazolam for sedation in flexible bronchoscopy: A systematic review and meta-analysis of randomised controlled trials
Journal article   Open access   Peer reviewed

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

Maria João Lúcio, Sara Ferreira, Maria Pereira, Catarina Barata, José Manuel Correia, Leonor Mota, Tiago Abreu, Júlio Semedo and Jafar Aljazeeri
Pulmonology, v 32(1), 2691458
Dec 2026
DOI: https://doi.org/10.1080/25310429.2026.2691458
PMID: 42313074
Featured in Collection :   Drexel's Newest Publications
url
https://doi.org/10.1080/25310429.2026.2691458View
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Abstract

Benzodiazepines - administration & dosage Benzodiazepines - adverse effects Benzodiazepines - therapeutic use Bradycardia - chemically induced Bradycardia - epidemiology Bronchoscopy - methods Humans Hypnotics and Sedatives - administration & dosage Hypnotics and Sedatives - adverse effects Hypnotics and Sedatives - therapeutic use Hypotension - chemically induced Hypotension - epidemiology Hypoxia - epidemiology Midazolam - adverse effects Midazolam - therapeutic use Procedural Sedation - methods Randomized Controlled Trials as Topic Respiratory Insufficiency - epidemiology Respiratory Insufficiency - prevention & control
Remimazolam is a novel benzodiazepine increasingly used for procedural sedation and general anaesthesia. Its role in clinical use in flexible bronchoscopy remains under investigation. To evaluate the efficacy and safety of remimazolam in adults undergoing flexible bronchoscopy. 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. 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;  = 0.02). Remimazolam significantly reduced the risk of respiratory depression (risk ratio [RR] = 0.42; 95% CI: 0.25-0.69;  = 0.0007), hypoxaemia (RR 0.61, 95% CI 0.39-0.95;  = 0.03), hypotension (RR = 0.52; 95% CI: 0.35-0.77;  = 0.001), and bradycardia (RR = 0.38; 95% CI: 0.21-0.69;  = 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;  < 0.00001) and shorter recovery (MD =-1.84 min; 95% CI: -3.31 to -0.37;  = 0.01). Compared with propofol, it had lower rates of hypotension, hypoxaemia, and injection pain. Remimazolam is a safe and effective alternative for bronchoscopy sedation, offering improved cardiopulmonary safety and favourable procedural characteristics.

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