Safety and Efficacy of Remimazolam Compared With Placebo and Midazolam for?Moderate Sedation During Bronchoscopy

摘要

Background While the complexity of flexible bronchoscopy has increased, standard options for moderate sedation medications have not changed in three decades. There is a need to improve moderate sedation while maintaining safety. Remimazolam was developed to address shortcomings of current sedation strategies. Methods A prospective, double-blind, randomized, multicenter, parallel group trial was performed at 30 US sites. The efficacy and safety of remimazolam for sedation during flexible bronchoscopy were compared with placebo and open-label midazolam. Results The success rates were 80.6%?in the remimazolam arm, 4.8%?in the placebo arm (P P P?= .0001) and midazolam (12.0 min; 95%?CI, 5.0-15.0). Remimazolam registered superior restoration of neuropsychiatric function compared with placebo and midazolam. Safety was comparable among all three arms, and 5.6%?of the patients in the remimazolam group had serious treatment-emergent adverse events as compared with 6.8%?in the placebo group. Conclusions Remimazolam administered under the supervision of a pulmonologist was effective and safe for moderate sedation during flexible bronchoscopy. In an exploratory analysis, it demonstrated a shorter onset of action and faster neuropsychiatric recovery than midazolam.