Remimazolam - current knowledge on a new benzodiazepine intravenous anesthetic agent

Intravenous anesthetic agents, such as midazolam, propofol or ketamine are routinely used to provide anesthesia and sedation. They have been shown to effectively induce and maintain amnesia, sedation and hypnosis in various patient groups and different clinical settings. However, all anesthetic agents may cause unwanted side effects, like hemodynamic instability, respiratory depression or slow recovery due to prolonged post-procedural sedation. Remimazolam, a recently approved benzodiazepine for general anesthesia and procedural sedation in Korea, has been successfully used to provide general anesthesia and sedation. Based on the data available to date inconclusive knowledge has been gained on the use of remimazolam in different patient populations and under various surgical conditions. With respect to the specific pharmacokinetic and pharmacodynamic characteristics of remimazolam, an increasing number of administrations of remimazolam to provide safe general anesthesia and sedation can be expected. It is the aim of this review to provide an overview of the specific basic and clinical pharmacology of remimazolam and to compare it to midazolam and propofol.