Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Oncology Letters
      • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Biomedical Reports
      • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • Information for Authors
    • Information for Reviewers
    • Information for Librarians
    • Information for Advertisers
    • Conferences
  • Language Editing
Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • For Authors
    • For Reviewers
    • For Librarians
    • For Advertisers
    • Conferences
  • Language Editing
Login Register Submit
  • This site uses cookies
  • You can change your cookie settings at any time by following the instructions in our Cookie Policy. To find out more, you may read our Privacy Policy.

    I agree
Search articles by DOI, keyword, author or affiliation
Search
Advanced Search
presentation
Biomedical Reports
Join Editorial Board Propose a Special Issue
Print ISSN: 2049-9434 Online ISSN: 2049-9442
Journal Cover
June-2026 Volume 24 Issue 6

Full Size Image

Sign up for eToc alerts
Recommend to Library

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

Medicine International

An International Open Access Journal Devoted to General Medicine.

Journal Cover
June-2026 Volume 24 Issue 6

Full Size Image

Sign up for eToc alerts
Recommend to Library

  • Article
  • Citations
    • Cite This Article
    • Download Citation
    • Create Citation Alert
    • Remove Citation Alert
    • Cited By
  • Similar Articles
    • Related Articles (in Spandidos Publications)
    • Similar Articles (Google Scholar)
    • Similar Articles (PubMed)
  • Download PDF
  • Download XML
  • View XML
Article Open Access

Comparative efficacy and safety of remimazolam vs. dexmedetomidine: A systematic review and meta‑analysis

  • Authors:
    • Rong Hu
    • Rongxiao Ping
  • View Affiliations / Copyright

    Affiliations: Department of Anesthesiology, CiXi Maternity and Child Health Care Hospital, Cixi, Zhejiang 315300, P.R. China
    Copyright: © Hu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 73
    |
    Published online on: April 17, 2026
       https://doi.org/10.3892/br.2026.2146
  • Expand metrics +
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )
Cited By (CrossRef): 0 citations Loading Articles...

This article is mentioned in:


Abstract

Sedation is a critical component of modern anesthesia and procedural medicine, particularly outside the operating room. Dexmedetomidine and remimazolam have emerged as prominent sedatives due to their unique pharmacological profiles. However, the comparative efficacy and safety of these agents remain incompletely understood, especially regarding recovery times and adverse events. In the present study, a systematic review and meta‑analysis as performed following Preferred Reporting Items for Systematic Reviews and Meta‑Analyses guidelines. A comprehensive literature search was conducted across PubMed, Cochrane Library and Scopus from inception until March 2025. The eligible studies compared the sedation efficacy, safety and recovery time of the dexmedetomidine group with the remimazolam group. Data extraction was independently conducted by two reviewers using a standardized data collection form. The methodological quality of observational studies was assessed using the Risk of Bias in Non‑randomized Studies‑of Interventions (ROBINS‑I) tool, while randomized controlled trials (RCTs) were evaluated using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool. Meta‑analyses were conducted using random‑effects models, and heterogeneity was evaluated through prediction interval analysis and sensitivity testing. A total of 9 studies were included, 4 of which were RCTs and judged to have low risk of bias across all domains. The remaining 5 observational studies, with most rated as having moderate risk of bias and 1 study rated as serious due to confounding and outcome measurement concerns. The forest plot analysis revealed that there was no statistically significant difference in the sedation efficacy between the dexmedetomidine group and the remimazolam group [standardized mean difference (SMD), 0.049; 95% confidence interval (CI), ‑0.101 to 0.198; P=0.523]. However, the remimazolam group consistently demonstrated significantly shorter full alertness times compared with the exmedetomidine group (SMDs ranging from ‑0.511 to ‑1.852, all P<0.001). There was no significant difference in the overall risk of adverse events between the two groups [odds ratio (OR), 1.509; 95% CI, 0.246‑9.153; P=0.654]; however, the subgroup analysis showed that the risk of arrhythmia in the dexmedetomidine group was significantly higher than that in the remimazolam group (OR, 2.152; 95% CI, 1.158‑3.999; P=0.015). In conclusion, both dexmedetomidine and remimazolam achieved similar sedation success rates, indicating no significant difference in procedural efficacy. However, remimazolam was associated with significantly faster recovery times and a lower risk of arrhythmia, making it particularly attractive for short‑duration or outpatient procedures where rapid emergence and hemodynamic stability are prioritized.
View Figures

Figure 1

Study selection process following the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines. The flowchart details the number of records identified
through database searches, the removal of duplicates and the
screening process based on title and abstract review. The flowchart
further outlines the exclusion of ineligible full-text articles,
culminating in the final inclusion of 9 studies in the systematic
review and meta-analysis.

Figure 2

Forest plot summarizing the SMD in
various outcomes comparing dexmedetomidine and remimazolam. The
outcomes include discharge time, expert satisfaction, patient
satisfaction, procedure success, procedure time and time to full
alertness. The pooled estimate at the bottom suggests no
significant overall difference between the two agents, as indicated
by an SMD of 0.049 (95% CI, -0.101 to 0.198; P=0.523). Significant
heterogeneity exists among individual studies, as seen in the
varied effect sizes across different trials. SMD, standardized mean
differences; CI, confidence interval.

Figure 3

Meta-regression plots assessing the
influence of age and dose on sedation outcomes. Each panel displays
a bubble plot representing meta-regression of the log odds ratios
for sedation success, with study weight proportional to bubble
size. The red line indicates the fitted regression line and the
green lines denote 95% confidence intervals. (A) Effect of the age
of patients on Rem sedation outcome. (B) Effect of the age of
patients on Dex sedation outcome. (C) Effect of Rem dose on
sedation outcome. (D) Effect of Dex dose on sedation outcome. Rem,
remimazolam; Dem, dexmedetomidine.

Figure 4

Leave-one-out sensitivity analysis
for procedure success. The plot assesses whether the exclusion of
any single study significantly alters the overall meta-analytic
findings. The results indicate that the pooled odds ratios remain
stable, ranging from 0.784 to 1.320, with CIs consistently
including 1.0, confirming the robustness of the results. No single
study exerts a disproportionate influence on the overall effect
estimate. CI, confidence intervals.

Figure 5

Funnel plot for publication bias
assessment in procedure success outcomes. The reasonably symmetric
distribution of studies suggests a low likelihood of significant
publication bias. This is further supported by Begg-Mazumdar rank
correlation test (Kendall's τ=0.20; P=0.53) and the fail-safe N
analysis, indicating that additional missing studies would not
significantly impact the observed effects.

Figure 6

Forest plot summarizing the safety
outcomes of dexmedetomidine and remimazolam. The included adverse
events analyzed across the studies are AKI, mortality, arrhythmia,
bradycardia, delirium, epistaxis, hypertension, hypotension,
hypoxia, respiratory depression, stroke and transfusion
requirements. The majority of CIs cross 1.0, suggesting no
significant difference between the two agents in terms of overall
safety, except for arrhythmia, which showed a higher odds ratio in
the dexmedetomidine group. AKI, acute kidney injury; CI, confidence
interval.

Figure 7

Distribution of true effects using a
prediction interval analysis. The mean standardized difference in
means was estimated at 0.92, with a 95% confidence interval ranging
from -0.13 to 1.97. The prediction interval, which estimates the
effect size in 95% of similar populations, extended from -1.43 to
3.27. This wide range suggests variability across studies and
highlights the uncertainty in estimating the true effect size in
different clinical settings.
View References

1 

Kim H, Kim Y, Bae J, Yoo S, Lim YJ and Kim JT: Comparison of remimazolam and dexmedetomidine for intraoperative sedation in patients undergoing lower extremity surgery under spinal anesthesia: A randomized clinical trial. Reg Anesth Pain Med. 49:110–116. 2024.PubMed/NCBI View Article : Google Scholar

2 

Keating GM: Dexmedetomidine: A review of its use for sedation in the intensive care setting. Drugs. 75:1119–1130. 2015.PubMed/NCBI View Article : Google Scholar

3 

Lee S: Dexmedetomidine: Present and future directions. Korean J Anesthesiol. 72:323–330. 2019.PubMed/NCBI View Article : Google Scholar

4 

Hoy SM and Keating GM: Dexmedetomidine: A review of its use for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation. Drugs. 71:1481–1501. 2011.PubMed/NCBI View Article : Google Scholar

5 

Huang X, Lin D, Sun Y, Wu A and Wei C: Effect of dexmedetomidine on postoperative sleep quality: A systematic review. Drug Des Devel Ther. 15:2161–2170. 2021.PubMed/NCBI View Article : Google Scholar

6 

Sulton C, McCracken C, Simon HK, Hebbar K, Reynolds J, Cravero J, Mallory M and Kamat P: Pediatric procedural sedation using dexmedetomidine: A report from the pediatric sedation research consortium. Hosp Pediatr. 6:536–544. 2016.PubMed/NCBI View Article : Google Scholar

7 

Kitaura A, Tsukimoto S, Sakamoto H, Hamasaki S, Nakao S and Nakajima Y: A retrospective comparative study of anesthesia with remimazolam and remifentanil versus dexmedetomidine and remifentanil for transcatheter aortic valve replacement. Sci Rep. 13(17074)2023.PubMed/NCBI View Article : Google Scholar

8 

Kempenaers S, Hansen TG and Van de Velde M: Remimazolam and serious adverse events: A scoping review. Eur J Anaesthesiol. 40:841–853. 2023.PubMed/NCBI View Article : Google Scholar

9 

Kuklin V and Hansen TG: Remimazolam for sedation and anesthesia in children: A scoping review. Acta Anaesthesiol Scand. 68:862–870. 2024.PubMed/NCBI View Article : Google Scholar

10 

Ma Y, Li C, Peng W and Wan Q: The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantation. Front Neurol. 14(1229990)2023.PubMed/NCBI View Article : Google Scholar

11 

Morgan ME, Kukora S, Nemshak M and Shuman CJ: Neonatal pain, agitation, and sedation scale's use, reliability, and validity: A systematic review. J Perinatol. 40:1753–1763. 2020.PubMed/NCBI View Article : Google Scholar

12 

Brüggemann V and Hansen TG: Remimazolam for sedation and anesthesia in children: Protocol for a scoping review. Acta Anaesthesiol Scand. 68:848–851. 2024.PubMed/NCBI View Article : Google Scholar

13 

Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, Schwam EM and Siegel JL: Validity and reliability of the observer's assessment of alertness/sedation scale: Study with intravenous midazolam. J Clin Psychopharmacol. 10:244–251. 1990.PubMed/NCBI

14 

Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, Tesoro EP and Elswick RK: The richmond agitation-sedation scale: Validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 166:1338–1344. 2002.PubMed/NCBI View Article : Google Scholar

15 

Kim JH, Nam JS, Seo WW, Joung KW, Chin JH, Kim WJ, Choi DK and Choi IC: Effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: A propensity score-matched, non-inferiority study. Korean J Anesthesiol. 77:537–545. 2024.PubMed/NCBI View Article : Google Scholar

16 

Chen Q, Qin B, Zhang M, Zhou Y, Shi X and Xie Y: The safety and efficacy of remimazolam compared to dexmedetomidine for awake tracheal intubation by flexible bronchoscopy: A randomized, double-blind, controlled trial. Drug Des Devel Ther. 18:967–978. 2024.PubMed/NCBI View Article : Google Scholar

17 

Chen X, Sang N, Song K, Zhong W, Wang H, Jiang J, Huang Y and Hu P: Psychomotor recovery following remimazolam-induced sedation and the effectiveness of flumazenil as an antidote. Clin Ther. 42:614–624. 2020.PubMed/NCBI View Article : Google Scholar

18 

Lee S, Kim M, Kang HY, Choi JH, Kim MK and You AH: Comparison of oxygen reserve index according to the remimazolam or dexmedetomidine for intraoperative sedation under regional anesthesia-A single-blind randomized controlled trial. Front Med (Lausanne). 10(1288243)2023.PubMed/NCBI View Article : Google Scholar

19 

Xu H, Wang L, Zhu W, Ren C, Liu G and Liu Y: Comparison of the safety and efficacy of remimazolam besylate versus dexmedetomidine for patients undergoing fiberoptic bronchoscopy: A prospective, randomized controlled trial. Drug Des Devel Ther. 18:2317–2327. 2024.PubMed/NCBI View Article : Google Scholar

20 

Hong SW, Park JY, Rhee KY and Kim SH: Comparison emergence of sedation, using dexmedetomidine and remimazolam, in spinal anaesthesia-double blinded randomized controlled trial. Int J Med Sci. 21:1552–1558. 2024.PubMed/NCBI View Article : Google Scholar

21 

Deng YF, Jiang XR and Feng ZG: Comparative observation of the effectiveness and safety of remimazolam besylate versus dexmedetomidine in gastrointestinal surgery in obese patients. World J Gastrointest Surg. 16:1320–1327. 2024.PubMed/NCBI View Article : Google Scholar

22 

Zhou L, Huang Y, Zhou R and Liu S: Comparison of remimazolam and dexmedetomidine for sedation in awake endotracheal intubation in scoliosis surgery: A retrospective analysis. Med Sci Monit. 30(e944632)2024.PubMed/NCBI View Article : Google Scholar

23 

Chen X, Xin D, Xu G, Zhao J and Lv Q: The efficacy and safety of remimazolam tosilate versus dexmedetomidine in outpatients undergoing flexible bronchoscopy: A prospective, randomized, blind, non-inferiority trial. Front Pharmacol. 13(902065)2022.PubMed/NCBI View Article : Google Scholar

24 

Pastis NJ, Yarmus LB, Schippers F, Ostroff R, Chen A, Akulian J, Wahidi M, Shojaee S, Tanner NT, Callahan SP, et al: Safety and efficacy of remimazolam compared with placebo and midazolam for moderate sedation during bronchoscopy. Chest. 155:137–146. 2019.PubMed/NCBI View Article : Google Scholar

25 

Andersen JH, Grevstad U, Siegel H, Dahl JB, Mathiesen O and Jæger P: Does dexmedetomidine have a perineural mechanism of action when used as an adjuvant to ropivacaine?: A paired, blinded, randomized trial in healthy volunteers. Anesthesiology. 126:66–73. 2017.PubMed/NCBI View Article : Google Scholar

26 

Chanavaz C, Tirel O, Wodey E, Bansard JY, Senhadji L, Robert JC and Ecoffey C: Haemodynamic effects of remifentanil in children with and without intravenous atropine. An echocardiographic study. Br J Anaesth. 94:74–79. 2005.PubMed/NCBI View Article : Google Scholar

Related Articles

  • Abstract
  • View
  • Download
  • Twitter
Copy and paste a formatted citation
Spandidos Publications style
Hu R and Ping R: Comparative efficacy and safety of remimazolam vs. dexmedetomidine: A systematic review and meta‑analysis. Biomed Rep 24: 73, 2026.
APA
Hu, R., & Ping, R. (2026). Comparative efficacy and safety of remimazolam vs. dexmedetomidine: A systematic review and meta‑analysis. Biomedical Reports, 24, 73. https://doi.org/10.3892/br.2026.2146
MLA
Hu, R., Ping, R."Comparative efficacy and safety of remimazolam vs. dexmedetomidine: A systematic review and meta‑analysis". Biomedical Reports 24.6 (2026): 73.
Chicago
Hu, R., Ping, R."Comparative efficacy and safety of remimazolam vs. dexmedetomidine: A systematic review and meta‑analysis". Biomedical Reports 24, no. 6 (2026): 73. https://doi.org/10.3892/br.2026.2146
Copy and paste a formatted citation
x
Spandidos Publications style
Hu R and Ping R: Comparative efficacy and safety of remimazolam vs. dexmedetomidine: A systematic review and meta‑analysis. Biomed Rep 24: 73, 2026.
APA
Hu, R., & Ping, R. (2026). Comparative efficacy and safety of remimazolam vs. dexmedetomidine: A systematic review and meta‑analysis. Biomedical Reports, 24, 73. https://doi.org/10.3892/br.2026.2146
MLA
Hu, R., Ping, R."Comparative efficacy and safety of remimazolam vs. dexmedetomidine: A systematic review and meta‑analysis". Biomedical Reports 24.6 (2026): 73.
Chicago
Hu, R., Ping, R."Comparative efficacy and safety of remimazolam vs. dexmedetomidine: A systematic review and meta‑analysis". Biomedical Reports 24, no. 6 (2026): 73. https://doi.org/10.3892/br.2026.2146
Follow us
  • Twitter
  • LinkedIn
  • Facebook
About
  • Spandidos Publications
  • Careers
  • Cookie Policy
  • Privacy Policy
How can we help?
  • Help
  • Live Chat
  • Contact
  • Email to our Support Team