Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Safety and efficacy of remimazolam in sedation dentistry: a scoping review

  • Toru Yamamoto (Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University) ;
  • Takutoshi Inoue (Department of Anatomy, Teikyo University School of Medicine) ;
  • Naotaka Kishimoto (Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University) ;
  • Kenji Seo (Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University)
  • Received : 2024.10.16
  • Accepted : 2024.12.16
  • Published : 2025.02.01
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Abstract

This review aims to evaluate the safety of remimazolam for intravenous sedation during dental treatment and oral surgery. The protocol was registered in the Open Science Framework (registration DOI: 10.17605/OSF.IO/RFPSZ), and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Literature searches and screenings were conducted using PubMed and the Cochrane database, with additional records manually reviewed from various sources. The selected studies, published in English, investigated the safety of remimazolam for sedation in dental and oral surgery. An initial search identified 20 studies, of which five prospective studies met the inclusion criteria. All included studies used an initial bolus administration of remimazolam. Primary outcomes assessed were the sedation success rate, incidence of adverse effects, onset time, awakening time, recovery time, and postoperative side effects. This scoping review indicates that all studies validated the superiority of remimazolam over other sedatives for dental treatment and oral surgery. The development and research of innovative technologies to reduce dental pain and anxiety presents opportunities for interdisciplinary collaboration and improved patient care in dental practice. Future clinical studies should focus on determining the optimal timing for additional dosing and discontinuation when remimazolam is administered continuously.

Keywords

Acknowledgement

We thank Angela Morben, DVM, ELS, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

References

  1. Dionne RA, Yagiela JA, Coté CJ, Donaldson M, Edwards M, Greenblatt DJ, et al. Balancing efficacy and safety in the use of oral sedation in dental outpatients. J Am Dent Assoc 2006; 137: 502-13. https://doi.org/10.14219/jada.archive.2006.0223
  2. Attri JP, Sharan R, Makkar V, Gupta KK, Khetarpal R, Kataria AP. Conscious sedation: emerging trends in pediatric dentistry. Anesth Essays Res 2017; 11: 277-81. https://doi.org/10.4103/0259-1162.171458
  3. Brohan M, Brohan J, Goudra B. Remimazolam and its place in the current landscape of procedural sedation and general anesthesia. J Clin Med 2024; 13: 4362. https://doi.org/10.3390/jcm13154362
  4. Nakagawa H, Hanamoto H, Kozu F, Yokoe C, Maegawa H, Kudo C, et al. Initial loading of dexmedetomidine and continuous propofol sedation for prevention of delayed recovery: a randomized controlled trial. J Am Dent Assoc 2023; 154: 1008-18. https://doi.org/10.1016/j.adaj.2023.08.003
  5. Togawa E, Hanamoto H, Maegawa H, Yokoe C, Niwa H. Dexmedetomidine and midazolam sedation reduces unexpected patient movement during dental surgery compared with propofol and midazolam sedation. J Oral Maxillofac Surg 2019; 77: 29-41. https://doi.org/10.1016/j.joms.2018.07.002
  6. Rehman F, Goyal A, Gauba K, Jain K, Kapur A. Safety and efficacy of iv dexmedetomidine as an adjunct to propofol to sedate anxious and uncooperative pediatric dental patients: a randomized controlled trial. J Clin Pediatr Dent 2021; 45: 428-32. https://doi.org/10.17796/1053-4625-45.6.10
  7. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018; 169: 467-73. https://doi.org/10.7326/M18-0850
  8. Swart R, Maes SSA, Cavanaugh D, Mason KP. Remimazolam pilot for office-based dental sedation: adverse events, awareness and outcomes. J Clin Med 2023; 12: 7308. https://doi.org/10.3390/jcm12237308
  9. Roback MG, Green SM, Andolfatto G, Leroy PL, Mason KP. Tracking and reporting outcomes of procedural sedation (TROOPS): standardized quality improvement and research tools from the international committee for the advancement of procedural sedation. Br J Anaesth 2018; 120: 164-72. https://doi.org/10.1016/j.bja.2017.08.004
  10. Oue K, Oda A, Shimizu Y, Takahashi T, Kamio H, Sasaki U, et al. Efficacy and safety of remimazolam besilate for sedation in outpatients undergoing impacted third molar extraction: a prospective exploratory study. BMC Oral Health 2023; 23: 774. https://doi.org/10.1186/s12903-023-03538-2
  11. Li X, Tian M, Deng Y, She T, Li K. Advantages of sedation with remimazolam compared to midazolam for the removal of impacted tooth in patients with dental anxiety. J Oral Maxillofac Surg 2023; 81: 536-45. https://doi.org/10.1016/j.joms.2023.02.001
  12. Zhao N, Zeng J, Fan L, Wang J, Zhang C, Zou S, et al. Moderate sedation by total intravenous remimazolam-alfentanil vs. propofol-alfentanil for third molar extraction: a prospective randomized controlled trial. Front Med (Lausanne) 2022; 9: 950564. https://doi.org/10.3389/fmed.2022.950564
  13. Guo Z, Wang X, Wang L, Liu Y, Yang X. Can remimazolam be a new sedative option for outpatients undergoing ambulatory oral and maxillofacial surgery? J Oral Maxillofac Surg 2023; 81: 8-16. https://doi.org/10.1016/j.joms.2022.09.008
  14. Oka S, Satomi H, Sekino R, Taguchi K, Kajiwara M, Oi Y, et al. Sedation outcomes for remimazolam, a new benzodiazepine. J Oral Sci 2021; 63: 209-11. https://doi.org/10.2334/josnusd.21-0051
  15. Rex DK, Bhandari R, Lorch DG, Meyers M, Schippers F, Bernstein D. Safety and efficacy of remimazolam in high risk colonoscopy: a randomized trial. Dig Liver Dis 2021; 53: 94-101. https://doi.org/10.1016/j.dld.2020.10.039
  16. Wang F, Zhou Q, Shen M, Quan J, Chen J, Shi J, et al. Efficacy and safety of remimazolam in procedural sedation and analgesia: a protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99: e20765. https://doi.org/10.1097/MD.0000000000020765
  17. Hassan H, Shado R, Novo Pereira I, Mistry M, Craig D. Efficacy and cost analysis of intravenous conscious sedation for long oral surgery procedures. Br J Oral Maxillofac Surg 2024; 62: 523-38. https://doi.org/10.1016/j.bjoms.2024.04.006
  18. Sun Y, Li Q. Evaluation of the efficacy and safety of remazolam in tooth extraction surgery: a randomized, single-blind, multi-center clinical trial. Technol Health Care 2024; 32: 3473-84. https://doi.org/10.3233/THC-240237
  19. Kempenaers S, Hansen TG, Van de Velde M. Remimazolam and serious adverse events: a scoping review. Eur J Anaesthesiol 2023; 40: 841-53. https://doi.org/10.1097/EJA.0000000000001902
  20. Park KN, Karm MH, Seo KS, Kim HJ, Ryoo SH. Patient-controlled sedation using remimazolam during third molar extraction: a case report. J Dent Anesth Pain Med 2024; 24: 75-80. https://doi.org/10.17245/jdapm.2024.24.1.75