A multi-site service evaluation on remimazolam for dental conscious sedation

Abstract

Background Remimazolam is a novel ultra-short-acting benzodiazepine which shows a high efficacy and safety profile for medical procedures, such as endoscopy; however, its use in dentistry is relatively new and lacks an evidence base. Aims The service evaluation aimed to establish the safety and efficacy of remimazolam as a conscious sedation agent in dental outpatient settings since its introduction into two secondary care sedation and special care dental services in 2023. Method Retrospective data collection of remimazolam sedation cases from April 2023 to April 2024 was carried out. Results The success rate of 111 remimazolam sedation cases was 97%. The mean interval between sedation start time and beginning of treatment was 2-4 minutes, while the mean time from the last administered dose to patient discharge was 24 minutes. The mean dose of remimazolam administered was 11.9 mg, with a range of 1.5-35 mg. Patients required a mean of four additional doses, with a mean interval of 5.7 minutes between top-ups. The majority of cases (82.9%) resulted in Ellis scores of 1 or 2. Five complications were documented: three cases of desaturation, one case of disinhibition and one case of post-operative hypertension, none of which necessitated flumazenil reversal. Conclusion This service evaluation provided promising insights into the potential safety profile and effectiveness of remimazolam for dental sedation in two secondary care settings; however, larger-scale studies are necessary to substantiate these findings. This is a rapidly emerging area of sedation practice that is likely to see an influx of research and development in the near future.