Remimazolam in pediatric anesthesia: a systematic review for clinical decision-making.

IF 2 3区医学 Q2 PEDIATRICS

Frontiers in Pediatrics Pub Date : 2025-09-23 eCollection Date: 2025-01-01 DOI:10.3389/fped.2025.1662752

Yi Zhang, Qiuxiang Chen, Linyun Wang, Qingjun Zeng, Haishan Cui, Shuang Guo, Fei Xiang, Yunbo Mo

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引用次数: 0

Abstract

Background: Remimazolam's role in pediatric anesthesia is evolving. We systematically reviewed 2024-2025 evidence to establish a clinical decision-making framework for its use.

Methods: Following PRISMA guidelines, a systematic search identified 23 studies (15 RCTs) involving 2,847 pediatric patients for narrative synthesis.

Results: Remimazolam demonstrated superior hemodynamic stability vs. propofol (cardiovascular complications: RR 0.30, 95% CI 0.20-0.46) and reduced emergence delirium by 61% (RR 0.39, 95% CI 0.21-0.70). The CES1 G143E polymorphism was identified as a genetic basis for prolonged sedation, reducing drug clearance >90%. Critical limitations include a 15% re-sedation rate post-flumazenil, a complete lack of data in infants <1 year, and unknown long-term neurodevelopmental safety.

Conclusion: Remimazolam represents a valuable anesthetic tool with specific advantages in pediatric anesthesia. While it demonstrates superior hemodynamic stability and reduced emergence delirium compared to standard agents, it is not a universal replacement for established anesthetics. Current evidence supports its use in specific clinical scenarios, particularly for preventing post-sevoflurane emergence delirium and in hemodynamically unstable patients. However, the absence of infant and long-term neurodevelopmental safety data necessitates continued research before widespread adoption.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251058023, PROSPERO CRD420251058023.

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雷马唑仑在小儿麻醉中的应用：临床决策的系统综述。

背景：雷马唑仑在小儿麻醉中的作用正在不断发展。我们系统地回顾了2024-2025年的证据，以建立其使用的临床决策框架。方法：遵循PRISMA指南，系统检索了23项研究（15项随机对照试验），涉及2,847名儿科患者进行叙事综合。结果：Remimazolam表现出优于异丙酚的血流动力学稳定性（心血管并发症：RR 0.30, 95% CI 0.20-0.46），并减少61%的紧急谵妄（RR 0.39, 95% CI 0.21-0.70）。CES1 G143E多态性被确定为延长镇静时间的遗传基础，降低药物清除率>90%。关键限制包括氟马西尼后再镇静率为15%，完全缺乏婴儿数据。结论：雷马唑仑在儿科麻醉中具有特殊优势，是一种有价值的麻醉工具。虽然与标准药物相比，它表现出优越的血流动力学稳定性和减少出现性谵妄，但它并不是现有麻醉剂的普遍替代品。目前的证据支持其在特定临床情况下的应用，特别是用于预防七氟醚后出现性谵妄和血流动力学不稳定的患者。然而，缺乏婴儿和长期神经发育安全性数据需要在广泛采用之前继续研究。系统评价注册：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251058023, PROSPERO CRD420251058023。

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来源期刊

Frontiers in Pediatrics Medicine-Pediatrics, Perinatology and Child Health

CiteScore

3.60

自引率

7.70%

发文量

2132

审稿时长

14 weeks

期刊介绍： Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.