Remimazolam use in obstetric patients: a single-center retrospective study (2021–2024)

Background

Remimazolam is an ultra-short-acting intravenous benzodiazepine approved for procedural sedation and general anaesthesia. Its favourable pharmacokinetic profile, including rapid onset, short context-sensitive half-time, and minimal cardiovascular depression, makes it a potential agent for obstetric anaesthesia, where maternal stability and fetal safety are paramount.

Methods

This scoping review evaluates the pharmacologic profile, clinical applications, safety considerations, and emerging evidence for the use of remimazolam in obstetric settings. A comprehensive literature search was conducted using PubMed and Ovid databases (inception to April 1, 2025), for English-language manuscripts related to remimazolam use in obstetric contexts. Search terms included remimazolam during labour analgesia, caesarean delivery, termination of pregnancy, and procedural sedation during obstetric care. No restrictions were placed on study design or manuscript type; however, grey literature and non-peer-reviewed sources were excluded.

Results

The existing literature on remimazolam in obstetric anaesthesia consists primarily of case reports (n=), case series (n=) and randomised control trials (n=). These suggest that remimazolam may be safely used in high-risk obstetric populations including those with maternal cardiac disease, providing effective sedation, stable haemodynamic, high patient satisfaction and favourable maternal-fetal outcomes. The availability of flumazenil as a reversal agent adds a safety margin.

Conclusion

While preliminary findings are encouraging, the current evidence is limited by the small cohorts evaluated in studies. Larger prospective studies are needed to validate its efficacy, confirm maternal and neonatal safety, address fluid compatibility concerns, and support guideline development for obstetric use.