Nurse-administered Remimazolam for procedural sedation in the emergency department: A prospective study of safety, effectiveness and patient satisfaction

INTRODUCTION: Remimazolam is a novel ultra-short acting benzodiazepine with a fast onset and short half-life, with similar safety profile as other sedatives such as midazolam or propofol. This study evaluated the safety of using remimazolam for procedural sedation in the emergency department (ED) by nurses without previous anesthesiologic specialization, who were experienced in airway management and trained to use remimazolam. METHODS: This prospective observational study was performed at the ED at Aalborg University Hospital between September 2024 and May 2025. Inclusion criteria were: patients needing sedation for a procedure, age > 12 years, ASA score 1-3, and an available nurse who had received thorough education in remimazolam, but having no anesthesiologic specialization. Safety was assessed using a three-level severity scale: 1 = no adverse event, 2 = mild/moderate adverse event, and 3 = severe adverse event. The results are presented as the percentage of patients within each category. RESULTS: A total of 183 patients were included, and 89% underwent procedural RM sedation without respiratory adverse effects, 7.5% experienced mild/moderate adverse effects, and 2.2% experienced severe respiratory complications. All complications were resolved in the ED within minutes. The majority of patients (94%) experienced amnesia for the procedure. Procedures could be started at a mean of 3 (IQR: 2-4) minutes after administration of remimazolam. Patients could safely be left unsupervised within 15 (IQR 12;20) minutes of the first remimazolam dose. CONCLUSION: Severe respiratory adverse effects were rare, and remimazolam was safe to use in the ED by nurses without anesthesiologic specialization. Most patients had amnesia and/or were satisfied with the sedation. Procedures could be initiated within minutes and resolved successfully in most cases.