Comparison of the Safety and Efficacy of Remimazolam for Sedation in Adults Undergoing Fiberoptic Bronchoscopy

BACKGROUND: Fiberoptic bronchoscopy requires effective sedation to ensure patient comfort while preserving gas exchange, hemodynamic stability, and predictable recovery. Remimazolam, a novel ultra-short-acting benzodiazepine, has emerged as a potential alternative to traditional sedatives. However, its safety and efficacy compared with those of other sedatives remain under investigation. This meta-analysis evaluated the safety and efficacy of remimazolam versus dexmedetomidine, midazolam, and propofol in adults undergoing fiberoptic bronchoscopy. METHODS: A systematic review of randomized controlled trials (RCTs) was conducted using 5 databases through January 2026. Outcomes included respiratory depression, hypotension, bradycardia, time to target sedation depth, procedure success rate, emergence time, and postanesthesia care unit (PACU) stay. Relative risks (RR) or mean differences (MD) with 95% CI were calculated using a random-effects model. RESULTS: Sixteen RCTs (2325 patients) were included. Remimazolam significantly reduced respiratory depression (RR: 0.51, 95% CI: 0.36-0.73, P<0.001), hypotension (RR: 0.50, 95% CI: 0.34-0.73, P<0.001), and bradycardia (RR: 0.37, 95% CI: 0.22-0.65, P=0.001) versus controls. Sedation onset was faster than dexmedetomidine (MD: -2.19 min), but slower than propofol (MD: 0.49 min). Success rates were comparable across groups (RR: 1.12, 95% CI: 0.98-1.28, P=0.097). Compared with dexmedetomidine and midazolam, remimazolam shortened emergence (MD: -1.79 and -4.37 min, respectively) and PACU stay (MD: -3.58 and -6.70 min). CONCLUSION: Remimazolam provides effective sedation for fiberoptic bronchoscopy with advantages in terms of respiratory and hemodynamic safety, rapid recovery, and procedural efficiency.