An interesting article titled “Can Remimazolam Be a New Sedative Option for Outpatients Undergoing Ambulatory Oral and Maxillofacial Surgery?” appears in the Journal of Oral and Maxillofacial Surgery written by Zijian Guo and et. al. (Available online 16 September 2022). The article discusses the sedative remimazolam and its possibility to sedate in oral surgery as effectively as midazolam.
In the article the authors discuss how patients can receive dental treatment with more comfort using sedation. Midazolam is widely used in oral and maxillofacial surgery but has side effects of increased accumulation and respiratory depression. Remimazolam has similar pharmacological effects to midazolam but has rapid onset, fast metabolism, less potential adverse effects. Remimazolam has a a mean half-life of between 0.5 and two minutes and a terminal half-life in plasma of 37 to 53 minutes.
The authors conducted the first ever potential study to explore the sedation effects of remimazolam in oral surgery relative to midazolam. The authors used a randomized, controlled, single-center study of 40 patients in Beijing, China undergoing oral surgery procedures. The patients in the study were randomly divided into two groups of patients given either remimazolam or midazolam. The outcome of the study was the success rate of sedation, which was defined as completing the procedure without the use of rescue medications being needed.
Of the 40 patients in the study the total sedation success rate was 82.5%. Further, the sedation success rate was 70% in the midazolam group
and 95% in the remimazolam group. The authors also found a a statistically significant difference in the median number of additional doses within 5 minutes between the midazolam group and the remimazolam group. Based on the results the authors feel that remimazolam can be used for patients having oral surgery with a high success rate. The authors state
“We showed that remimazolam had a higher success rate and required fewer additional doses despite its ultra-short action.”
The authors do mention that remimazolam is considered a Schedule IV controlled substance in the U.S. and thus has potential for misuse. The authors did mention several limitations of their study which included a small sample size, there was no no statistically significant differences in body weight and BMI between the two groups given the different sedatives, and that different types of surgical procedures may affect the sedation although it is noted by that authors that there was no difference in the types of operations between the two sedation groups.
It seems that additional studies to explore the potential for remimazolam for wisdom teeth surgery could be beneficial.