Remimazolam Versus Dexmedetomidine for Monitored Anesthesia Care in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation: A Randomized Clinical Trial
In brief
Remimazolam shortened recovery by 19 minutes during valve implantation
In a 34-patient randomized trial, patients receiving remimazolam recovered in about 14 minutes, compared with 32 minutes on dexmedetomidine, and surgeons less often asked for deeper sedation. The study found no significant differences in low blood pressure episodes or vasopressor doses, but was too small to establish that the drugs are equivalent on those outcomes.
- Journal
- Journal of clinical medicine (Q1)
- Published
- 16 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Sung-Woo Hyung, Myokyung Choi, Mee Young Chung, Wonjung Hwang
- PMID
- 42795954
- DOI
- 10.3390/jcm15187182
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 29 September 2026): Remimazolam vs dexmedetomidine for MAC in TAVI
Abstract
Background/Objectives: Monitored anesthesia care is increasingly used for transfemoral transcatheter aortic valve implantation (tf-TAVI), but the optimal sedative regimen remains uncertain. We compared remimazolam with dexmedetomidine during tf-TAVI. Methods: In this single-center randomized trial, 34 patients were assigned 1:1 to remimazolam or dexmedetomidine. Primary outcomes were the number of intraoperative hypotensive episodes, defined as mean arterial pressure <65 mmHg requiring vasopressor treatment, and cumulative phenylephrine and norepinephrine doses. Secondary outcomes included hemodynamic and physiological variables, regional cerebral oxygen saturation (rSO2), arterial blood gases, recovery time, surgeon requests for deeper sedation, and procedural outcomes. Longitudinal variables were analyzed using generalized estimating equations with Holm adjustment for time-specific comparisons. Results: No significant between-group differences were detected in intraoperative hypotensive episodes or cumulative phenylephrine and norepinephrine doses, and no significant group-by-time interactions were observed for blood pressure. Both left and right rSO2 showed significant group-by-time interactions, with higher remimazolam values at selected time points after Holm adjustment. Arterial carbon dioxide tension was higher and arterial pH lower with remimazolam immediately before rapid ventricular pacing and at procedure completion. Recovery was faster with remimazolam (mean ± standard deviation, 13.5 ± 7.2 vs. 32.4 ± 12.5 min; p < 0.001), and surgeon requests for deeper sedation were less frequent (11.8% vs. 76.5%; p < 0.001). Conclusions: Remimazolam was associated with faster recovery and fewer surgeon requests for deeper sedation; however, the trial was not designed or powered to establish equivalence for hypotensive episodes, vasopressor requirements or hemodynamic outcomes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.