Efficacy and safety of remimazolam sedation for gastrointestinal endoscopy in elderly versus non-elderly patients
In brief
Older endoscopy patients received 35% less remimazolam, but four had mild adverse events
In this post hoc analysis of 39 patients, sedation succeeded in every patient, while those 65 and older received about 35% less remimazolam than younger patients. Recovery times did not differ significantly, but four older patients had mild adverse events, compared with none of the younger patients; the small exploratory study supports careful monitoring, not firm conclusions about comparative safety.
- Journal
- Digestion (Q1)
- Published
- 29 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Daisuke Yamaguchi, Ryoji Ichijima, Hisatomo Ikehara, Yosuke Minoda, Mitsuru Esaki, Ayako Takamori, et al.
- PMID
- 42809477
- DOI
- 10.1159/dig/acmag023
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 4 October 2026): Remimazolam provided effective sedation for GI endoscopy
Abstract
BACKGROUND/AIMS: This study aimed to evaluate the efficacy, recovery profile, and safety of remimazolam sedation during gastrointestinal (GI) endoscopy in elderly and non-elderly patients. METHODS: This post hoc secondary analysis used data from a multicenter randomized controlled trial of remimazolam vs. midazolam for sedated GI endoscopy in Japan (jRCTs071240062). Patients receiving remimazolam were divided into elderly (≥65 years, n=19) and non-elderly (n=20) groups. Outcomes included sedation success, sedative dose, time to awakening, time to ambulation, and adverse events. RESULTS: Sedation was successful in 100% of patients in both groups. ASA-PS class I was less common in the elderly group (26.3% vs. 65.0%, p=0.025), whereas the upper/lower GI endoscopy ratio did not differ (12/7 vs. 8/12, p=0.205). Total remimazolam dose was significantly lower in the elderly group (3.7 ± 0.9 vs. 5.7 ± 1.6 mg, p<0.001). More elderly patients were sedated with the initial dose alone (52.6% vs. 5.0%, p=0.001). Time to awakening (1.9 ± 3.5 vs. 0.8 ± 1.8 min, p=0.205) and ambulation (3.9 ± 3.7 vs. 2.0 ± 2.5 min, p=0.077) did not differ significantly. Adverse events were observed only in the elderly group (4/19 [21.1%] vs. 0/20, p=0.047), including hypoxemia (n=2), hypertension (n=1), and hypotension (n=1), all of which were mild and resolved with minimal intervention. CONCLUSION: Remimazolam provided effective sedation for GI endoscopy, and elderly patients received a lower total dose under the study protocol. Although these adverse events were mild and resolved with minimal intervention, their occurrence in elderly patients warrants careful monitoring. These exploratory findings warrant confirmation in adequately powered prospective studies.
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.