Can Remimazolam Be a New Sedative Option for Outpatients Undergoing Ambulatory Oral and Maxillofacial Surgery?

Purpose: Midazolam is a classic sedative drug. The sedative effect of remimazolam has not been demon-strated in ambulatory oral and maxillofacial surgery (OMS). This study aimed to measure whether remima-zolam can achieve the same sedation effects compared with midazolam, but with a faster recovery and fewer adverse reactions in outpatients undergoing ambulatory OMS.Materials and Methods: This was a prospective, randomized, controlled, single-center study of 40 pa-tients who underwent ambulatory OMS at Peking University Hospital of Stomatology, Beijing, China, be-tween April 2021 and June 2021. The patients were randomly divided into a midazolam group (Group M) and a remimazolam group (Group R). The success rate of sedation, which was defined as completion of the operation with no rescue sedative medication, was the primary outcome. In this study, bispectral index and modified observer's assessment of alertness/sedation value, intraoperative adverse events, time to discharge, and the number of additional doses of sedative were compared. Descriptive, compara-tive analyses were conducted.Results: Forty patients were eligible for this study, and the final sample size was 40 (including 25 males, average age was 29). The success rate of sedation in Group R was statistically significantly higher than that in Group M (Group R vs Group M: 95% [19/20] vs 70% [14/20], P = .037, 95% confidence interval [CI]: 0.681 to 0.913). The median number of additional doses of the medications per 5 minutes in Group R was lower than that in Group M (0.51 [0.19, 0.71] vs 0.82 [0.51, 1.25], P = .006, 95% CI: 0.013 to 0.583). Group R showed a higher bispectral index number (93.9 +/- 4.6 vs 86.6 +/- 7.2, P = .001, 95% CI: 3.451 to 11.149) at the end of the surgery and a higher modified observer's assessment of alertness/seda-tion score (4.70 +/- 0.47 vs 4.05 +/- 0.68, P = .001, 95% CI: 0.273 to 1.027) after 5 minutes at the recovery room compared with Group M.Conclusions: The success rate of remimazolam is higher than that of midazolam. The use of remimazo-lam is effective for sedation of patients undergoing ambulatory OMS.