The Effect of Remimazolam Administration on Emergence Delirium in Children After General Anesthesia: A Systematic Review With Meta-Analysis of Randomized Controlled Trials.

BACKGROUND

Emergence delirium commonly occurs in pediatric patients after general anesthesia, causing distress and potential harm. Remimazolam, an ultra-short-acting benzodiazepine, has recently been introduced in pediatric anesthesia, but its preventive role against emergence delirium remains unclear.

AIMS: This systematic review with meta-analysis evaluated the effect of remimazolam on the incidence and severity of emergence delirium in children undergoing general anesthesia.

METHODS

PubMed, EMBASE, CENTRAL, Scopus, Web of Science, and Google Scholar were searched for relevant studies. The primary outcome was the incidence of emergence delirium. Secondary outcomes included Pediatric Anesthesia Emergence Delirium score, incidence of hypotension and bradycardia, extubation time, postanesthesia care unit stay, and postoperative nausea and vomiting incidence. Relative risks (RR) or mean difference (MD) with 95% confidence intervals (CI) were calculated using a random-effects model.

RESULTS

Ten randomized controlled trials involving 1231 children were included. Remimazolam significantly reduced the incidence of emergence delirium (RR 0.38, 95% CI 0.23-0.63; p = 0.0002) and Pediatric Anesthesia Emergence Delirium score (MD -1.70, 95% CI -2.77 to -0.63; p = 0.0019). It also decreased bradycardia (RR 0.39, 95% CI 0.21-0.70; p = 0.0018). Although the overall incidence of hypotension did not differ significantly (RR 0.35, p = 0.0991), subgroup analysis showed a lower incidence with remimazolam than with propofol (RR 0.14, p = 0.0376). Overall extubation time was comparable (MD -0.75, p = 0.5088), but shorter with remimazolam than propofol (MD -3.36, p < 0.0001). No significant differences were found in postanesthesia care unit stay or postoperative nausea and vomiting.

CONCLUSIONS

Remimazolam may reduce the incidence and severity of emergence delirium in children after general anesthesia, without affecting hemodynamic stability or recovery time.

TRIAL REGISTRATION: PROSPERO: CRD420251236789.