Nitta Yukie, Kamimura Yuji, Shiroshita Akihiro, Kido Kanta
Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, JPN.
Department of Systematic Reviewers, Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, JPN.
Cureus. 2025 Mar 4;17(3):e80044. doi: 10.7759/cureus.80044. eCollection 2025 Mar.
Emergence delirium (ED) is a typical postoperative complication in pediatric anesthesia, especially with inhalational agents. Remimazolam, a short-acting benzodiazepine, shows potential for reducing the occurrence of ED. Given limited evidence of its use in pediatric anesthesia, we evaluated the efficacy and safety of remimazolam by conducting a systematic review and meta-analysis. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and International Clinical Trials Registry Platform (ICTRP) databases were explored for studies on remimazolam in pediatric anesthesia. The studies included were randomized controlled trials (RCTs), prospective and retrospective cohort studies, case series, and case reports. Eligible patients were pediatric patients as American Society of Anesthesiologists Physical Status I or II who underwent sevoflurane-based general anesthesia. Primary outcomes included ED and emergence time. Study quality was assessed using the Risk of Bias 2 tool, and evidence certainty was evaluated by the Grading of Recommendations, Assessment, Development, and Evaluation approach. Random-effects meta-analyses estimated pooled risk ratios (RRs). Three RCTs (n = 310) were included. A 0.2 mg/kg remimazolam bolus may result in a large reduction in ED (RR 0.26, 95% confidence intervals (CIs) 0.16 to 0.44, I² = 0%; low certainty, three studies). Continuous infusion showed similar effects (RR 0.22, 95% CIs 0.08 to 0.60, low certainty, one study). Emergence times varied by dosage and administration method, with continuous infusion associated with prolonged emergence times (mean difference 5.7 minutes, 95% CIs 3.67 to 7.73, low evidence, one study). Evidence certainty ranged from very low to low, with the 0.2 mg/kg bolus rated very low. The concomitant use of intravenous remimazolam with inhalation anesthesia may reduce the ED in pediatric patients. However, evidence on emergence times remains inconclusive. Anesthetists could potentially use remimazolam to reduce the ED in children after inhalation anesthesia, but further investigation regarding its efficacy and safety across diverse populations is warranted.
苏醒期谵妄（ED）是小儿麻醉中的一种典型术后并发症，尤其是在使用吸入性麻醉剂时。瑞米唑仑是一种短效苯二氮䓬类药物，显示出降低ED发生率的潜力。鉴于其在小儿麻醉中使用的证据有限，我们通过进行系统评价和荟萃分析来评估瑞米唑仑的有效性和安全性。检索了MEDLINE、EMBASE、Cochrane对照试验中央注册库、ClinicalTrials.gov和国际临床试验注册平台（ICTRP）数据库，以查找有关瑞米唑仑在小儿麻醉中的研究。纳入的研究包括随机对照试验（RCT）、前瞻性和回顾性队列研究、病例系列和病例报告。符合条件的患者为美国麻醉医师协会身体状况I或II级、接受七氟醚全身麻醉的小儿患者。主要结局包括ED和苏醒时间。使用偏倚风险2工具评估研究质量，并通过推荐分级、评估、制定和评价方法评估证据确定性。随机效应荟萃分析估计合并风险比（RR）。纳入了三项RCT（n = 310）。静脉注射0.2 mg/kg瑞米唑仑可能会大幅降低ED（RR 0.26，95%置信区间（CI）0.16至0.44，I² = 0%；低确定性，三项研究）。持续输注显示出相似的效果（RR 0.22，95%CI 0.08至0.60，低确定性，一项研究）。苏醒时间因剂量和给药方法而异，持续输注与苏醒时间延长有关（平均差异5.7分钟，95%CI 3.67至7.73，低证据，一项研究）。证据确定性范围从极低到低，0.2 mg/kg静脉注射的证据确定性等级为极低。静脉注射瑞米唑仑与吸入麻醉联合使用可能会降低小儿患者的ED。然而，关于苏醒时间的证据仍然不明确。麻醉医生可能会使用瑞米唑仑来降低小儿吸入麻醉后的ED，但有必要对其在不同人群中的有效性和安全性进行进一步研究。
