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A multi-site service evaluation on remimazolam for dental conscious sedation

British Dental Journal (2025)Cite this article

Abstract

Background Remimazolam is a novel ultra-short-acting benzodiazepine which shows a high efficacy and safety profile for medical procedures, such as endoscopy; however, its use in dentistry is relatively new and lacks an evidence base.

Aims The service evaluation aimed to establish the safety and efficacy of remimazolam as a conscious sedation agent in dental outpatient settings since its introduction into two secondary care sedation and special care dental services in 2023.

Method Retrospective data collection of remimazolam sedation cases from April 2023 to April 2024 was carried out.

Results The success rate of 111 remimazolam sedation cases was 97%. The mean interval between sedation start time and beginning of treatment was 2-4 minutes, while the mean time from the last administered dose to patient discharge was 24 minutes. The mean dose of remimazolam administered was 11.9 mg, with a range of 1.5-35 mg. Patients required a mean of four additional doses, with a mean interval of 5.7 minutes between top-ups. The majority of cases (82.9%) resulted in Ellis scores of 1 or 2. Five complications were documented: three cases of desaturation, one case of disinhibition and one case of post-operative hypertension, none of which necessitated flumazenil reversal.

Conclusion This service evaluation provided promising insights into the potential safety profile and effectiveness of remimazolam for dental sedation in two secondary care settings; however, larger-scale studies are necessary to substantiate these findings. This is a rapidly emerging area of sedation practice that is likely to see an influx of research and development in the near future.

Key points

  • Remimazolam - a novel ultra-short-acting benzodiazepine with its quick onset and offset - showed enhanced safety and efficacy in endoscopy which could be used in dentistry, particularly in medically complex patients.

  • With careful case selection, remimazolam can facilitate successful completion of a range of dental procedures safely.

  • The incidence of failures and complications was low; however, further larger-scale studies in a range of dental settings are required to validate its effectiveness and safety profile.

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Data availability

Access to anonymised data may be considered on a case-by-case basis, subject to institutional approval and appropriate data-sharing agreements. Requests for data should be directed to the corresponding author and will be reviewed in compliance with Trust guidelines and patient confidentiality policies.

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Acknowledgements

The authors would like to thank all the sedationists involved in data collection and the special care dentistry team and the pharmacy team who contributed to the proposal leading to the approval of remimazolam use in the respective services.

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Authors and Affiliations

  1. Specialty Registrar in Special Care Dentistry, Bart´s Health NHS Trust, United Kingdom

    Xin Hui Yeo

  2. Clinical Lead and Consultant in Special Care Dentistry, Surrey and Sussex Healthcare NHS Trust, United Kingdom

    Mili Doshi

  3. Consultant in Special Care Dentistry, Bart´s Health NHS Trust, United Kingdom

    Stacey Clough

  4. Clinical Lead and Consultant in Special Care Dentistry, Bart´s Health NHS Trust, United Kingdom

    Zahra Shehabi

Authors
  1. Xin Hui Yeo
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  2. Mili Doshi
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  3. Stacey Clough
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  4. Zahra Shehabi
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Contributions

XHY: study design, data collection, data analysis, interpretation of results and manuscript preparation. MD: data collection, review of results and data analysis, manuscript review. SC: study proposal and design, supervision of data collection, review of results and data analysis, manuscript review. ZS: study proposal and design, data collection, review of results and data analysis, manuscript review. The final manuscript was reviewed and finalised by all authors.

Corresponding author

Correspondence to Xin Hui Yeo.

Ethics declarations

The authors declare there are no conflicts of interest. This is a retrospective service evaluation and ethics approval was not required according to the Medical Research Council HRA toolkit. The retrospective nature of data collection meant that it had no influence on patient care/interventions. Consent was not required. Under NHS guidelines, all patients are informed that their data may be used for audit and monitoring purposes unless they choose to opt out. Additionally, all patients provided written consent for the use of remimazolam as part of their treatment plan. Both services have registered the service evaluation with their respective audit/clinical effectiveness unit (CEU).

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Yeo, X., Doshi, M., Clough, S. et al. A multi-site service evaluation on remimazolam for dental conscious sedation. Br Dent J (2025). https://doi.org/10.1038/s41415-025-8717-0

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