Remimazolam in neuroanesthesia

Purpose of review Remimazolam is a novel ultrashort-acting benzodiazepine that has recently gained attention for its potential benefits in neuroanesthesia. This review aims to critically assess the latest evidence regarding its hemodynamic properties, neurophysiological monitoring compatibility, and recovery profile while highlighting gaps in research and clinical uncertainties. Recent findings Several randomized controlled trials and case reports suggest that remimazolam may reduce episodes of hypotension, minimize vasopressor use, and facilitate quicker emergence, especially with flumazenil reversal, when compared with other anesthetics. Nonetheless, the agent's tendency to produce higher bispectral index readings at equivalent sedation levels raises questions about monitoring accuracy. In addition, its long-term safety profile and effectiveness across diverse patient populations remain incompletely understood. The possibility of tolerance development and lack of standardized dosing protocols further underscore the need for more robust, large-scale evaluations. Summary Although remimazolam has shown promise in providing a favorable hemodynamic profile and rapid recovery in neuroanesthesia, definitive conclusions would require additional high-quality, multicenter trials with standardized methodologies. Clinicians should exercise careful judgment in dosing and monitoring till more comprehensive safety and efficacy data are available, to ensure that remimazolam's potential benefits are cautiously utilized based on evolving evidence