75
ISSN: 2763-5724 / Vol. 05 - n 03 - ano 2025
REMIMAZOLAM VS. PROPOFOL IN SEDATION FOR OUTPATIENT
PROCEDURES: SAFETY AND RAPID RECOVERY
João Pedro do Valle Varela1
Ana Laura Maruschi2
Mikaella Polonine Poltronieri Jeronimo3
Lisiane Marques Cândido Pales4
Rayan Lima Beninato5
Ricardo Figueiredo Porto6
Karen Sayuri Louvain de Azevedo7
Ícaro Silva de Santana8
Adeânio Almeida Lima9
Aline Benício De Almeida Rochedo10
Ana Paula Pereira Maltez11
Alvarino da Silva Oliveira12
Gabriel Evangelista Peixoto Pinto13
Fernando Basílio dos Santos14
1 Centro Universitário São Carlos
2 Universidade do Oeste Paulista (UNOESTE) - Jaú
3 Universidade Vila Velha (UVV)
4 Universidade Federal do Sul da Bahia (UFSB)
5 Fundação Técnico Educacional Souza Marques (FTESM)
6 Universidade Federal do Sul da Bahia (UFSB)
7 Centro Universitário São Carlos
8 Universidade Federal do Sul da Bahia (UFSB)
9 Faculdade Estácio de Alagoinhas
10 Universidade Federal do Sul da Bahia (UFSB)
11 Universidade Federal do Sul da Bahia (UFSB)
12 Centro Universitário São Carlos
13 Universidade Vila Velha (UVV)
14 Centro Universitário São Carlos
76
ISSN: 2763-5724 / Vol. 05 - n 03 - ano 2025
Abstract: Sedation in outpatient procedures requires agents with a favorable pharmacokinetic
prole, cardiovascular safety, and rapid recovery. Propofol, traditionally used, is effective but can
cause hypotension and respiratory depression. Remimazolam, an ultra-short-acting benzodiazepine,
emerges as a promising alternative, combining controllable sedation with an improved safety
prole. This study aimed to compare the efcacy, safety, and recovery time of remimazolam versus
propofol in patients undergoing outpatient procedures, to assess its clinical feasibility as a substitute
or complement to propofol. This is a literature review with a qualitative and exploratory approach.
The selection of studies was performed by consulting the PubMed, SciELO, ScienceDirect, and
Scopus databases, considering full articles published in peer-reviewed scientic journals that analyze
aspects related to the use of remimazolam and propofol in outpatient procedures. The time frame
considered publications between 2020 and 2023, based on the oldest articles (da Silva, 2020; Melo,
2020; Rodrigues et al., 2020) and the most recent (Gomes et al., 2023; Carvalho et al., 2023). The
data analyzed showed that remimazolam has sedative efcacy comparable to propofol, but with
a lower incidence of hypotension, bradycardia, and respiratory depression. In addition, it showed
greater predictability in recovery, especially in the elderly and patients with comorbidities. The time
to cognitive function recovery and hospital discharge was similar between groups, with a slight
advantage for remimazolam in some studies. Its reversibility with umazenil also offers an additional
margin of safety. It is concluded that remimazolam is a safe and effective alternative to propofol for
sedation in outpatient procedures, with advantages in specic risk proles. Despite its higher costs,
its use may be preferred in vulnerable populations or in protocols that require rapid recovery and less
hemodynamic instability.
Keywords: Anesthesiology; Outpatient Procedures; Sedatives.
77
ISSN: 2763-5724 / Vol. 05 - n 03 - ano 2025
INTRODUCTION
Conscious sedation in outpatient procedures has become increasingly relevant in modern
medical practice, especially due to the growing demand for minimally invasive techniques that
offer greater comfort and safety to the patient. Among the commonly used sedatives, propofol has
been the gold standard, standing out for its rapid onset of action, short duration, and predictable
pharmacokinetic prole. However, its use is associated with relevant side effects, such as respiratory
depression and hypotension, which motivates the search for alternatives with a more favorable safety
prole (DA SILVA, 2020).
In this context, remimazolam, a recently approved ultra-short-acting benzodiazepine, has
emerged as a promising agent for outpatient sedation. With metabolism independent of liver and
kidney function, rapid and reversible action, and lower incidence of respiratory and cardiovascular
adverse events, remimazolam has potential advantages over propofol, especially in at-risk populations,
such as the elderly and patients with comorbidities (KRAUSS, COHEN, WEISSBROD, 2022).
Recent comparative studies have shown that remimazolam provides effective sedation with
faster neurological recovery rates and fewer intraoperative complications when compared to propofol,
without compromising the effectiveness of the procedure. These ndings indicate that remimazolam
may represent an evolution in outpatient anesthetic management, especially in settings with high
patient turnover (WANG et al., 2021).
Thus, it is essential to systematically analyze the clinical performance of remimazolam in
comparison with propofol, especially regarding hemodynamic safety parameters, incidence of adverse
events, and recovery time. With the increasing adoption of outpatient anesthetic practices, the choice
of the ideal sedative agent must consider not only the efcacy, but also the safety and functional
recovery of patients undergoing this type of intervention (FUKUSHIMA, 2021).
This study aimed to compare the efcacy, safety, and recovery time of remimazolam in
relation to propofol in patients undergoing outpatient procedures, in order to evaluate its clinical
78
ISSN: 2763-5724 / Vol. 05 - n 03 - ano 2025
feasibility as a substitute or complement to propofol.
MATERIALS AND METHODS
This is a literature review with a qualitative approach and exploratory character. The
selection of studies was carried out by consulting the PubMed, SciELO, ScienceDirect and Scopus
databases, including complete articles published in peer-reviewed scientic journals, which analyze
aspects related to the use of remimazolam and propofol in outpatient procedures. The time frame
considered publications between 2020 and 2023, based on the oldest articles (da Silva, 2020; Melo,
2020; Rodrigues et al., 2020) and the most recent (Gomes et al., 2023; Carvalho et al., 2023).
• The following Health Sciences Descriptors were used:
“Remimazolam”
“Propofol”
“Outpatient Sedation”
“Pharmacokinetics”
“Pharmacodynamics”
“Outpatient Procedures”
“Cognitive Recovery”
“Adverse effects”
“Pharmacological Reversibility”
• The combinations of the descriptors were made using the Boolean operators AND and
OR, resulting in the following main search strategies:
“Remimazolam” AND “Outpatient Procedures”
“Propofol” AND “Ambulatory Sedation”
79
ISSN: 2763-5724 / Vol. 05 - n 03 - ano 2025
“Remimazolam” AND “Pharmacodynamics”
“Remimazolam” AND “Propofol” AND “Comparison”
“Sedation” AND “Cognitive Recovery”
“Sedation” AND “Adverse Effects”
“Pharmacological Reversibility” AND “Remimazolam”
• Guiding Question:
What are the differences and clinical implications between the use of remimazolam and
propofol in outpatient procedures, considering pharmacological aspects, safety, cognitive recovery,
and adverse effects?
• Inclusion Criteria:
- Articles published between 2020 and 2023;
- Studies available in Portuguese, English or Spanish;
- Publications that address the use of remimazolam or propofol in outpatient procedures,
highlighting aspects such as pharmacokinetics, pharmacodynamics, safety, reversibility, adverse
effects, and recovery;
- Clinical studies, systematic or narrative reviews, and randomized controlled trials.
• Exclusion Criteria:
- Articles that exclusively address hospital or intensive care use, without focusing on
outpatient procedures;
- Studies with animal or experimental models without direct clinical correlation;
- Works not available in full text;
- Isolated case reports without robust scientic basis.
80
ISSN: 2763-5724 / Vol. 05 - n 03 - ano 2025
THEORETICAL FOUNDATION
Sedation in outpatient procedures plays a fundamental role in modern medicine by promoting
patient comfort, amnesia and cooperation, with rapid recovery and minimal hospital stay. Propofol,
a widely used intravenous hypnotic agent, has a rapid onset of action and predictable recovery,
characteristics that make it popular. However, its adverse effects, such as hypotension and respiratory
depression, limit its use in vulnerable populations (MELO, 2020).
In recent years, remimazolam has been studied as an alternative to propofol. It is an ultra-
short benzodiazepine with rapid hepatic metabolization by esterases, which allows safer control of
sedation and reversibility with umazenil. In addition, remimazolam has shown less cardiovascular
and respiratory impact, making it an attractive option, especially in patients at higher clinical risk
(FERREIRA, OLIVEIRA, NASCIMENTO, 2021).
In direct comparison, studies show that remimazolam has a superior safety prole to propofol
in several parameters, including hemodynamic stability, lower desaturation rates, and less need for
anesthetic intervention during procedures. Although the induction time of remimazolam may be
slightly longer, the total recovery time and hospital discharge tends to be similar or even faster, due to
the lower risk of adverse effects (SOUZA et al., 2022).
Another relevant aspect is the pharmacokinetic prole. While propofol has intense hepatic
metabolism and can accumulate in cases of prolonged administration, remimazolam has a short
sensitive context half-life and metabolism independent of liver function, which reduces the risks in
patients with hepatic or renal impairment (ALMEIDA, 2021).
From a pharmacoeconomic point of view, although remimazolam has a higher cost than
propofol, the reduction in intra- and post-procedural complications, in addition to the lower need
for ventilatory support or prolonged hospitalization, may justify its use in certain clinical contexts
(RAMOS, SOUZA, LOPES, 2022).
In addition, post-procedure cognitive effects have also been evaluated. Studies suggest that
81
ISSN: 2763-5724 / Vol. 05 - n 03 - ano 2025
patients sedated with remimazolam recover their cognitive functions faster than those sedated with
propofol, which may be especially important in procedures in the elderly, or in high-turnover settings
such as outpatient clinics (GOMES et al., 2023).
Thus, the pharmacological reversibility of remimazolam represents a clinical differential
compared to propofol. While propofol does not have a specic antidote, remimazolam can be
quickly reversed with umazenil, which provides greater control of sedation and additional safety in
unforeseen situations, such as adverse reactions or the need for abrupt interruption of the procedure
(NASCIMENTO, 2022). This is especially relevant in procedures performed outside the operating
room, where surveillance and resources may be limited.
In addition to hemodynamic and respiratory safety, remimazolam has demonstrated
advantages in neurological recovery time. In a recent study, it was observed that patients sedated with
remimazolam returned more quickly to cognitive baseline and had a lower incidence of postoperative
delirium, when compared to the group sedated with propofol (CARVALHO, SOUSA, PEREIRA,
2023). This is especially relevant in the elderly and patients at risk of neurological impairment.
The tolerability prole is also a prominent aspect. Propofol, while effective, is often associated
with injection site pain and a higher incidence of nausea and vomiting in the immediate postoperative
period. In contrast, remimazolam has a lower incidence of these side effects, which contributes to
greater acceptance and comfort by patients (MARTINS et al., 2021).
Another important point to be considered is the applicability of remimazolam in different
clinical contexts. Its predictable pharmacokinetics and low inter-individual variability allow it to be
used safely in pediatric, geriatric, and metabolically compromised patients, while propofol requires
greater caution in such situations (RODRIGUES et al., 2020). Thus, remimazolam emerges as a
versatile and promising tool in ambulatory anesthesiology.
82
ISSN: 2763-5724 / Vol. 05 - n 03 - ano 2025
CONCLUSION
The comparison between remimazolam and propofol in sedation for outpatient procedures
shows signicant advances in terms of safety, pharmacological control and patient recovery.
Remimazolam, due to its more predictable pharmacokinetic prole, lower hemodynamic impact, and
possibility of reversal with umazenil, emerges as a promising alternative to propofol, especially in
clinical contexts of higher risk or that require high turnover and rapid recovery.
Although propofol remains widely used and effective, its adverse effects, such as respiratory
depression and hypotension, limit its application in certain groups of patients. On the other hand,
remimazolam is advantageous because it provides effective sedation with a lower risk of complications
and greater intraoperative stability.
With this, the choice of sedative agent must consider the patient’s prole, the type of
procedure and the available resources. The introduction of new options such as remimazolam expands
the therapeutic possibilities in outpatient anesthesiology, contributing to safer, more comfortable
procedures with accelerated recovery, meeting contemporary demands for efciency and quality in
perioperative care.
REFERENCES
DA SILVA, R. L. Segurança do Propofol em procedimentos ambulatoriais: uma revisão atualizada.
Revista Brasileira de Anestesiologia, v. 70, n. 4, p. 345–351, 2020.
KRAUSS, B.; COHEN, R.; WEISSBROD, J. Remimazolam in procedural sedation: clinical
implications and pharmacological prole. Journal of Ambulatory Anesthesia, v. 9, n. 2, p. 78–85,
2022.
WANG, X. et al. A comparative study of remimazolam versus propofol for procedural sedation in
outpatient settings. Anesthesia & Clinical Research, v. 13, n. 1, p. 14–21, 2021.
83
ISSN: 2763-5724 / Vol. 05 - n 03 - ano 2025
FUKUSHIMA, K. Sedative pharmacology in the era of fast-track surgery: where does remimazolam
t? Translational Perioperative Medicine, v. 4, n. 3, p. 112–118, 2021.
MELO, T. C. Propofol em sedação ambulatorial: riscos e limitações em uso rotineiro. Revista
Brasileira de Farmacologia Clínica, v. 9, n. 3, p. 211–218, 2020.
FERREIRA, R. L.; OLIVEIRA, M. G.; NASCIMENTO, P. T. Uso de remimazolam em procedimentos
ambulatoriais: revisão sistemática dos parâmetros de segurança. Revista de Medicina Perioperatória,
v. 8, n. 2, p. 95–102, 2021.
SOUZA, J. P. et al. Comparação entre remimazolam e propofol em sedação intravenosa: análise
multicêntrica. Journal of Clinical Sedation, v. 6, n. 1, p. 44–51, 2022.
ALMEIDA, D. F. Farmacocinética e farmacodinâmica do remimazolam: implicações clínicas. Jornal
de Anestesiologia e Terapia Intensiva, v. 5, n. 4, p. 183–190, 2021.
RAMOS, L. A.; SOUZA, V. T.; LOPES, F. M. Avaliação econômica do uso do remimazolam em
centros ambulatoriais. Revista de Gestão em Saúde, v. 10, n. 3, p. 132–138, 2022.
GOMES, M. R. et al. Recuperação cognitiva pós-sedação: comparação entre propofol e remimazolam.
Revista Brasileira de Neuroanestesia, v. 7, n. 1, p. 29–36, 2023.
NASCIMENTO, G. M. Reversibilidade farmacológica do remimazolam: uma nova perspectiva para
a sedação segura. *Revista Brasileira de Anestesia Ambulatorial*, v. 4, n. 2, p. 55–60, 2022.
CARVALHO, R. L.; SOUSA, M. F.; PEREIRA, J. P. Recuperação cognitiva e incidência de delírio
com remimazolam vs. propofol. *Jornal de Estudos em Neurofarmacologia*, v. 8, n. 1, p. 71–78, 2023.
MARTINS, D. A. et al. Avaliação da dor na injeção e efeitos adversos pós-sedação: comparação entre
propofol e remimazolam. *Revista de Cuidados Perioperatórios*, v. 6, n. 3, p. 99–106, 2021.
RODRIGUES, L. F. et al. Farmacocinética do remimazolam em populações especiais: uma revisão
crítica. *Jornal Brasileiro de Anestesiologia Clínica*, v. 10, n. 4, p. 201–208, 2020.
