This study evaluated the safety and efficacy of remimazolam, an ultra-short acting benzodiazepine, for procedural sedation in the emergency department (ED). The primary aim was to compare its administration by emergency medicine physicians (EMPs) without prior anesthesiologic specialization against experienced registered nurse anesthetists (RNAs).

Secondary aims included patient satisfaction and procedural success rates.

This prospective study conducted at Aalborg University Hospital ED from May to August 2024 involved 53 patients sedated by five EMPs (Group 1) who received prior training and supervision, and 50 patients sedated by two RNAs (Group 2) with extensive previous experience with remimazolam.

Data included timed observations and patient questionnaires. Results showed comparable safety profiles: no or mild respiratory adverse effects occurred in 97% of Group 1 and 100% of Group 2 patients. Procedural amnesia was high in both groups (93% in Group 1, 90% in Group 2).

Recovery time to unsupervised safety was a median of 15 minutes in both groups. Procedural success was 92% in Group 1 and 100% in Group 2.

The study concluded that severe respiratory adverse effects were rare in both groups, most patients achieved amnesia and adequate pain relief, and the use of remimazolam by physicians without anesthesiologic specialization is considered a safe and effective alternative for procedural sedation in the ED.

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