Anesthesia with remimazolam versus dexmedetomidine and midazolam for the endoscopic submucosal dissection of the esophagus, stomach, and colorectum: A retrospective comparative study

Objective Endoscopic submucosal dissection (ESD) requires prolonged and stable sedation. Although midazolam combined with dexmedetomidine (MDZ+DEX) is widely used, delayed postoperative awakening and hemodynamic instability remain concerns, particularly in elderly patients. This study aimed to compare the efficacy and safety of remimazolam (RMZ) with MDZ+DEX for sedation during ESD. Methods This single-center retrospective study was conducted in Japan. The primary outcome was the quality of postoperative awakening. The secondary outcomes included procedural outcomes and sedation-related adverse events, such as hypotension, bradycardia, and hypoxemia. Patients A total of 195 patients who underwent ESD between January 2023 and October 2025 were analyzed. The patients were divided into the RMZ group (n=69) and the MDZ+DEX group (n=126). Results The baseline patient and procedural characteristics were comparable between the two groups. The Postprocedural Richmond Agitation-Sedation Scale scores did not differ significantly. However, poor postoperative awakening was significantly less frequent in the RMZ group than in the MDZ+DEX group (27.5% vs. 76.2%, p