SAAD Digest 

March 2026
Volume: 42
Issue: 1
DOI: 10.63507/RHEB8576

Title: The combined use of oral/transmucosal midazolam sedation with IV remimazolam for special care patients – a case series

Author(s): N. Storch, M. Doshi

Abstract: 
Introduction
Remimazolam, a short-acting benzodiazepine, is increasingly being used for dental sedation in the UK. Current guidance from the Intercollegiate Advisory Committee on Sedation in Dentistry advises that remimazolam and midazolam should not be used together routinely. At the time of writing, no published literature described the combined use of oral / transmucosal midazolam with intravenous remimazolam.

Case series
This paper presents a series of cases in which midazolam pre-medication was followed by intravenous remimazolam to support patients in special care undergoing dental treatment. Pre-medication ranged from 10 to 20 mg of midazolam and included both intranasal and oral forms. Patient factors influencing the choice to use remimazolam included an increased risk of respiratory depression, dysphagia, the previous need for flumazenil, and patient age. 

Outcomes
In all cases, recovery was uneventful with no need for supplemental oxygen or use of flumazenil. Recovery times ranged from 25 to 57 minutes. The combined use of midazolam and remimazolam is beneficial in patients where a faster return to baseline is desired.

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Articles from Digest 42(I)