SAAD Digest
September 2026
Volume: 42
Issue: 2
DOI: 10.63507/ANQF5951
Title: The use of remimazolam in patients with a learning disability and elevated body mass index: a case series
Author(s): T. Thayaparan, M. Doshi, R. Fitzgerald
Abstract:
The number of adults with learning disabilities and elevated body mass index (BMI) is increasing, with a corresponding rise in dental patients presenting with complex medical, behavioural and airway-related risk factors. In this group, sedation can be challenging due to altered respiratory physiology, higher rates of sleep-disordered breathing and unpredictable pharmacokinetics. Remimazolam, an ultra-short-acting benzodiazepine, is increasingly used for dental sedation across the UK and may offer advantages in higher-risk patients because of its rapid onset and recovery profile. This paper presents three cases involving adults with raised BMI and significant additional needs, including learning disability and medical comorbidities, who required dental treatment under sedation in a secondary care setting. Remimazolam was chosen where other options, such as inhalation sedation, anaesthetist-led sedation or general anaesthesia, were unsuitable or not considered to be in the patient’s best interests. Sedation regimens were individualised with cautious titration and comprehensive monitoring, including continuous capnography, to detect early respiratory depression.
Outcomes
Remimazolam provided effective and safe sedation, allowing successful completion of dental treatment without respiratory or cardiovascular complications and rapid recovery. These cases suggest that remimazolam may be a safe and effective option for selected high-BMI patients requiring dental-led sedation, provided thorough assessment and close monitoring are undertaken.
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