{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:40:31Z","timestamp":1780544431345,"version":"3.54.1"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Remimazolam's role in pediatric anesthesia is evolving. We systematically reviewed 2024\u20132025 evidence to establish a clinical decision-making framework for its use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Following PRISMA guidelines, a systematic search identified 23 studies (15 RCTs) involving 2,847 pediatric patients for narrative synthesis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Remimazolam demonstrated superior hemodynamic stability vs. propofol (cardiovascular complications: RR 0.30, 95% CI 0.20\u20130.46) and reduced emergence delirium by 61% (RR 0.39, 95% CI 0.21\u20130.70). The CES1 G143E polymorphism was identified as a genetic basis for prolonged sedation, reducing drug clearance &amp;gt;90%. Critical limitations include a 15% re-sedation rate post-flumazenil, a complete lack of data in infants &amp;lt;1 year, and unknown long-term neurodevelopmental safety.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Remimazolam represents a valuable anesthetic tool with specific advantages in pediatric anesthesia. While it demonstrates superior hemodynamic stability and reduced emergence delirium compared to standard agents, it is not a universal replacement for established anesthetics. Current evidence supports its use in specific clinical scenarios, particularly for preventing post-sevoflurane emergence delirium and in hemodynamically unstable patients. However, the absence of infant and long-term neurodevelopmental safety data necessitates continued research before widespread adoption.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic Review Registration<\/jats:title><jats:p><jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD420251058023, PROSPERO CRD420251058023<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1662752","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T04:13:03Z","timestamp":1758600783000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Remimazolam in pediatric anesthesia: a systematic review for clinical 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