Abstract:Monitored anesthesia care (MAC) is a technique in which anesthesiologists use analgesic or sedative drugs while closely monitoring the vital signs of patients undergoing anesthesia without intubation and with spontaneous breathing. Its advantages include maintaining patient’s spontaneous breathing, avoiding lung injury caused by mechanical ventilation, and shortening the postoperative recovery time. Currently, the drug regimens for MAC mainly consist of anesthetic sedatives combined with analgesics. Common sedative drugs include propofol and midazolam. However, they have inhibitory effects on the respiratory and circulatory systems, which limits their application in clinical practice. In recent years, a newly discovered anesthetic, remimazolam, is a short-acting intravenous anesthetic developed from midazolam by adding a methyl propionate side chain. Reminazolam has a minor effect on respiration and circulation, a low incidence of injection pain, rapid onset, and inactive metabolites, presenting certain advantages in terms of anesthetic safety. Existing research has found that remimazolam can stabilize circulation, reduce respiratory depression, and lower the incidence of adverse reactions such as nausea and vomiting when used in MAC, with broad application prospects. However, the safety and efficacy of remimazolam in general anesthesia still need to be confirmed. This article will review the pharmacological characteristics of remimazolam, its perioperative application advantages, and the problems that need to be solved, providing a reference for the majority of clinical practitioners.