BACKGROUND: Remimazolam is a novel benzodiazepine increasingly used for procedural sedation and general anaesthesia. Its role in clinical use in flexible bronchoscopy remains under investigation. AIM: To evaluate the efficacy and safety of remimazolam in adults undergoing flexible bronchoscopy. METHODS: This meta-analysis followed PRISMA and Cochrane guidelines. A systematic search of PubMed, Scopus, and the Cochrane Library identified randomised controlled trials (RCT)comparing remimazolam with other sedatives. RESULTS: Fifteen RCTs including 2,243 patients were analysed. Procedural success was higher with remimazolam compared with overall sedatives (RR = 1.10; 95% CI: 1.02-1.19; p = 0.02). Remimazolam significantly reduced the risk of respiratory depression (risk ratio [RR] = 0.42; 95% CI: 0.25-0.69; p = 0.0007), hypoxaemia (RR 0.61, 95% CI 0.39-0.95; p = 0.03), hypotension (RR = 0.52; 95% CI: 0.35-0.77; p = 0.001), and bradycardia (RR = 0.38; 95% CI: 0.21-0.69; p = 0.002). Compared with midazolam, remimazolam had a faster onset, though not statistically significant. Compared with dexmedetomidine, it showed significantly faster onset (MD = -2.16 min, 95% CI: -2.65 to -1.67; p < 0.00001) and shorter recovery (MD =-1.84 min; 95% CI: -3.31 to -0.37; p = 0.01). Compared with propofol, it had lower rates of hypotension, hypoxaemia, and injection pain. CONCLUSION: Remimazolam is a safe and effective alternative for bronchoscopy sedation, offering improved cardiopulmonary safety and favourable procedural characteristics.