Effect of remimazolam on intraoperative neurophysiology monitoring of visual-evoked potential: a case series

Yamada, Shoto; Hayamizu, Kengo; Akiyama, Yukinori; Kimura, Yusuke; Hashimoto, Shuichi; Mikuni, Nobuhiro; Yamakage, Michiaki

doi:10.1007/s00540-022-03159-z

Cited by 5 publications

(5 citation statements)

References 13 publications

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“…The effects of remimazolam on intraoperative VEP are little known [12]. The present study assessed the intraoperative neuromonitoring of pregnant women using remimazolam.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative neuromonitoring of visual evoked potentials in a pregnant patient with meningioma: a case report

Mori,

Sumi,

Watanabe

et al. 2024

Preprint

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Background: Meningiomas in the parasellar region leads to visual impairment, therefore intraoperative neurological monitoring is essential for enucleation surgery. However intraoperative neurological monitoring in pregnant women is challenging, as anesthesia management is required that considers the effects and risks to the fetus. Remimazolam is a newly introduced intravenous anesthetic, that has little effect on blood pressure. The effects of remimazolam on intraoperative neuromonitoring are little known. We treated a pregnant patient with parasellar meningioma who developed visual impairment, anesthesia was administered using remimazolam, intraoperative neurophysiological monitoring of the visual evoked potential. Case presentation: A 34-year-old woman who was 20 weeks pregnant presented with visual acuity disturbances. Neuroimaging demonstrated a parasellar meningioma, and rapid tumor growth and worsening of symptoms subsequently occurred. Craniotomy for tumor removal was performed under anesthesia with remimazolam, and the visual evoked potentials could be measured. Her visual acuity was restored postoperatively, and no adverse events occurred in the fetus. Conclusion: The intraoperative neuromonitoring of pregnant women showed that remimazolam may be useful for performing neurosurgical surgery combined with intraoperative neurological monitoring for pregnant women who are vulnerable to blood pressure fluctuations.

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“…The effects of remimazolam on intraoperative VEP are little known [12]. The present study assessed the intraoperative neuromonitoring of pregnant women using remimazolam.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative neuromonitoring of visual evoked potentials in a pregnant patient with meningioma: a case report

Mori,

Sumi,

Watanabe

et al. 2024

Preprint

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“…To date, there have been limited case reports detailing the impact of remimazolam on intraoperative evoked potential monitoring during neurosurgery [ 12 , 13 ]. This prospective, randomized, controlled, and non-inferiority trial aimed to investigate whether stable and repeatable flash visual evoked potential waveforms can be obtained under remimazolam general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Remimazolam, a new benzodiazepine drug, has been shown to enhance the function of γ-aminobutyric acid (GABA) receptors in the central nervous system, producing sedative and hypnotic effects [ 28 ]. A recent case series study also found that reproducible FVEP can be acquired under both remimazolam and propofol anesthesia [ 13 ]. Notably, Ma J et al reported that a stable FVEP waveform can be elicited using a combination of propofol and 0.5 MAC sevoflurane [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, remimazolam tosilate, developed by Jiangsu Hengrui Pharmaceutical Co., Ltd. in China, has been confirmed to have sedative effects on γ-aminobutyrate subtype A (GABA A ) receptors [10], and we have used it for general anesthesia in a previous study [11]. To data, very few case reports have explored the impact of remimazolam on neurological evoked potential monitoring, such as motor, visual, and sensory evoked potentials during neurosurgery [12][13][14]. Although the results suggested that remimazolam may be a candidate to propofol for evoked potential monitoring, the existing data are insufficient to explain whether remimazolam is beneficial to FVEP monitoring.…”

Section: Introductionmentioning

confidence: 99%

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Application of remimazolam-0.6% sevoflurane anesthesia for flash visual evoked potential monitoring during pituitary adenoma resection: a non-inferiority randomized controlled trial

Shi,

Tang,

et al. 2024

BMC Anesthesiol

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Background Flash visual evoked potential (FVEP) is a critical method for monitoring intraoperative visual function during neurosurgery. A new benzodiazepine drug called remimazolam has recently been used for general anesthesia. However, the impact of remimazolam on FVEP remains unclear. Therefore, we aimed to investigate how remimazolam, in comparison to propofol, when combined with 0.6% sevoflurane anesthesia, affects the FVEP waveform during pituitary adenoma resection. Methods Overall, 36 patients undergoing pituitary adenoma resection under general anesthesia were randomly assigned to either the remimazolam group (Group R) or the propofol group (Group P) in a prospective, randomized, controlled, non-inferiority trial. For anesthesia induction, a bolus of 0.2 mg/kg remimazolam or 2 mg/kg propofol was intravenously infused for approximately one minute. The anesthesia was maintained by continuous infusion of either remimazolam (0.7-1.0 mg/kg/h) or propofol (4–6 mg/kg/h), in combination with 0.6% sevoflurane, aimed at sustaining the bispectral index (BIS) within the range of 40–60. The primary outcome was the N75-P100 amplitude of FVEP recorded at approximately 20 min after intubation (T0). 10% of the amplitude at T0 in group P was defined as the non-inferiority margin (δ). Confidence interval testing was used to evaluate the non-inferiority hypothesis. The secondary outcomes covered the P100 latency of FVEP, electroretinogram (ERG) b wave amplitude, demographic characteristics, hemodynamics, and occurrence of adverse events. Results The BIS index during anesthesia was comparable between the groups at the same measured time points (P > 0.05). The N75-P100 amplitude at T0 in group R was 7.64 ± 1.36 µV, while it was 6.96 ± 0.95 µV in group P (P = 0.09), with a mean difference of 0.68 µV (95% CI, -0.11 µV to 1.48 µV). The δ was set at 0.7 and the lower limit of the 95% CI exceeded the -δ. Both remimazolam and propofol had little effect on ERG b-wave amplitudes. At the designated time points, FVEP amplitude and P100 latency displayed no appreciable variation between the two groups (P > 0.05). Furthermore, there were no significant differences in the incidence of adverse events related to anesthesia, needle electrodes, or surgery between the two groups (P > 0.05). Conclusion Our findings suggest that remimazolam-0.6% sevoflurane is non-inferior to propofol-0.6% sevoflurane for general anesthesia, based on the FVEP N75-P100 amplitude. The electrophysiological data obtained in both groups indicate that reproducible and stable FVEP and ERG waveforms can be acquired at set time points. Therefore, for reliable FVEP monitoring, remimazolam-0.6% sevoflurane appears to be a safe and effective protocol in general anesthesia. Trials registration This study was registered on chictr.org.cn (ChiCTR2200056803, 17/02/2022).

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“…Case series reports of adult patients have shown that motor-evoked potentials [49] and visual-evoked potentials [50] can be monitored appropriately under remimazolam anesthesia. In infants, the monitoring of somatosensory-evoked potentials was suboptimal under remimazolam or propofol anesthesia [51].…”

Section: Evoked Potential Monitoringmentioning

confidence: 99%

Remimazolam: its clinical pharmacology and evolving role in anesthesia and sedation practice

Masui

2024

Current Opinion in Anaesthesiology

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Purpose of review Remimazolam is a novel benzodiazepine anesthetic/sedative, designed as a rapidly metabolized carboxylic acid. Since its recent launch, the role of remimazolam in modern anesthesia and sedation practice is still evolving. This review aims to outline the clinical pharmacology and clinical utility of remimazolam to elucidate its potential advantages and limitations. Recent findings Remimazolam is “short-acting” but not ultra-short-acting compared with propofol based on context-sensitive decrement times. But compared to propofol, the availability of the benzodiazepine antagonist, flumazenil, is considered an advantage, particularly in certain emergency situations such as in patients with difficult airways. However, because flumazenil is shorter acting than remimazolam when remimazolam accumulates or is present in a high concentration, the reappearance of remimazolam sedation may occur after the initial reversal of anesthesia/sedation from flumazenil administration. Although it is beneficial that remimazolam causes less respiratory depression and hypotension than propofol, serious respiratory depression and hypotension can still occur. Remimazolam administration causes minimal or no pain on injection. Remimazolam is associated with less postoperative nausea and vomiting than inhaled anesthetics, but propofol is clearly superior in this regard. The anesthetic/sedative effects may be prolonged by severe hepatic impairment; remimazolam tolerance can occur in long-term benzodiazepine users. Summary Remimazolam may be beneficial to use in procedural sedation and general anesthesia for patients with difficult airways or hemodynamic instability. Further clinical studies with remimazolam are warranted to identify the potential benefits in other settings and patient populations.

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Effect of remimazolam on intraoperative neurophysiology monitoring of visual-evoked potential: a case series

Cited by 5 publications

References 13 publications

Intraoperative neuromonitoring of visual evoked potentials in a pregnant patient with meningioma: a case report

Intraoperative neuromonitoring of visual evoked potentials in a pregnant patient with meningioma: a case report

Application of remimazolam-0.6% sevoflurane anesthesia for flash visual evoked potential monitoring during pituitary adenoma resection: a non-inferiority randomized controlled trial

Remimazolam: its clinical pharmacology and evolving role in anesthesia and sedation practice

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