Effect of remimazolam on intraoperative neuromonitoring during thyroid surgery: a case series

Hayamizu, Kengo; Chaki, Tomohiro; Tachibana, Shunsuke; Hirata, Naoyuki; Yamakage, Michiaki

doi:10.1007/s00540-021-02955-3

Cited by 4 publications

(4 citation statements)

References 12 publications

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“…Clearly, further study is required on the use of remimazolam in craniotomy to understand better the risk/ benefit balance. Successful use of remimazolam has been described in spine surgery incorporating motor evoked potential monitoring (Kondo et al, 2020), thyroid surgery with neuromonitoring (Hayamizu et al, 2021), and cardiac surgery with cardiopulmonary bypass (Saito et al, 2021). Remimazolam's successful use in high-risk patients, including endoscopic retrograde cholangiopancreatography in a patient with impaired respiratory function due to myotonic dystrophy (Fukuda et al, 2021), MitraClip implantation in a patient with advanced heart failure (Satoh et al, 2021), and cochlear implant in a patient with mitochondrial myopathy (Suzuki et al, 2021) has been published.…”

Section: Case Reportsmentioning

confidence: 99%

Remimazolam: Non-Clinical and Clinical Profile of a New Sedative/Anesthetic Agent

Kilpatrick¹

2021

Front. Pharmacol.

104

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A program to identify novel intravenous sedatives with a short and predictable duration of action was initiated in the late 1990’s by Glaxo Wellcome. The program focussed on the identification of ester-based benzodiazepine derivatives that are rapidly broken down by esterases. Remimazolam was identified as one of the lead compounds. The project at Glaxo was shelved for strategic reasons at the late lead optimization stage. Via the GSK ventures initiative, the program was acquired by the small biotechnology company, TheraSci, and, through successive acquisitions, developed as the besylate salt at CeNeS and PAION. The development of remimazolam besylate has been slow by industry standards, primarily because of the resource limitations of these small companies. It has, however, recently been approved for anesthesia in Japan and South Korea, procedural sedation in the United States, China, and Europe, and for compassionate use in intensive care unit sedation in Belgium. A second development program of remimazolam was later initiated in China, using a slightly different salt form, remimazolam tosylate. This salt form of the compound has also recently been approved for procedural sedation in China. Remimazolam has the pharmacological profile of a classical benzodiazepine, such as midazolam, but is differentiated from other intravenous benzodiazepines by its rapid conversion to an inactive metabolite resulting in a short onset/offset profile. It is differentiated from other intravenous hypnotic agents, such as propofol, by its low liability for cardiovascular depression, respiratory depression, and injection pain. The benzodiazepine antagonist flumazenil can reverse the effects of remimazolam in case of adverse events and further shorten recovery times. The aim of this review is to provide an analysis of, and perspective on, published non-clinical and clinical information on 1) the pharmacology, metabolism, pharmacokinetics, and pharmacodynamic profile of remimazolam, 2) the profile of remimazolam compared with established agents, 3) gaps in the current understanding of remimazolam, 4) the compound’s discovery and development process and 5) likely future developments in the clinical use of remimazolam.

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Section: Case Reportsmentioning

confidence: 99%

Remimazolam: Non-Clinical and Clinical Profile of a New Sedative/Anesthetic Agent

Kilpatrick¹

2021

Front. Pharmacol.

104

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“…To our knowledge, there were many reports that reported the use of remimazolam in specific surgeries, including spinal operation, 33 thyroid surgery, 34 awake craniotomy [35][36][37] and cardiopulmonary bypass. 38,39 More attention should be given to the application of remimazolam in the induction and maintenance of general anesthesia in patients with respiratory impairment (such as mitochondrial encephalomyopathy 40 and muscular dystrophy).…”

Section: Case Reportmentioning

confidence: 99%

Profile of Remimazolam in Anesthesiology: A Narrative Review of Clinical Research Progress

Wang¹,

Zhao²,

Peng³

et al. 2022

DDDT

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Remimazolam is a novel short-acting γ-aminobutyric acid (GABA) receptor agonist with typical characteristics of benzodiazepine sedative drugs, nonorgan-dependent metabolism, long-term infusion without accumulation, and no injection pain. It is quite different from the other current sedative drugs and has broad prospects for application. It has been established that the metabolites of remimazolam are inactive, and the interactions with other drugs are weak with slight cardiopulmonary suppressive effects, showing good effectiveness and safety. During the 2-year period that it has been on the market, remimazolam has been used in multiple clinical scenarios, such as the induction and maintenance of general anesthesia and sedation in outpatient minor procedures or examinations. However, it's use has also prompted widespread concern around the world. Therefore, given its short-and rapid-acting, controllable characteristics remimazolam deserves in-depth study in order for it to be used in fast-track surgery, comfort diagnosis and treatment. Notably, such agents might be of great significance, especially in elderly individuals, patients with critical diseases or patients with liver and kidney insufficiency. The current study reviews recent clinical studies (2015-2022) on remimazolam and summarizes the characteristics of its applications. Specifically, the use of remimazolam in some specific populations are described. This study attempts to provide scientific support for the clinical application of this novel sedative drug in the field of anesthesia.

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“…Previous studies demonstrated that remimazolam and propofol have the same success rate for sedation, with a lower incidence of respiratory and circulatory depression for remimazolam 12–15 . Remimazolam has been successfully administered to patients for general anaesthesia 6,16–21 . Since it has only recently been licensed for use in induction and maintenance of anaesthesia (Japan, January 2020; South Korea, January 2021; China, November 2021), randomised controlled clinical trials of its use in general anaesthesia are lacking.…”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14][15] Remimazolam has been successfully administered to patients for general anaesthesia. 6,[16][17][18][19][20][21] Since it has only recently been licensed for use in induction and maintenance of anaesthesia (Japan, January 2020; South Korea, January 2021; China, November 2021), randomised controlled clinical trials of its use in general anaesthesia are lacking. We performed a prospective, single-blind, randomised, noninferiority clinical trial to compare the efficacy of remimazolam with that of propofol combined with remifentanil and cisatracurium for total intravenous anaesthesia (TIVA) in patients undergoing urological surgery.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of remimazolam tosilate versus propofol for total intravenous anaesthesia in urological surgery

Lan,

Cao,

Liu

et al. 2024

European Journal of Anaesthesiology

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BACKGROUND Remimazolam is a novel ultra-short-acting benzodiazepine sedative that acts on the gamma-aminobutyric acid type A receptor (GABAAR). OBJECTIVE To compare the efficacies of remimazolam (RMZ), and propofol (PROP) combined with remifentanil and cisatracurium for total intravenous anaesthesia (TIVA) in patients undergoing urological surgery. DESIGN A prospective, single-blind, randomised, noninferiority clinical trial. SETTING Single centre from 1 January 2022 to 30 March 2022. PATIENTS A total of 146 adult patients undergoing elective urological surgery. INTERVENTION Patients were randomly allocated in a 1 : 1 ratio to the PROP or RMZ groups. In the PROP group, anaesthesia was induced with propofol at 100 mg min−1 to reach a bispectral index score (BIS) of 40 to 60. After loss of consciousness (LOC), intravenous fentanyl 3 μg kg−1 was administered, followed by cisatracurium 0.3 mg kg−1. Patients were intubated 3 min after cisatracurium administration. Anaesthesia was maintained with the combination of propofol (plasma concentration: 2.5 to 4 μg ml−1) and remifentanil (plasma concentration: 2.5 to 4 ng ml−1). In the RMZ group, anaesthesia was induced with remimazolam tosilate starting at 10 mg kg−1 h−1 to reach a BIS of 40 to 60 and maintained between 0.2 and 2 mg kg−1 h−1. After LOC, fentanyl and cisatracurium were administered and intubation was performed as in the PROP group. Anaesthesia was maintained with a combination of remimazolam (0.2 to 2 mg kg−1 h−1) and remifentanil (plasma concentration: 2.5 to 4 ng ml−1). MAIN OUTCOME MEASURES The primary outcome was the TIVA success rate. The predefined noninferiority margin considered an absolute difference of 6% in the primary outcome between the groups. The secondary outcomes were vital signs, anaesthesia and surgery characteristics, and adverse events. RESULTS All patients completed the trial. The success rates of TIVA with remimazolam and propofol were 100 and 98.6%, respectively. The incidence of hypotension during anaesthesia was lower in the RMZ group (26%) than in the PROP group (46.6%) (P = 0.016). The median [IQR] total consumption of ephedrine during anaesthesia was higher in the PROP group 10 [0 to 12.5] mg than in the RMZ group 0 [0 to 10] mg (P = 0.0002). The incidence of injection pain was significantly higher in the PROP group (76.7%) than in the RMZ group (0; P < 0.001). No significant differences in the controllability of the anaesthesia depth, anaesthesia and surgery characteristics, or vital signs were observed between the groups. CONCLUSION Remimazolam demonstrated noninferior efficacy to propofol combined with remifentanil and cisatracurium for TIVA in patients undergoing urological surgery. TRIAL REGISTRATION Chictr.org.cn, identifier: ChiCTR2100050923. CLINICAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry (ChiCTR2100050923, Principal investigator: Xuehai Guan, Date of registration: 8 November 2021, https://www.chictr.org.cn/showproj.html?proj=133466).

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Effect of remimazolam on intraoperative neuromonitoring during thyroid surgery: a case series

Cited by 4 publications

References 12 publications

Remimazolam: Non-Clinical and Clinical Profile of a New Sedative/Anesthetic Agent

Remimazolam: Non-Clinical and Clinical Profile of a New Sedative/Anesthetic Agent

Profile of Remimazolam in Anesthesiology: A Narrative Review of Clinical Research Progress

Efficacy of remimazolam tosilate versus propofol for total intravenous anaesthesia in urological surgery

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