Remimazolam for Sedation During Fiberoptic Intubation in an Adolescent

Abstract

In specific clinical scenarios, fiberoptic intubation (FOI) may be the preferred technique for airway management and endotracheal intubation. In addition to topical anesthesia of the airway, sedation is frequently necessary, especially in younger patients, to facilitate the procedure. The goal is to facilitate the procedure by providing sedation, anxiolysis, and analgesia with maintenance of spontaneous ventilation. Remimazolam is a novel benzodiazepine with a short half-life and limited context sensitive half-life that can be titrated by continuous infusion. These novel properties may make it a suitable agent for sedation during FOI of the trachea. We report the novel use of a combination of remimazolam and remifentanil infusions to provide sedation during FOI in an adolescent. The basic pharmacology of remimazolam is presented and previous reports of its use for sedation during FOI are reviewed.

Clinical Application and Research Progress of Remimazolam for Pediatric Patients

“…The short CSHT of remimazolam and its ease of titration by continuous infusion may make it an appropriate choice for sedation during FOI in children. Hughes et al 37 reported the successful use of remimazolam (15 µg/kg/min) and remifentanil (0.05 µg/kg/mi) for analgesia and sedation in a 12-year-old boy with postburn neck contracture and FOI was completed. This result suggests that the potential of remimazolam to preserve spontaneous breathing and rapidly reverse sedation is extremely important in patients who are difficult to intubate.…”

“…Flumazenil can quickly reverse the hypnotic effect of remimazolam, shorten the postoperative extubation time in children, allow spontaneous breathing after failed intubation and avoid delayed awakening in children with congenital metabolic diseases, which improves the safety and controllability of remimazolam anesthesia. 32 , 37 , 41 The FDA-approved doses of remimazolam for benzodiazepine reversal when used for pediatric patients (children 1 year and older and adolescents) receiving conscious sedation or general anesthesia are the initial dose of 0.01 mg/kg given over 15 seconds (up to a maximum dose of 0.2 mg). If no desired return of consciousness is noted after 45 seconds, repeat 0.01 mg/kg (up to 0.2 mg) at 1-minute intervals as needed.…”