Remimazolam: pharmacological characteristics and clinical applications in anesthesiology

Kim, Kyung Mi

doi:10.17085/apm.21115

Cited by 117 publications

(113 citation statements)

References 54 publications

Supporting

Mentioning

109

Contrasting

Unclassified

Order By: Relevance

“…We believe that the high controllability and predictability of remimazolam besylate facilitates "switching" between sedation and arousal, avoiding frequent and uncontrollable fluctuations in consciousness. 44 The "soft pharmacology" 45 of remimazolam enhanced our confidence in applying this novel benzodiazepine to control acute agitation symptoms. However, whether it is detrimental to the recovery from delirium is a matter of concern to us at the outset.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Remimazolam Besylate versus Dexmedetomidine for Sedation in Non-Intubated Older Patients with Agitated Delirium After Orthopedic Surgery: A Randomized Controlled Trial

Deng¹,

Qin²,

Wu³

et al. 2022

DDDT

View full text Add to dashboard Cite

The purpose of the present study was to investigate the efficacy and safety of remimazolam besylate compared with dexmedetomidine for the relief of agitated delirium in non-intubated older patients after orthopedic surgery. Patients and methods: Seventy-five patients were randomly divided into two groups. Patients assigned to the remimazolam group received a loading dose of 0.075 mg/kg remimazolam besylate over 1 minute, followed by a continuous infusion of 0.1 to 0.3 mg/kg/h. Subjects randomized to the dexmedetomidine group received a loading infusion of 0.5 μg/kg dexmedetomidine over 10 minutes, followed by a maintenance dose of 0.2 to 0.7 μg/kg/h. Meanwhile, RASS score-guided dose titration was followed. To assess the efficacy of the study drugs in terms of time to resolution of agitation, time to first achievement of target sedation, percentage of time within the target sedation range, and time to delirium resolution. Safety of the sedatives was evaluated by adverse events during hospitalization. Results: Time to resolution of agitation did not differ between the two groups. The time to first achievement of target sedation was 19.0 (9.5 to 31.0) minutes for remimazolam besylate vs 43.5 (15.0 to 142.5) minutes for dexmedetomidine (P < 0.001). Percentage of time within the target sedation range was 77.8% for remimazolam besylate-treated patients and 67.4% for dexmedetomidine-treated patients (P = 0.001). Patients in the remimazolam group had longer time to delirium resolution (29.5 [21.3 to 32.5] hours) than those in the dexmedetomidine group (22.8 [18.9 to 28.5] hours) (P = 0.042). Patients sedated with remimazolam besylate had more oversedation (P = 0.036) but less hypotension (P = 0.007). Conclusion: Compared with dexmedetomidine, remimazolam besylate was equally effective in relieving agitation, and resulted in earlier achievement of sedation goal and more controllable sedation. Remimazolam may be an ideal agent for obtaining rapid tranquillisation.

show abstract

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Remimazolam Besylate versus Dexmedetomidine for Sedation in Non-Intubated Older Patients with Agitated Delirium After Orthopedic Surgery: A Randomized Controlled Trial

Deng¹,

Qin²,

Wu³

et al. 2022

DDDT

View full text Add to dashboard Cite

show abstract

“…Remimazolam is developed on the basis of midazolam, which has better efficacy and safety [11] , better anesthesia effect [12] and remimazolam can also act on GABA receptors to reduce neuronal excitation. There is no accumulation in the body and the retention time is shorter than that of midazolam, which can induce less movement of rats, thereby exerting a better sedative role [13,14] .…”

Section: Resultsmentioning

confidence: 99%

Remimazolam Inhibits Neuronal Apoptosis in Rat Brain via Slit Guidance Ligand 2/Roundabout 4 Signaling Pathway

Li¹,

Dong²,

Lin³

et al. 2022

IJPS

View full text Add to dashboard Cite

To investigate the effect of remimazolam on neuronal apoptosis in rat brain through slit guidance ligand 2/roundabout 4 signaling pathway. Primary cortical neurons were obtained from specific pathogen free 3 w old male Wistar rats and sub cultured in cell culture dishes. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay detected cell viability; Hochest/propidium iodide double staining and flow cytometry detected cell apoptosis. Western blot detected apoptosis-related gene expression and slit guidance ligand 2/roundabout 4 signaling pathway-related protein expression. In addition, after slit guidance ligand 2 inhibitor administration, Western blot detected the changes in expression levels of key genes in cells. Relative to control group, cell viability in each remimazolam group presented elevation and apoptosis presented depletion (p<0.05) in a dose-dependent manner. With the increase of remimazolam treatment time, Bcl-2associated X protein, cleaved caspase-3 and cleaved poly adenosine diphosphate-ribose polymerase protein levels showed a gradual decrease and anti-apoptotic protein B-cell lymphoma 2 level showed a gradual increase relative to 0 h (p<0.05). At the same time, with the increase of remimazolam treatment time (0, 3, 6, 12 and 24 h), slit guidance ligand 2 and roundabout 4 protein levels increased continuously relative to 0 h. Additionally, relative to remimazolam group, Bcl-2-associated X protein, cleaved caspase-3 and cleaved poly adenosine diphosphate-ribose polymerase showed a gradual up regulation and B-cell lymphoma 2 showed a gradual down regulation in slit guidance ligand 2 inhibitor and remimazolam co-treatment group. Remimazolam pretreatment may inhibit rat cortical neuronal apoptosis through slit guidance ligand 2/ roundabout 4 signaling pathway and providing new ideas for clinical brain protection.

show abstract

“…Should recovery be too prolonged after the administration of remimazolam, the rapid reversal of hypnosis can be achieved shortly after the administration of flumazenil. In this kind of situation, flumazenil should be slowly injected to prevent adverse events after administration, such as hypertension or tachycardia [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Quality of recovery in patients administered remimazolam versus those administered an inhalant agent for the maintenance of general anesthesia: a randomized control trial

et al. 2022

View full text Add to dashboard Cite

Background Remimazolam is a novel intravenous benzodiazepine that is appropriate for the maintenance of anesthesia. Quality of recovery is an important component of health care quality, but there is no published randomized control trial focused on the quality of recovery in patients undergoing total intravenous anesthesia with remimazolam. Methods This parallel-group, single-blind randomized control trial at a tertiary care medical center in South Korea was conducted to determine the difference in the quality of recovery between the patients administered remimazolam and those administered an inhalant anesthetic agent. A total of 168 patients aged 19–65 years who underwent elective laparoscopic cholecystectomy or robotic gynecologic surgery were considered for enrollment. Randomization was performed using sealed envelopes containing computer-generated random allocation sequences. Remimazolam was administered for the maintenance of anesthesia in the remimazolam group (Group R), and desflurane was administered in the desflurane group (Group D). The induction protocol and the target value of the bispectral index were identical in both groups. Patients were blinded to the drug that was administered until they finished the postoperative questionnaire. The main outcome measure was the decrement of the QoR-40 score on postoperative day 1 compared to the QoR-40 score on the day before surgery. Results A total of 165 patients were analyzed. The preoperative and postoperative global QoR-40 scores were 183 and 152 (IQR 173–192 and 136–169), respectively. The perioperative decrement of the global QoR-40 score was 29.96 ± 22.49. The decrement of the QoR-40 score was smaller in Group R than in Group D (26.99 versus 32.90, respectively; mean difference 5.91, 95% confidence interval -0.96–12.79). After adjustment for sex, the type of surgery and surgical time, the administration of remimazolam resulted in a 7.03-point (95% CI 0.35–13.72) less decrement of the QoR-40 score than desflurane. There were no severe adverse events in either group. Conclusion Total intravenous anesthesia maintained with remimazolam provides a better quality of recovery than anesthesia maintained with an inhalant agent in patients undergoing laparoscopic surgery. Additionally, postoperative nausea and vomiting were largely reduced with remimazolam. Trial registration KCT0006288, Clinical Research Information Service (CRIS), Republic of Korea Registration date: 23/06/2021

show abstract

Remimazolam: pharmacological characteristics and clinical applications in anesthesiology

Cited by 117 publications

References 54 publications

Efficacy and Safety of Remimazolam Besylate versus Dexmedetomidine for Sedation in Non-Intubated Older Patients with Agitated Delirium After Orthopedic Surgery: A Randomized Controlled Trial

Efficacy and Safety of Remimazolam Besylate versus Dexmedetomidine for Sedation in Non-Intubated Older Patients with Agitated Delirium After Orthopedic Surgery: A Randomized Controlled Trial

Remimazolam Inhibits Neuronal Apoptosis in Rat Brain via Slit Guidance Ligand 2/Roundabout 4 Signaling Pathway

Quality of recovery in patients administered remimazolam versus those administered an inhalant agent for the maintenance of general anesthesia: a randomized control trial

Contact Info

Product

Resources

About