Remimazolam use for awake craniotomy

Tachibana, Shunsuke; Hayamizu, Kengo; Yamakage, Michiaki

doi:10.1186/s40981-021-00428-w

Cited by 4 publications

(3 citation statements)

References 4 publications

(4 reference statements)

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“…The use in awake craniotomy is of particular interest, especially incorporating the planned use of flumazenil to reverse sedation during the procedure ( Yoshida et al, 2021 ). However, Tachibana et al ( Tachibana et al, 2021 ) have questioned the effectiveness of remimazolam for craniotomy based on observation from two subjects. They make three points.…”

Section: Remimazolammentioning

confidence: 99%

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

Kilpatrick¹

2021

Front. Pharmacol.

129

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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: Remimazolammentioning

confidence: 99%

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

Kilpatrick¹

2021

Front. Pharmacol.

129

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“…Remimazolam is less effective at suppressing the pharyngeal reflex [ 25 ]. Throat irritation is severe during gastroscope insertion, which requires a combination of opioids and propofol.…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial for anesthesia during gastroscopy: interactions between remimazolam and propofol in combination with sufentanil

et al. 2023

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Background Remimazolam is a new short-duration anesthetic currently used for gastroscopy and can be mixed with propofol and potent opioids. Aim The study aimed to investigate the synergistic interaction between remimazolam and propofol after sufentanil administration and to determine the appropriate dose ratios between remimazolam and propofol. Method This study used a randomized controlled design. Patients scheduled for gastrointestinal endoscopy were included and randomized into five groups. The randomized block design was applied at a randomization ratio of 1:1. Patients in each group received sufentanil (0.1 μg/kg) and the calculated doses of remimazolam and propofol. Using the up and down method, the median effective dose (ED50) and the 95% confidence interval (CI) were determined based on whether the eyelash reflex disappeared in each treatment group. Isobolographic analysis was used to analyze the presence of drug interactions. The interaction coefficient and the dose ratio between remimazolam and propofol were calculated by algebraic analysis. Statistical analysis was performed using interval estimates and 95% CI for statistical attributes. Results Cross-sectional analysis of the isobologram showed a clinically significant synergistic effect between remimazolam and propofol. When 0.016, 0.032, and 0.047 mg/kg of remimazolam were combined with 0.477, 0.221, and 0.131 mg/kg of propofol, the interaction coefficients were 1.04, 1.21, and 1.06, respectively. The dose ratio of remimazolam to propofol was approximately 1:7. Conclusion Remimazolam and propofol have synergistic clinical effects. A strong synergistic effect was observed when the remimazolam and propofol dose ratio was 1:7 (mg/kg). Clinical trial The study protocol was registered at the Chinese Clinical Trial Registry (ChiCTR2100052425).

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“…For 30 min and 45 min after extubation, compared with the Group R, more patients in Group P were in the state of drowsiness, and more patients fell into the confusion of consciousness. Compared with propofol, Remimazolam Toluenesulfonic acid not only had no injection pain, but also a lower incidence of hypotension, suggesting that it was relatively safer and more comfortable (Jia, et al, 2021;Tachibana, et al, 2021). Remimazolam Toluenesulfonic acid is a kind of benzodiazepine sedative hypnotic drug, which produces a sedative efect by regulating GABAA receptor ( et al,2011;.…”

Section: Discussionmentioning

confidence: 99%

Difference between remimazolam toluenesulfonic acid and propofol in waking quality and conscious state after general anesthesia

Zhou

Yang

et al. 2021

Ibrain

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ObjectiveTo explore the difference of anesthesia recovery and postoperative conscious state between remimazolam toluenesulfonic acid and propofol after induction and maintenance of general anesthesia.Methods104 patients undergoing elective tracheal intubation general anesthesia in our hospital were randomly divided into 2 groups: Remimazolam Toluenesulfonic acid group (Group R) and Propofol group (Group P). MOAA/S score, the modified Aldrete score, recovery index, time point, a state of consciousness, interpretative vital signs and adverse events were monitored at different time.ResultsCompared with the Group P, the extubation time and orientation recovery time of the Group R were significantly shorter. When the operation time was less than 1 hour, the MOAA/S score of the Group R was shorter than that of Group P at 5 min and 15 min after the operation. To compare with the Group P, the score of MOAA/S in the Group R increased at 5 min, 20 min and 30 min after the operation. When the operation time was less than or equal to 1 h, the modified Aldrete score in the Group R was slightly higher than that in the Group P at 30 min after extubation. There was no injection pain in the the Group R, and the incidence of hypotension was lower than that of propofol.ConclusionCompared with Propofol, when the operation time of general anesthesia is more than 1 hour, recovery time of Remimazolam Toluenesulfonic acid is shorter, with more complete and higher‐quality recovery.

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Remimazolam use for awake craniotomy

Cited by 4 publications

References 4 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

Randomized controlled trial for anesthesia during gastroscopy: interactions between remimazolam and propofol in combination with sufentanil

Difference between remimazolam toluenesulfonic acid and propofol in waking quality and conscious state after general anesthesia

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