The Role of Remimazolam in Neurosurgery and in Patients With Neurological Diseases: A Narrative Review

Teixeira, Miguel T.; Brinkman, Nathan; Pasternak, Jeffrey J.; Abcejo, Arnoley S.

doi:10.1097/ana.0000000000000917

Cited by 9 publications

(3 citation statements)

References 49 publications

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“…Thus, remimazolam postconditioning might produce effective postresuscitation cerebral protection through the inhibition of inflammation, oxidative stress, apoptosis, and necroptosis. In addition, recent studies have observed several adverse effects and adverse reactions of remimazolam administration including decreased blood pressure and respiratory frequency, increased blood bilirubin, dizziness, headache, delirium, and delayed neurocognitive recovery (29,30), which should be paid more attention when considering its use in the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Remimazolam Improves the Markers of Postresuscitation Cerebral Injury in a Swine Model of Cardiac Arrest

Shen,

Liu,

Fei

et al. 2024

Shock

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Introduction Previous studies have manifested that those sedatives acting on γ-aminobutyric acid A (GABAa) receptor could produce effective brain protection against regional and global ischemic stimulation. The present study was designed to investigate the effect of a novel GABAa receptor agonist, remimazolam post-conditioning (RP) on cerebral outcome after global ischemic stimulation induced by cardiac arrest and resuscitation in swine. Methods A total of 24 swine were utilized in this study, in which the animals were randomly divided into the following three groups: Sham group (n = 6), CPR group (n = 9), and CPR + RP group (n = 9). The experimental model was established by the procedure of 10 min of cardiac arrest and 5 min of cardiopulmonary resuscitation (CPR). Those resuscitated swine in the CPR + RP group received an intravenous infusion of 2.5 mg/kg of remimazolam within 60 min. Post-resuscitation cerebral injury biomarkers and neurological function were evaluated for a total of 24 h. At 24 h post-resuscitation, brain cortex was harvested to evaluate the severity of pathologic damage including tissue inflammation, oxidative stress, apoptosis, and necroptosis. Results Baseline characteristics and CPR outcomes were not significantly different between the CPR and CPR + RP groups. After resuscitation, significantly greater cerebral injury and neurological dysfunction were observed in the CPR and CPR + RP groups than in the Sham group. However, remimazolam post-conditioning significantly alleviated cerebral injury and improved neurological dysfunction after resuscitation when compared with the CPR group. At 24 h post-resuscitation, tissue inflammation, oxidative stress, and cell apoptosis and necroptosis were significantly increased in the CPR and CPR + RP groups when compared with the Sham group. Nevertheless, the severity of pathologic damage mentioned above were significantly milder in those swine treated with the remimazolam when compared to the CPR group. Conclusions In a swine model of cardiac arrest and resuscitation, the remimazolam administered after resuscitation significantly improved the markers of post-resuscitation cerebral injury and therefore protected the brain against global ischemic stimulation.

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Section: Discussionmentioning

confidence: 99%

Remimazolam Improves the Markers of Postresuscitation Cerebral Injury in a Swine Model of Cardiac Arrest

Shen,

Liu,

Fei

et al. 2024

Shock

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“…Very recently, remimazolam has been introduced in clinical practice. Remimazolam is a new ultrashort-acting benzodiazepine with high water solubility and metabolism via tissue esterases [137]. Few reports exist on the use of remimazolam during IONM.…”

Section: Anesthesia During Ionmmentioning

confidence: 99%

Intraoperative Neurophysiological Monitoring in Neurosurgery

Guzzi,

Ricciuti,

Della Torre

et al. 2024

JCM

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Intraoperative neurophysiological monitoring (IONM) is a crucial advancement in neurosurgery, enhancing procedural safety and precision. This technique involves continuous real-time assessment of neurophysiological signals, aiding surgeons in timely interventions to protect neural structures. In addition to inherent limitations, IONM necessitates a detailed anesthetic plan for accurate signal recording. Given the growing importance of IONM in neurosurgery, we conducted a narrative review including the most relevant studies about the modalities and their application in different fields of neurosurgery. In particular, this review provides insights for all physicians and healthcare professionals unfamiliar with IONM, elucidating commonly used techniques in neurosurgery. In particular, it discusses the roles of IONM in various neurosurgical settings such as tumoral brain resection, neurovascular surgery, epilepsy surgery, spinal surgery, and peripheral nerve surgery. Furthermore, it offers an overview of the anesthesiologic strategies and limitations of techniques essential for the effective implementation of IONM.

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“…Remimazolam has exhibited a lower incidence of hypotension, reduced vasopressor requirements, and fewer instances of bradycardia compared to propofol-based TIVA (Doi et al 2020). Remimazolam would be quite appealing in patients undergoing cerebrovascular surgery because early emergence from anesthesia is critically important for early neurological assessment and maintaining perfusion pressure is essential to prevent cerebral ischemia in this population (Teixeira et al 2024).…”

Section: Introductionmentioning

confidence: 99%

Effect of remimazolam versus propofol anesthesia on postoperative delirium in neurovascular surgery: study protocol for a randomized controlled, non-inferiority trial

Kim,

Lee,

Park

et al. 2024

Perioper Med

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Background Remimazolam is a short-acting benzodiazepine newly approved for the induction and maintenance of general anesthesia. Remimazolam emerges as an ideal drug for the neurosurgical population due to its rapid emergence, enabling early neurological assessment, and its ability to maintain perfusion pressure, which is crucial for preventing cerebral ischemia. However, the use of benzodiazepine has been associated with an increased risk of postoperative delirium (POD). There is currently limited evidence about the relationship between remimazolam-based total intravenous anesthesia (TIVA) and POD. Methods In this double-blind, randomized, non-inferiority trial, we plan to include 696 adult patients with American Society of Anesthesiologists physical status class I to III, undergoing elective neurovascular surgery under general anesthesia. After informed consent, the patients will be randomized to receive either remimazolam or propofol-based TIVA with a 1:1 ratio. The primary outcome is the incidence of POD within 5 days after surgery. Secondary outcomes include subtypes, number of positive assessments and severity of POD, emergence agitation, intraoperative awareness and undesirable patient movement, intraoperative hypotension, and postoperative cognitive function. The data will be analyzed in modified intention to treat. Discussion This trial will evaluate the effect of remimazolam on the development of POD compared to propofol anesthesia. The results of this trial will provide evidence regarding the choice of optimal anesthetics to minimize the risk of POD in neurosurgical patients. Trial registration The study protocol was prospectively registered at the Clinical trials (https://clinicaltrials.gov, NCT06115031, principal investigator: Jiseon Jeong; date of first registration: November 2, 2023, before the recruitment of the first participant.

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The Role of Remimazolam in Neurosurgery and in Patients With Neurological Diseases: A Narrative Review

Cited by 9 publications

References 49 publications

Remimazolam Improves the Markers of Postresuscitation Cerebral Injury in a Swine Model of Cardiac Arrest

Remimazolam Improves the Markers of Postresuscitation Cerebral Injury in a Swine Model of Cardiac Arrest

Intraoperative Neurophysiological Monitoring in Neurosurgery

Effect of remimazolam versus propofol anesthesia on postoperative delirium in neurovascular surgery: study protocol for a randomized controlled, non-inferiority trial

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