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Three cases of difficulty in achieving definitive loss of consciousness with remimazolam

Mao Miyanishi1, Toru Yaguramaki2, Yasuhiro Maehara3

  • 1Department of Anesthesiology, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. maooooon527@gmail.com.

JA Clinical Reports
|January 11, 2022
PubMed
Abstract

Insights

High doses of remimazolam may be needed in patients with prior benzodiazepine use or of different races. Conversion to propofol may be necessary if remimazolam (an ultra-short-acting anesthetic) shows inadequate sedation.

Area of Science:

  • Anesthesiology
  • Pharmacology

Background:

  • Remimazolam is a novel ultra-short-acting benzodiazepine for general anesthesia.
  • Its tolerance in patients with prior benzodiazepine use is not well-established.
  • Efficacy across different races requires further elucidation.

Purpose of the Study:

  • To investigate the anesthetic depth and tolerance of remimazolam in specific patient populations.
  • To determine the need for alternative anesthetic agents in challenging cases.

Main Methods:

  • Case series of three patients requiring high-dose remimazolam.
  • Inclusion of patients with pre-existing benzodiazepine use and of different racial backgrounds.
  • Monitoring for anesthetic depth and need for conversion to other agents.

Main Results:

  • Two cases involved patients with prior benzodiazepine use.
  • One case involved a Chinese patient.
  • All three cases necessitated conversion to propofol for adequate anesthesia.

Conclusions:

  • Remimazolam may require higher doses in benzodiazepine-tolerant patients or those of different races.
  • Conversion to propofol is a viable option when remimazolam shows insufficient sedative effects in these groups.
Keywords:
BenzodiazepineBispectral indexRemimazolamTolerance

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