Apnea during moderate to deep sedation using continuous infusion of remimazolam compared to propofol and...

Area of Science:

• Anesthesiology
• Pharmacology
• Critical Care Medicine

Background:

• Remimazolam offers rapid onset and offset for sedation during regional anesthesia.
• Its respiratory safety profile, especially with continuous infusion, requires further investigation.
• Comparative data against established sedatives like propofol and dexmedetomidine is limited.

Purpose of the Study:

• To compare the incidence of apnea during continuous infusion of remimazolam versus propofol and dexmedetomidine for moderate to deep sedation after regional anesthesia.
• To evaluate the respiratory safety of remimazolam in this clinical setting.

Main Methods:

• Retrospective study analyzing 634 patients undergoing orthopedic surgery under regional anesthesia.
• Patients received moderate to deep sedation via continuous infusion of remimazolam (Group R), propofol (Group P), or dexmedetomidine (Group D).
• Propensity score weighted multivariable logistic regression was used to compare apnea incidence (>10 seconds) across groups.

Main Results:

• Apnea incidence was 63.9% for remimazolam, 67.3% for propofol, and 48.5% for dexmedetomidine.
• Adjusted odds ratios for apnea were significantly higher for remimazolam (2.33) and propofol (2.50) compared to dexmedetomidine.
• The study highlights a substantial rate of apnea associated with remimazolam at the suggested dosage.

Conclusions:

• Continuous infusion of remimazolam, similar to propofol, is associated with a high incidence of apnea when used for moderate to deep sedation post-regional anesthesia.
• Dexmedetomidine demonstrated a comparatively lower rate of apnea.
• Close titration and vigilant respiratory monitoring are essential for patients receiving remimazolam sedation.