Related Experiment Video
Updated: Jun 7, 2025
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Effect-Site Concentration of Remimazolam by Age Groups During Target-Controlled Infusion for Total Intravenous
Jaesik Park1, Kwon Hui Seo2, Jueun Kwak2
1Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Purpose:
Pharmacokinetic and pharmacodynamic (PKPD) models exist for remimazolam, but data for target-controlled infusion (TCI) are limited. The Schüttler PKPD model, a three-compartment model including body weight as a covariate, does not account for age as a variable. This study aimed to investigate remimazolam's effect-site concentration (Ce) in different age groups during sedation and general anesthesia with TCI using Schüttler PKPD model.
Patients And Methods:
Records of patients who underwent remimazolam TCI with the Schüttler model were reviewed. During anesthesia induction, the target Ce of remimazolam was gradually increased until loss of responsiveness, and it was titrated to maintain bispectral index of 40-70 during operation. Patients were categorized into young (20-40 years, n=24), middle-aged (41-60 years, n=27), and elderly (61-80 years, n=35) groups. Bispectral index and hemodynamic variables were also assessed.
Results:
The elderly group had significantly lower remimazolam Ce compared to the young and middle-aged groups at all sedation levels, intubation, and surgery. Mean highest intraoperative Ce was 0.78±0.10, 0.71±0.07, and 0.61±0.10 µg/mL in young, middle-aged, and elderly groups, respectively (P<0.001). The recovery of responsiveness during emergence occurred at significantly lower Ce in the elderly group (0.28±0.06 µg/mL) than in the young (0.41±0.07 µg/mL) and middle-aged groups (0.35±0.07 µg/mL, P<0.001). Ce during sedation and general anesthesia was comparable between the young and middle-aged groups. The bispectral index was similar across groups but fluctuated more in the elderly group during general anesthesia. Elderly patients also showed the greatest systolic blood pressure suppression (18.4 ± 13.29% before intubation and 34.31 ± 14.91% during surgery).
Conclusion:
Older patients may require lower target Ce during remimazolam TCI for sedation and anesthesia, with emergence occurring at lower Ce. Blood pressure suppression may be greater in elderly patients under deep sedation or general anesthesia.
More Related Videos
08:49Assessing Changes in Volatile General Anesthetic Sensitivity of Mice after Local or Systemic Pharmacological Intervention
Published on: October 16, 2013
04:56In Vitro Method to Control Concentrations of Halogenated Gases in Cultured Alveolar Epithelial Cells
Published on: October 23, 2018
Related Concept Videos
01:22Stages of General Anesthesia
01:24Parenteral Anesthetics: Overview
01:20Inhalational Anesthetics: Overview
01:21Factors Affecting Drug Response: Overview
01:17Sedatives and Hypnotics Drugs: Miscellaneous Agents
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
01:24General Anesthesia: Overview
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...