Dose Equivalence of Remimazolam and Propofol for Loss of Consciousness in Pediatric Patients: A Randomized Clinical

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Recording Brain Electromagnetic Activity During the Administration of the Gaseous Anesthetic Agents Xenon and Nitrous Oxide in Healthy Volunteers

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Yang Shen1, Ying Sun1, Yan-Ting Wang1

  • 1Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Pain Physician
|December 2, 2024
PubMed

Insights

Remimazolam is more potent for pediatric anesthesia induction than propofol. The study suggests a remimazolam dose of 0.34 mg/kg for safe and effective general anesthesia in children.

Area of Science:

  • Anesthesiology and Pharmacology

Background:

  • Remimazolam and propofol are used for general anesthesia, but pediatric dosing for remimazolam induction is not established.
  • Accurate pediatric anesthesia induction doses are critical for patient safety and procedural success.

Purpose of the Study:

  • To determine the median effective dose (ED50) for loss of consciousness (LOC) with remimazolam and propofol in pediatric patients.
  • To establish the dose equivalence between remimazolam and propofol for anesthesia induction.

Main Methods:

  • A prospective, randomized, single-center trial conducted in a tertiary pediatric hospital in China.
  • Pediatric patients aged 3-15 years received intravenous bolus doses of either remimazolam (0.1-0.3 mg/kg) or propofol (0.75-1.5 mg/kg).
  • Primary endpoint was ED50 for LOC; secondary endpoint was dose equivalence.

Main Results:

  • The calculated ED50 for remimazolam was 0.19 mg/kg (95% CI: 0.10-0.35).
  • The calculated ED50 for propofol was 1.11 mg/kg (95% CI: 0.53-2.15).
  • Remimazolam demonstrated approximately 5.8 times greater potency than propofol.

Conclusions:

  • Remimazolam exhibits significantly higher sedative efficacy in pediatric patients compared to propofol.
  • A recommended induction dose of 0.34 mg/kg remimazolam is proposed, based on comparison with a 2 mg/kg propofol dose.
  • Limitations include lack of blinding and potential bias in LOC assessment, necessitating further research.
Abstract

Keywords:
dose equivalenceintravenous bolus administrationloss of consciousness (LOC)median effective dose (ED50)pediatric anesthesiapropofolRemimazolam

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