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Determining ED90 of Flumazenil for Selective Respiratory Distress Improvement Using Remimazolam During Endoscopic

Hyun Il Kim1, Da Hyun Jung2, Sung Jin Lee1

  • 1Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.

Cancers
|January 25, 2025
PubMed
Abstract

Insights

Low doses of flumazenil effectively improved respiratory distress in patients receiving remimazolam during monitored anesthesia care (MAC). The study determined the effective dose (ED90) of flumazenil for this specific application.

Area of Science:

  • Anesthesiology
  • Pharmacology

Background:

  • Patients undergoing endoscopic submucosal dissection under monitored anesthesia care (MAC) with remimazolam may experience respiratory distress.
  • Low-dose flumazenil has shown potential to improve respiratory distress without fully reversing sedation in these cases.

Purpose of the Study:

  • To determine the effective dose 90 (ED90) of flumazenil for selectively improving respiratory distress in patients receiving remimazolam for MAC.

Main Methods:

  • A biased-coin up-and-down design was employed for flumazenil dose determination, starting at 5 mcg.
  • Improvement in respiratory distress was recorded within 30 seconds of administration.
  • Centered isotonic regression was used to estimate the ED90.

Main Results:

  • The estimated ED90 of flumazenil was 76.72 mcg (95% CI: 68.07-102.62).
  • Memory recall was infrequent (15%) in patients near the ED90 dose range.
  • No major postoperative complications were observed within 2 days.

Conclusions:

  • The ED90 of flumazenil for alleviating respiratory distress during remimazolam-induced MAC was determined to be 76.7 mcg.
  • Flumazenil effectively improved respiratory distress without reversing consciousness.
  • Findings offer guidance for managing sedation in patients undergoing MAC.
Keywords:
anesthesia safetyendoscopic submucosal dissectionflumazenilmonitored anesthesia careremimazolamrespiratory distresssedationsedation reversal

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