Remimazolam in neurosurgery
Milena Stojanovic1, Radmilo Jankovic1,2
1Clinic for Anesthesia and Intensive Therapy, University Clinical Center Nis.
Current Opinion in Anaesthesiology
|April 10, 2025
Summary
Remimazolam, a new ultrashort-acting anesthetic, offers predictable onset and rapid recovery. It shows promise for neurosurgery, potentially improving hemodynamic stability and patient arousal.
Area of Science:
- Anesthesiology
- Pharmacology
- Neurosurgery
Background:
- Remimazolam is a novel intravenous anesthetic agent introduced in 2020.
- It is an ultrashort-acting benzodiazepine with unique pharmacokinetic properties, metabolized by tissue esterases.
- Its use is currently approved for procedural sedation and general anesthesia in select countries.
Purpose of the Study:
- To review the literature and evidence regarding the use of remimazolam in neurosurgical procedures.
- To evaluate the safety and efficacy of remimazolam for anesthesia and sedation in neurosurgery.
Main Methods:
- Literature search of existing studies and evidence on remimazolam.
- Analysis of pharmacokinetic properties, clinical effects, and safety profile.
Main Results:
- Remimazolam offers predictable onset, short duration, and rapid recovery.
- It has a lower risk of respiratory and cardiovascular depression compared to other agents.
- Studies suggest it may improve hemodynamic stability during cerebral aneurysm coiling and does not alter cerebral metabolism, blood flow, or volume.
- Its rapid arousal profile makes it suitable for awake craniotomy.
Conclusions:
- Remimazolam presents desirable properties including a reduced risk of prolonged sedation and a reliable safety margin.
- It is expected to enhance the safety of sedation and general anesthesia in neurosurgical settings.
- Further research and clinical adoption are anticipated.
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