Stereotactic Functional Neurosurgery Combining Sedation and Awake Procedures Using Remimazolam Besylate and...

Area of Science:

• Neurosurgery
• Anesthesiology
• Pharmacology

Background:

• Current anesthesia methods for stereotactic functional neurosurgery present limitations.
• Local anesthesia and mild sedation can cause patient discomfort.
• General anesthesia hinders critical real-time neurological assessments.

Purpose of the Study:

• To introduce and evaluate a novel sedation protocol for stereotactic functional neurosurgery.
• To assess the safety and feasibility of using remimazolam besylate and flumazenil.
• To determine the efficacy of this protocol in facilitating intraoperative neurological assessments.

Main Methods:

• A protocol using intravenous remimazolam besylate for sedation and flumazenil for reversal was administered to 30 patients with movement disorders.
• Sedation levels were monitored using bispectral index, and spontaneous respiration was maintained.
• Fentanyl was used for analgesia; no muscle relaxants were employed.

Main Results:

• All 30 patients tolerated the procedures well, reporting no intraprocedural discomfort or pain.
• The mean awakening time after flumazenil administration was 130.3 ± 73.9 seconds.
• No significant adverse events like respiratory depression or re-sedation were observed; one patient required re-sedation for claustrophobia.

Conclusions:

• The novel sedation protocol using remimazolam besylate and flumazenil is feasible and safe for stereotactic functional neurosurgery.
• This approach effectively allows for intraoperative neurological assessments by enabling awake patient participation.
• Further research with larger patient groups is recommended to validate these findings.