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Clinical utility of effect-site concentration simulation during remimazolam general anesthesia

Yasuhiro Morimoto1, Manabu Yoshimura2, Mani Koga2

  • 1Department of Anesthesiology, Ube Central Hospital, 750 Nishikiwa Ube, Yamaguchi, 755-0151, Japan. yasumorimo@gmail.com.

Journal of Anesthesia
|April 9, 2026
PubMed
Abstract

Insights

Effect-site concentration simulation aids remimazolam anesthesia management. While useful for predicting anesthetic depth and emergence, electroencephalogram (EEG) indices like BIS showed limited reliability in this study.

Area of Science:

  • Anesthesiology
  • Pharmacokinetics
  • Clinical Pharmacology

Background:

  • Remimazolam is a novel ultra-short-acting benzodiazepine.
  • Accurate anesthetic depth monitoring is crucial for patient safety and optimal drug utilization.

Purpose of the Study:

  • To evaluate the clinical utility of effect-site concentration (Ce) simulation for remimazolam anesthesia.
  • To assess the reliability of EEG-derived parameters (BIS, BSR) during remimazolam infusion.

Main Methods:

  • Prospective observational study of 48 adult patients undergoing orthopedic surgery.
  • Remimazolam infusion for induction with Ce simulation.
  • Assessment of responsiveness and recording of EEG parameters (BIS, BSR).

Main Results:

  • Mean remimazolam Ces at loss and recovery of responsiveness were similar (0.35 ± 0.08 µg/mL vs. 0.36 ± 0.07 µg/mL).
  • A positive correlation (r=0.76) was found between remimazolam Ce and responsiveness.
  • Weak correlation between remimazolam Ce and BIS; BSR was 0 in 98% of data points.

Conclusions:

  • Effect-site concentration simulation is clinically useful for estimating anesthetic depth and predicting emergence with remimazolam.
  • EEG-derived indices, particularly BIS, demonstrated limited reliability in this context.
  • Further research with TCI systems and higher concentrations is recommended.
Keywords:
Bispectral indexEffect-site concentrationRemimazolam

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