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Respiratory Depression Following Concomitant Infusion of Remimazolam and Remifentanil Using Targeted Effect-Site
Ha Yeon Kim1,2, Sang Kee Min1, Jee Hwan Moon1
1Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-ro, Youngtong-gu, Suwon-si 16499, Gyeonggi-do, Republic of Korea.
Medicina (Kaunas, Lithuania)
|May 27, 2026
Summary
Combining remimazolam and remifentanil causes dose-dependent respiratory depression and loss of consciousness (LOC) preceded by desaturation. Continuous monitoring is essential for safe co-administration.
Area of Science:
- Anesthesiology and Pharmacology
Background:
- Remimazolam and remifentanil are ultra-short-acting agents for sedation and analgesia.
- Their combined impact on respiratory function requires investigation.
Purpose of the Study:
- To evaluate dose-dependent respiratory depression and loss of consciousness (LOC) from remimazolam-remifentanil co-administration.
- To determine if LOC is preceded by oxygen desaturation.
Main Methods:
- A randomized, double-blind trial involving 108 female patients undergoing elective gynecological surgery.
- Patients received fixed remimazolam (500 ng/mL Ce) with varying remifentanil concentrations (1.0, 1.5, 2.0 ng/mL Ce).
- Respiratory variables, LOC timing, and adverse events were monitored.
Main Results:
- Respiratory depression increased with higher remifentanil doses.
- Jaw thrust and 100% oxygen requirements escalated significantly with increasing doses.
- Minute ventilation decreased only at the highest remifentanil concentration.
Conclusions:
- Remimazolam-remifentanil co-administration induces dose-dependent respiratory depression.
- Oxygen desaturation can precede loss of consciousness (LOC) during this combination.
- Continuous monitoring and careful dose titration are crucial for patient safety.
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