Remimazolam anesthesia for cardiac surgery with cardiopulmonary bypass: a case report

Saito, Kota; Ohno, Sho; Maeda, Makishi; Hirata, Naoyuki; Yamakage, Michiaki

doi:10.1186/s40981-021-00424-0

Cited by 28 publications

(22 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, remimazolam can be used for patients with a history of egg allergy. However, there has been only one report on the effects of remimazolam on MEP response [10]. Our case report provides further evidence regarding the use of remimazolam for MEP monitoring.…”

Section: Discussionsupporting

confidence: 65%

“…The amplitude of MEPs decreased in our patient, and weakness of the foot was confirmed after anesthesia because of the rapid elimination of remimazolam. Remimazolam has some advantages including no vascular pain at administration and less circulatory depression [10]. In addition, remimazolam can be used for patients with a history of egg allergy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Case of Decreased Amplitude in Motor Evoked Potentials Under Remimazolam Anesthesia

Aratani¹,

Tokinaga²,

Tanioku³

et al. 2022

Cureus

View full text Add to dashboard Cite

Remimazolam is a newly developed benzodiazepine derivative. Although one case report on the use of remimazolam for motor evoked potential (MEP) monitoring has been reported, there has been no report of changes in the MEP response under remimazolam anesthesia, which is associated with impairment of the corticospinal motor track. This is a case of a 54-year-old woman who was diagnosed with an extradural extramedullary tumor. The patient reported being allergic to chicken eggs. We used remimazolam instead of propofol for anesthesia management. During tumor resection, the amplitudes of MEP responses at the left quadriceps femoris, left tibialis anterior, and left abductor hallucis muscle decreased. The surgery was scaled down and the tumor was removed in a reduced size. The patient had muscle weakness immediately after surgery but eventually recovered. In this case, we could detect changes in MEP response under remimazolam anesthesia, which suggested impairment of the motor tracts during surgery.

show abstract

Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

A Case of Decreased Amplitude in Motor Evoked Potentials Under Remimazolam Anesthesia

Aratani¹,

Tokinaga²,

Tanioku³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…Even 6 mg/kg/h remimazolam was successful at inducing anaesthesia in all critically ill patients in ASA class III or higher [ 9 ]. One study reported that general anaesthesia for cardiac surgery was induced with 6 mg/kg/h remimazolam [ 10 ]. We selected 6 mg/kg/h as the induction dose based on the patient’s cardiac condition.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management using remimazolam in a patient with severe aortic stenosis: a case report

2021

View full text Add to dashboard Cite

Background The administration of general anaesthesia in patients with aortic stenosis (AS) requires careful attention to haemodynamics. We used remimazolam for the induction and maintenance of anaesthesia in a woman with severe AS undergoing a total mastectomy. Case presentation An 81-year-old woman with severe AS was scheduled to undergo a total mastectomy. We decided to administer total intravenous anaesthesia with remimazolam to minimize haemodynamic changes. Although the patient showed transient hypotension after anaesthesia induction, the cardiac index was preserved with a low dose of continuous noradrenaline. The anaesthesia was then safely maintained without a decrease in the patient’s cardiac index. Conclusions General anaesthesia using remimazolam preserved cardiac output in this patient; therefore, remimazolam can be safely used to avoid the risk of cardiac suppression in patients with severe AS.

show abstract

“…Clearly, further study is required on the use of remimazolam in craniotomy to understand better the risk/ benefit balance. Successful use of remimazolam has been described in spine surgery incorporating motor evoked potential monitoring (Kondo et al, 2020), thyroid surgery with neuromonitoring (Hayamizu et al, 2021), and cardiac surgery with cardiopulmonary bypass (Saito et al, 2021). Remimazolam's successful use in high-risk patients, including endoscopic retrograde cholangiopancreatography in a patient with impaired respiratory function due to myotonic dystrophy (Fukuda et al, 2021), MitraClip implantation in a patient with advanced heart failure (Satoh et al, 2021), and cochlear implant in a patient with mitochondrial myopathy (Suzuki et al, 2021) has been published.…”

Section: Case Reportsmentioning

confidence: 99%

Remimazolam: Non-Clinical and Clinical Profile of a New Sedative/Anesthetic Agent

Kilpatrick¹

2021

Front. Pharmacol.

145

View full text Add to dashboard Cite

A program to identify novel intravenous sedatives with a short and predictable duration of action was initiated in the late 1990’s by Glaxo Wellcome. The program focussed on the identification of ester-based benzodiazepine derivatives that are rapidly broken down by esterases. Remimazolam was identified as one of the lead compounds. The project at Glaxo was shelved for strategic reasons at the late lead optimization stage. Via the GSK ventures initiative, the program was acquired by the small biotechnology company, TheraSci, and, through successive acquisitions, developed as the besylate salt at CeNeS and PAION. The development of remimazolam besylate has been slow by industry standards, primarily because of the resource limitations of these small companies. It has, however, recently been approved for anesthesia in Japan and South Korea, procedural sedation in the United States, China, and Europe, and for compassionate use in intensive care unit sedation in Belgium. A second development program of remimazolam was later initiated in China, using a slightly different salt form, remimazolam tosylate. This salt form of the compound has also recently been approved for procedural sedation in China. Remimazolam has the pharmacological profile of a classical benzodiazepine, such as midazolam, but is differentiated from other intravenous benzodiazepines by its rapid conversion to an inactive metabolite resulting in a short onset/offset profile. It is differentiated from other intravenous hypnotic agents, such as propofol, by its low liability for cardiovascular depression, respiratory depression, and injection pain. The benzodiazepine antagonist flumazenil can reverse the effects of remimazolam in case of adverse events and further shorten recovery times. The aim of this review is to provide an analysis of, and perspective on, published non-clinical and clinical information on 1) the pharmacology, metabolism, pharmacokinetics, and pharmacodynamic profile of remimazolam, 2) the profile of remimazolam compared with established agents, 3) gaps in the current understanding of remimazolam, 4) the compound’s discovery and development process and 5) likely future developments in the clinical use of remimazolam.

show abstract

Remimazolam anesthesia for cardiac surgery with cardiopulmonary bypass: a case report

Cited by 28 publications

References 13 publications

A Case of Decreased Amplitude in Motor Evoked Potentials Under Remimazolam Anesthesia

A Case of Decreased Amplitude in Motor Evoked Potentials Under Remimazolam Anesthesia

Anaesthetic management using remimazolam in a patient with severe aortic stenosis: a case report

Remimazolam: Non-Clinical and Clinical Profile of a New Sedative/Anesthetic Agent

Contact Info

Product

Resources

About