Sedation/analgesia techniques for nonoperating room anesthesia: new drugs and devices

Abstract

Purpose of reviewThe purpose of this article is to review new drugs and devices for nonoperating room anesthesia (NORA). Recent findingsRemimazolam is an ultra-short-acting, water-soluble intravenous benzodiazepine with a fast onset and offset that has been approved recently for use in procedural sedation. Phase III trials have established the effectiveness of remimazolam sedation compared with placebo and midazolam in gastrointestinal endoscopy and bronchoscopy. More research is required investigating remimazolam in real-world NORA settings, including comparisons with propofol sedation. Oliceridine is a m-agonist with selectivity for the G protein pathway and low potency for b-arrestin recruitment. As such it may be associated with less nausea, vomiting and respiratory depression than traditional opioids used. Although no studies have been published about oliceridine use in NORA to date, results from surgical studies indicate a potential place in nonoperating room practice. Research continues into alternative methods of drug delivery, such as patientcontrolled sedation but no new devices are described. SummaryFurther studies are required before these new drugs and devices are embraced in NORA.

The Efficacy and Safety of Remimazolam Tosilate Versus Dexmedetomidine in Outpatients Undergoing Flexible Bronchoscopy: A Prospective, Randomized, Blind, Non-Inferiority Trial

“…However, anodynia fiberoptic bronchoscopy represents a challenge for anesthesiologists because they must share the same airway with the endoscopist ( Semmelmann and Loop, 2022 ). In addition, the interactions and synergism between sedatives and opioids can significantly increase respiratory depression ( Finlay and Leslie, 2021 ). Therefore, it is vital to maintain oxygenation via the open, flexible bronchoscope, which may also depend to a significant degree on staff expertise and equipment availability.…”

EUS-guided left lobe liver biopsy: Safer modality with similar diagnostic yield as right lobe: a pilot study

“…All patients underwent pre-anesthetic evaluation prior to EUS-LB. Patients were sedated using 1 % propofol at a dose of 0.5 to 1 mg/kg intravenously as a loading dose and repeated as required in 0.5 mg/kg increments every 3 to 5 minutes under anesthetist supervision 21 . EUS-LB was performed by one of the operators (SL, JB, RK) using a linear echo-endoscope (GF-UT-180, Olympus, Tokyo, Japan) and 22 G EUS FNB needle (Acquire, Boston Scientific Corp.).…”

Clinical profile of a new anesthetic: remimazolam

“…Remimazolam is a novel water-soluble, ultrashort-acting benzodiazepine that acts on g-aminobutyric acid A receptor [1]. The ideal characteristics of anesthetics and sedatives are fast onset and offset, predictable action duration and recovery profiles, favorable adverse effects, and minimal residual sedation [2,3]. From this viewpoint, remimazolam has its own specific, unique, and favorable characteristics, such as fast onset and recovery times as well as predictability of action duration, owing to its structural similarity to remifentanil and rapid hydrolysis by nonspecific tissue esterase activity [1,2,4].…”

“…Remimazolam is mainly excreted in urine and binds to plasma proteins, mainly serum albumin approximately 92% [2]. In addition, its other favorable characteristics include organ-independent metabolism, which allows for easy titration, pharmacological reversibility (flumazenil), and hemodynamic stability [2,3].…”