Three cases of difficulty in achieving definitive loss of consciousness with remimazolam

Abstract

Background Remimazolam is a novel, ultra-short-acting benzodiazepine used for general anesthesia. Because remimazolam is an emerging drug, the tolerance to remimazolam in benzodiazepine-taking patients has been unclear. Also, the efficacy of remimazolam in different races is not fully elucidated so far. Case presentation Here we experienced three cases in which high dose of remimazolam was needed for attempting to achieve appropriate anesthetic depth. Two of the three cases were of preoperatively benzodiazepine-taking patients. The other was a case of a Chinese patient. In all three cases, conversion to general anesthesia with propofol was necessitated. Conclusions When signs of inadequate sedative effect of remimazolam are observed in patients of benzodiazepine users or of different races, conversion to another sedative agent such as propofol should be considered.

Effect of converting from propofol to remimazolam with flumazenil reversal on recovery from anesthesia in outpatients with mental disabilities: a randomized controlled trial

“…Previous studies have demonstrated that remimazolam-based TIVA can lead to elevated PSI values compared with propofol-based TIVA, with some values exceeding the threshold of 50 [ 16 , 37 ]. Additionally, there have been reports of chronic benzodiazepine users developing tolerance to remimazolam, necessitating the use of alternative anesthetics or higher remimazolam dosages [ 38 , 39 ]. Although our study included chronic benzodiazepine users, we did not observe any such discrepancies.…”

Frequency and characteristics of patients with bispectral index values of 60 or higher during the induction and maintenance of general anesthesia with remimazolam

“…However, when remimazolam is administered externally at the approved maximum infusion rate, the BIS value should be maintained ˂ 60 regardless of endozepines levels. In a case report, two patients receiving benzodiazepines before surgery required large doses of remimazolam to achieve a BIS of less than 60 27 . This suggests that the patient’s concomitant medications may affect intraoperative BIS values.…”

Successful recording of direct cortical motor-evoked potential from a pediatric patient under remimazolam anesthesia: a case report

“…This case report demonstrates that dc-MEP recording under remimazolam Remimazolam has some issues that should be addressed. First, the reliability of frontal EEG-derived index alteration is still controversial [21], despite the good correlations between the BIS value, and the effects of propofol, midazolam, and isoflurane on the level of consciousness and recall were evident [22]. The EEG effects of benzodiazepines are predominantly a monotonic beta activation, especially in frontal areas, and these effects map to higher EEG-derived indices to estimate the anesthesia depth [23].…”