2023, Number 3
<< Back Next >>
Rev Mex Anest 2023; 46 (3)
Remimazolam: the ideal agent for sedation, induction and maintenance of anesthesia?
Portela-Ortiz JM, Enríquez-Barajas A, García-Rangel FY, Olvera-Meza P, García-Hernández LA
Language: Spanish
References: 23
Page: 204-207
PDF size: 247.00 Kb.
ABSTRACT
Remimazolam is a new benzodiacepine that combines the pharmacological properties of two agents used in anesthesia: the hypnotic effect of midazolam and the metabolism of remifentanyl. Remimazolam is hydrolized by nonspecific tissue esterases into inactive metabolytes, allowing high clearance and fast recovery. Due to its pharmacological characteristics, it has been proposed as an ultra- short acting agent for sedation out operating room, induction and maintenance of anesthesia, as well as for sedation in the Intensive Care Unit. Remimazolam has an elevated safety profile, as it might that, it has less pronounced hemodynamic and cardiorespiratory effects in contrast to other drugs used in the same procedures. Like other benzodiacepines, remimazolam effects can be reversed with flumazenil. Remimazolam has proven to be an effective hypnotic agent, however further research and clinical evaluation is required to establish its use.
REFERENCES
Kilpatrick GJ. Remimazolam: non-clinical and clinical profile of a new sedative/anesthetic agent. Front Pharmacol. 2021;12:690-875.
Schüttler J, Eisenried A, Lerch M, Fechner J, Jeleazcov C, Ihmsen H. Pharmacokinetics and pharmacodynamics of remimazolam (CNS 7056) after continuous infusion in healthy male volunteers: part I. Pharmacokinetics and clinical pharmacodynamics. Anesthesiology. 2020;132:636-651.
Eisenried A, Schüttler J, Lerch M, Ihmsen H, Jeleazcov C. Pharmacokinetics and Pharmacodynamics of remimazolam (CNS 7056) after continuous infusion in healthy male volunteers: part ii. pharmacodynamics of electroencephalogram effects. Anesthesiology. 2020;132:652-666.
Kilpatrick GJ, McIntyre MS, Cox RF et al. CNS 7056: a novel ultra-short-acting Benzodiazepine. Anesthesiology. 2007;107:60-66.
Rex DK, Bhandari R, Desta T, et al. A phase III study evaluating the efficacy and safety of remimazolam (CNS 7056) compared with placebo and midazolam in patients undergoing colonoscopy. Gastrointest Endosc. 2018;88:427-437.
Antonik LJ, Goldwater DR, Kilpatrick GJ, Tilbrook GS, Borkett KM. A placebo- and midazolam-controlled phase I single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamics of remimazolam (CNS 7056): Part I. Safety, efficacy, and basic pharmacokinetics. Anesth Analg. 2012;115:274-283.
Sneyd JR, Gambus PL, Rigby-Jones AE. Current status of perioperative hypnotics, role of benzodiazepines, and the case for remimazolam: a narrative review. Br J Anaesth. 2021;127:41-55.
Wiltshire HR, Kilpatrick GJ, Tilbrook GS, Borkett KM. A placebo- and midazolam-controlled phase I single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamics of remimazolam (CNS 7056): Part II. Population pharmacokinetic and pharmacodynamic modeling and simulation. Anesth Analg. 2012;115:284-296.
Shah RR. The significance of QT interval in drug development. Br J Clin Pharmacol. 2002;54:188-202.
Parker RB, Hu ZY, Meibohm B, Laizure SC. Effects of alcohol on human carboxylesterase drug metabolism. Clin Pharmacokinet. 2015;54:627-638.
Pesic M, Stöhr T, Ossig J et al. Remimazolam has low oral bioavailability and no potential for misuse in drug-facilitated sexual assaults, with or without alcohol: results from two randomised clinical trials. Drugs R D. 2020;20:267-277.
Glass PS, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology. 1997;86:836-847.
Kim KM. Remimazolam: pharmacological characteristics and clinical applications in anesthesiology. Anesth Pain Med (Seoul). 2022;17:1-11.
Probst S, Bevilacqua C, Eibel S, et al. Difference in vasopressor use and usage patterns in patients undergoing cardiac surgery with remimazolam versus propofol/sevoflurane for general anesthesia. Anesthesiology. 2020.
Sasaki H, Hoshijima H, Mizuta K. Ringer's acetate solution-induced precipitation of remimazolam. Br J Anaesth. 2021;126:e87-e89.
Chen X, Zhang J, Yuan S, Huang H. Remimazolam besylate for the sedation of postoperative patients undergoing invasive mechanical ventilation in the ICU: a prospective dose-response study. Sci Rep. 2022;12:19022.
Deng Y, Qin Z, Wu Q, et al. Efficacy and safety of remimazolam besylate versus dexmedetomidine for sedation in non-intubated older patients with agitated delirium after orthopedic surgery: a randomized controlled trial. Drug Des Devel Ther. 2022;16:2439-2451.
Zhang X, Li S, Liu J. Efficacy and safety of remimazolam besylate versus propofol during hysteroscopy: single-centre randomized controlled trial. BMC Anesthesiol. 2021;21:156. Erratum in: BMC Anesthesiol. 2021;21:173.
Yoshikawa H, Hosokawa M, Kashima Y, Oki S, Masui K. Remimazolam tolerance in long-term benzodiazepine users: a case report of 2 cases. A Pract. 2021;15:e01460.
Pastis NJ, Yarmus LB, Schippers F et al. Safety and efficacy of remimazolam compared with placebo and midazolam for moderate sedation during bronchoscopy. Chest. 2019;155:137-146.
Pesic M, Schippers F, Saunders R, Webster L, Donsbach M, Stoehr T. Pharmacokinetics and pharmacodynamics of intranasal remimazolam-a randomized controlled clinical trial. Eur J Clin Pharmacol. 2020;76:1505-1516.
Tsurumi K, Takahashi S, Hiramoto Y, Nagumo K, Takazawa T, Kamiyama Y. Remimazolam anaphylaxis during anesthesia induction. J Anesth. 2021;35:571-575.
Sneyd JR, Rigby-Jones AE. Remimazolam for anaesthesia or sedation. Curr Opin Anaesthesiol. 2020;33:506-511.