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

Mao Miyanishi; Toru Yaguramaki; Yasuhiro Maehara; Osamu Nagata

doi:10.1186/s40981-021-00485-1

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

JA Clin Rep. 2022 Jan 11;8(1):4. doi: 10.1186/s40981-021-00485-1.

Authors

Mao Miyanishi¹, Toru Yaguramaki², Yasuhiro Maehara³, Osamu Nagata³

Affiliations

¹ Department of Anesthesiology, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. maooooon527@gmail.com.
² Department of Orthopaedic Surgery, JR Tokyo General Hospital, 2-1-3, Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan.
³ Department of Anesthesiology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.

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.

Keywords: Benzodiazepine; Bispectral index; Remimazolam; Tolerance.