Remimazolam: Indications
Remimazolam is a drug that constitutes a pharmacological innovation in anesthesia. This innovation combines the properties of two drugs that are already being used, which are: midazolam and remifentanil.
Although anesthesiology as a specialty has evolved a lot, the search for an ideal anesthetic still continues. The objective is to have drugs that have the least possible adverse effects, for this reason, research on drugs used in continuous anesthesia.
What is remimazolam and how does it work?
This medicine has in common with midazolam its mechanism of action, and with remifentanil its metabolism. It can be used as a sedative in the intensive care unit and also as a drug for sedation in some procedures.
It differs from other available rapid-acting intravenous sedatives, in which remimazloma has very little tendency to cause apnea. Remimazolam is a derivative of midazolam that has properties Remifentanil Pharmacokinetics.
Remimazolam uses and dosages
In the field of anesthesia, remimazolam is a drug that can be used in four areas:
- Single dose for premedication.
- Bolus followed by supplementary doses for procedural sedation.
- IV anesthesia, along with an opioid, as part of total IV anesthesia.
- Sedation in the intensive care unit (ICU).
Single dose for premedication
Used as a premedication or pre-induction sedative, remimazolam is not superior to midazolam. However, its effect lasts longer. which can be good if it is an anxious patient waiting for induction. However, treatment for anxiety in general should be given just before going into the operating room.
Remimazolam has the advantage that it can be used in patients requiring short-term sedation. It is also useful in cases where the use of long-acting sedatives can be potentially dangerous.
Remimazolam infusion for procedural sedation
Many procedures such as gastrointestinal endoscopies can be done with sedation using a short-acting benzodiazepine, along with a short-acting opioid such as fentanyl.
The effect of remimazolam appears after 1 to 3 minutes, although it is a short time, it is slow. This is a disadvantage when you are interested in speeding up the process, since the he majority of the gastroduodenoscopies that are carried out for diagnosis have a very short duration of 2 – 3 minutes.
Although the onset of effect of remimazolam can be accelerated by using higher doses, or combined with fentanyl, it is not advisable to do so, this combination can lead to more cases of respiratory depression.
IV anesthetic along with an opioid
Many anesthesia specialists use and teach their students to use a combination involving a benzodiazepine, an opioid, an inhalation agent, and a muscle relaxant.
Remimazolam produces dose-dependent hypnosis. It is known from its known metabolism that the drug does not accumulate after being infused over a long period of time. In addition, if necessary, its action can be reversed with flumazenil.
Infusion for ICU sedation with remimazolam
Often critical patients, in addition to having their functions altered, experience essential liver or kidney organ failure. Currently, l Most of the sedatives used require hepatic metabolism and renal clearance. This whole process is a problem, even if the sedation stops. Furthermore, most drugs have a significantly long drug half-life.
The ideal first-line drug for these cases would be one that has a short action, and a metabolism that does not pass through the liver or kidneys. Remimazolam meets these requirements, making it the drug of choice in these critically ill patients.
The future of remimazolam
Remimazolam is likely to be the sedative of the future. There are high expectations regarding the results of the trials that are being carried out in various parts of the world. In addition, it would be ideal for patients with liver or kidney disorders.
