Remimazolam is a novel intravenous ultra-short acting benzodiazepine that has the potential of being a safe and effective new sedative for use in intensive care unit (ICU) settings. Because remimazolam metabolizes rapidly by being hydrolyzed to an inactive metabolite (CNS 7054) through non-specific tissue esterase activity, specific dosing adjustment for older adults and for patients with renal or hepatic impairment patients (except for those with severe hepatic impairment) is not required. In addition, research has shown that remimazolam may be reversed by administration of flumazenil, as its half time was sufficiently short compared to flumazenil. It shows a lower incidence of cardiorespiratory depression, less injection pain, and no fatal complications such as propofol infusion syndrome and malignant hyperthermia of inhalational anesthetics. Future studies to study the suitability of remimazolam for managing the sedation of ICU patients who need sedation for a long time over several days is required.
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Remimazolam: A New Ingress in Cardiac Surgical Intensive Care Unit Minati Choudhury, Poonam Malhotra Kapoor Journal of Cardiac Critical Care TSS.2023; 7: 133. CrossRef
Safety and efficacy of remimazolam tosilate combined with low-dose fentanyl for procedural sedation in obese patients undergoing gastroscopy: study protocol for a single-centre, double-blind, randomised controlled trial Lijuan Yan, Xiao Wang, Zhenyi Chen, Ningning Wu, Hao Li, Bin Yang BMJ Open.2023; 13(12): e079095. CrossRef
Remimazolam: An Updated Review of a New Sedative and Anaesthetic Qinxue Hu, Xing Liu, Chengli Wen, Duo Li, Xianying Lei Drug Design, Development and Therapy.2022; Volume 16: 3957. CrossRef
Análisis nacional de la sedación aplicada en pacientes de cuidados críticos Grace Pamela López Pérez, Melani Dayana Carrera Casa, Gissela Lizbeth Amancha Moyulema, Yadira Nathaly Chicaiza Quilligana, Ana Belén Guamán Tacuri, Joselyn Mireya Iza Arias Salud, Ciencia y Tecnología.2022; 2(S1): 234. CrossRef
BACKGROUND Many critically ill patients treated in the intensive care unit (ICU) experience sleep disruption.
Midazolam is commonly used for the sedation of critically ill patients. This pilot study is aimed to identify the optimal dose of midazolam for achieving sound sleep in critically ill patients. METHODS This prospective study was conducted in the medical ICU of a tertiary referral hospital. Polysomnography recording was performed over 24 hours to assess the quantity and quality of sleep in patients sedated with midazolam. RESULTS A total of five patients were enrolled. Median total sleep time was 494.0 (IQR: 113.5-859.0) min. The majority of sleep was stage 1 (median 82.0 [IQR 60.5-372.5] min) and 2 (median 88.0 [60.5-621.0] min) with scant REM (median 10.0 [6.0-50.5] min) and no stage 3 (0.0 min) sleep.
The median number of wakings in 1 hour was 16.1 (IQR: 7.6-28.6). The dose of midazolam showed a positive correlation with total sleep time (r = 0.975, p = 0.005). CONCLUSIONS The appropriate quantity of sleep in critically ill patients was achieved with a continuous infusion of 0.02-0.03 mg/kg/h midazolam. However, the quality of sleep was poor. Further study is required for the promotion of quality sleep in such patients.
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Effect of prolonged sedation with dexmedetomidine, midazolam, propofol, and sevoflurane on sleep homeostasis in rats Brian H. Silverstein, Anjum Parkar, Trent Groenhout, Zuzanna Fracz, Anna M. Fryzel, Christopher W. Fields, Amanda Nelson, Tiecheng Liu, Giancarlo Vanini, George A. Mashour, Dinesh Pal British Journal of Anaesthesia.2023;[Epub] CrossRef
Reliability of the Korean version of the Richards-Campbell Sleep Questionnaire Jae Kyoung Kim, Ju-Hee Park, Jaeyoung Cho, Sang-Min Lee, Jinwoo Lee Acute and Critical Care.2020; 35(3): 164. CrossRef
Sedation in Critically Ill Patients Mark Oldham, Margaret A. Pisani Critical Care Clinics.2015; 31(3): 563. CrossRef
Paraganglioma is a tumor originating from the extra-adrenal chromaffin cells, and functional paraganglioma causes paroxysmal hypertension, headache and tachycardia, due to excess excretion of catecholamine. However, rarely, ARDS, acute myocardial infarction, heart failure, arrhythmia, and pulmonary edema are also seen in patients with paraganglioma and clinical manifestations are depending on the patient's intravascular volume status. Seventy one-years-old male was presented with hypotension and pulmonary edema after intravenous midazolam injection during colonoscopy under conscious sedation. The patient was initially suspected with anaphylactic shock, due to midazolam injection. However, later, he was diagnosed with paraganglioma, and blood pressure was successfully controlled with alpha adrenergic blockade. We suggest that when we encounter heart failure, pulmonary edema and shock of unknown origin, pheochromocytoma must be taken into consideration.