The ultra-short-acting benzodiazepine remimazolam, may be an acceptable alternative to propofol for induction and maintenance of anaesthesia in high-risk patients.

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• Matsuyuki Doi, Naoyuki Hirata, Toshiyasu Suzuki, Hiroshi Morisaki, Hiroshi Morimatsu, and Atsuhiro Sakamoto.
• Department of Anesthesiology and Intensive Care, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan. matsuyuki_doi@nifty.com.
• J Anesth. 2020 Aug 1; 34 (4): 491-501.

PurposeRemimazolam, an ultra-short-acting benzodiazepine sedative is equally effective as propofol in induction and maintenance of general anesthesia with improved hemodynamic stability in American Society of Anesthesiologists (ASA) Class I and II patients. This trial investigated remimazolam's efficacy and safety in vulnerable patients (ASA Class III) undergoing elective general surgery.MethodsA multicenter, randomized, double-blind, parallel-group trial in 67 adult surgical patients undergoing general anesthesia with two remimazolam induction doses (6 mg kg-1 h-1-group A and 12 mg kg-1 h-1-group B) has been conducted in 6 trials sites in Japan. Remimazolam was infused up to 2 mg kg-1 h-1 for maintenance of anesthesia in both groups.ResultsThe functional anesthetic capability of the investigated drug was 100% in both arms. The mean time to loss of consciousness (LoC) was significantly shorter in group B (81.7 s) compared to group A (97.2 s), p = 0.0139. The mean bispectral index (BIS) value during maintenance of anesthesia ranged from 46.0 to 68.0 and from 44.7 to 67.5 in group A and B, respectively. There was no statistically significant difference between the remimazolam arms concerning the incidence of blood pressure (BP) decrease (67.7% in group B vs. 54.8% in group A), recovery profile or the incidence or severity of adverse events (AEs) or adverse drug reactions (ADRs).ConclusionBoth induction regimens (6 and 12 mg kg-1 h-1) were equally efficacious and safe in surgical patients ASA Class III. A significantly shorter time to LoC was observed with the higher remimazolam dosage. Clinical trial registration This trial is registered with the Japan Pharmaceutical Information Center-Clinical Trials Information (JapicCTI). JapicCTI number: 121977.

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