Remimazolam: Useful or Useless?

[Ronin786]

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A few articles have come out describing the characteristics of remimazolam infusions and it appears to have been approved for use in Japan as a general anesthetic.

Anybody think this will change your practice?

Efficacy and safety of remimazolam versus propofol for general anesthesia: a multicenter, single-blind, randomized, parallel-group, phase IIb/III trial - Journal of Anesthesia

Purpose This trial was conducted to confirm the non-inferiority of remimazolam versus propofol in the induction and maintenance of general anesthesia in surgical patients. Methods Surgical patients (n = 375) were randomized to remimazolam started at 6 or 12 mg/kg/h by continuous intravenous (IV)...

link.springer.com

Safety and efficacy of remimazolam in induction and maintenance of general anesthesia in high-risk surgical patients (ASA Class III): results of a multicenter, randomized, double-blind, parallel-group comparative trial - Journal of Anesthesia

Purpose Remimazolam, 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...

link.springer.com

Remimazolam besilate, a benzodiazepine, has been approved for general anesthesia!! - Journal of Anesthesia

link.springer.com

 

[anbuitachi]

a lot of people here thinks it will be very useful. kind of like remifentanil .

 

[deleted641888]

.

 

[vector2]

There's a whole lot of sick pts out there where if they require an ICU intubation or sedation for a relatively short case or something like that, it requires a judicious and skilled hand administering non-ideal drugs like etomidate and/or ketamine and/or propofol+pressor to make sure the pt doesn't die.

The lack of hemodynamic effects and the ability to get relatively profound but shortlived general anesthesia certainly piques my interest, but I'm sure it'll be too prohibitively expensive to join our formulary

 

[coffeebythelake]

I imagine it would be useful to relieve anxiety in elderly patients and other situations where you wouldn't want BDZs hanging around.

Is this true though? Has it been shown to reduce such effects?

 

[secretasianman]

If it’s cheap enough then I can see a big change in the gi centers that exploit anesthesia services.

 

[coffeebythelake]

I have a feeling this drug will end up more like mivacurium than remifentanil

 

[drmwvr]

Odds are will be an adjunct to the tried and true techniques...prop-sux-tube-vol agent...just like remi just like propofol infusions just like precedex. Game changers like ETCO2 or pulse oximetry or suggamadex come around once, maybe twice in a generation....Even propofol for induction wasn't really a game changer. Pentothal/Brevital works just fine....etomidate...don't let's get started.....

 

[kmurp]

Odds are will be an adjunct to the tried and true techniques...prop-sux-tube-vol agent...just like remi just like propofol infusions just like precedex. Game changers like ETCO2 or pulse oximetry or suggamadex come around once, maybe twice in a generation....Even propofol for induction wasn't really a game changer. Pentothal/Brevital works just fine....etomidate...don't let's get started.....

Agree though I would say propofol for MAC usage has been a game changer. I would also add ultrasound and the glidescope to your list.

 

[vector2]

Odds are will be an adjunct to the tried and true techniques...prop-sux-tube-vol agent...just like remi just like propofol infusions just like precedex. Game changers like ETCO2 or pulse oximetry or suggamadex come around once, maybe twice in a generation....Even propofol for induction wasn't really a game changer. Pentothal/Brevital works just fine....etomidate...don't let's get started.....

How can you say propofol wasn't a game changer when 99% of MACs and generals now involve propofol...

 

[dhb]

Agree though I would say propofol for MAC usage has been a game changer. I would also add ultrasound and the glidescope to your list.

Well that's more then 1 in a generation then 🤔😉

PS: the name sucks

 

[AdmiralChz]

If it’s cheap enough then I can see a big change in the gi centers that exploit anesthesia services.

It’s a new drug. Won’t be cheap. Think like the early days of precedex and remifentanil.

I don’t use a ton of versed these days, especially In the elderly. Even a huge cardiac case it’s max of 5. And it is literally dirt cheap. Medicine in general is getting away from BDZs, and rightfully so with the delirium/worsened dementia seen. I don’t see much of a use, personally. We have a short acting, titratable hypnotic (propofol) and narcotic (remifentanil). Propofol in particular is pretty cheap. Given good supply of both I don’t see much need for a rapid BDZ.

 

[epidural man]

Looks interesting.

 

[deleted875186]

I imagine it would make for some interesting TIVA combinations

 

[drmwvr]

How can you say propofol wasn't a game changer when 99% of MACs and generals now involve propofol...

If by MAC you mean what used to be sedation with local, I don't disagree. But what propofol (a great drug) has done is make ham handed surgeons think general anesthesia only comes through a tube and that they're geniuses when it comes to local field blocks when all the time their patients are out cold. One drug replacing another doesn't make it a game changer. It's more of a technique change than anything else, IMO...

 

[coffeebythelake]

If by MAC you mean what used to be sedation with local, I don't disagree. But what propofol (a great drug) has done is make ham handed surgeons think general anesthesia only comes through a tube and that they're geniuses when it comes to local field blocks when all the time their patients are out cold. One drug replacing another doesn't make it a game changer. It's more of a technique change than anything else, IMO...

Exactly. Surgeons expect sedation nowadays as GA without an airway. Some surgeons demand sedation but complain when patients move because they suck with local.