Remimazolam: Uses And Dosages

Remimazolam is a pharmacological innovation in anesthesia. This innovation combines the properties of two drugs that are already in use: midazolam and remifentanil.

Although anesthesiology has evolved greatly as a specialty, the search for an ideal anesthetic continues. The goal is to have medicines that have as few side effects as possible. That’s why researchers are still studying drugs for anesthesia.

What is remimazolam and how does it work?

This medicine works in the same way as midazolam and has the same metabolism as remifentanil. It can also be used as an intensive care sedative and as a sedative drug in some procedures.

It is different from other available rapid-acting intravenous sedatives, where remimazolam tends not to cause apnea. In other words, remimazolam is a derivative of midazolam that has properties of remifentanil.

Uses and Dosages of Remimazolam

In the field of anesthesia, remimazolam is a drug that doctors can use in four ways:

• Single dose for premedication.
• An initial dose followed by additional doses for procedural sedation.
• Intravenous anesthesia, along with an opioid, as part of total intravenous anesthesia.
• Sedation in the Intensive Care Unit (ICU).

Single dose for premedication

Used as a premedication or pre-induction sedative, remimazolam is no better than midazolam. However, the effects last longer, which can be good if the patient is anxious while waiting. Also, the specialist should give the patient a treatment for anxiety just before he or she goes to the operating room.

In addition, remimazolam has the advantage that it can be used in patients who need short-term sedation. It is also useful in cases where the use of long-term sedatives can be potentially dangerous.

Infusion of remimazolam for procedural sedation

Many procedures, such as gastrointestinal endoscopies, may use a short-acting benzodiazepine along with a short-acting opioid such as fentanyl.

The effect of remimazolam occurs after 1 to 3 minutes. Although this is a short time, it is actually slow. This is a disadvantage when speed is important to the process, as most gastroduodenoscopies (Spanish link) only take about 2-3 minutes.

While you can speed up the effect of remimazolam by using higher doses, or combining it with fentanyl, it’s not a good idea to do so. In addition, this combination can lead to breathing problems.

Intravenous anesthesia along with an opioid

Many anesthesiologists use and teach their students to use a combination of a benzodiazepine, an opioid inhaler, and a muscle relaxant.

Remimazolam produces dose-dependent hypnosis. The drug is known not to build up after being administered for a long period of time. In addition, you can reverse it with flumazenil if necessary.

Infusion for IC Sedation with Remimazolam

Often, seriously ill patients, in addition to having their functions changed, experience liver or kidney failure. Currently, most sedatives require hepatic metabolism and renal clearance. This whole process is a problem even when the sedation stops. In addition, most drugs have a significantly long half-life.

The ideal first-line drug for these cases would be one with a short-acting and metabolism that doesn’t pass through the liver or kidneys. Remimazolam fulfills these requirements, making it the drug of choice for these critically ill patients.

The future of remimazolam

Remimazolam is probably the sedative of the future. There are high hopes for the results of the trials being conducted around the world. In addition, it would be ideal for patients with liver or kidney disease.