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

Doi, Matsuyuki; Hirata, Naoyuki; Suzuki, Toshiyasu; Morisaki, Hiroshi; Morimatsu, Hiroshi; Sakamoto, Atsuhiro

doi:10.1007/s00540-020-02776-w

Cited by 242Anesthesia and Sedative AgentsAnesthesia and Pain ManagementAnesthesia and Neurotoxicity Research

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

Doi, Matsuyuki, Hirata, Naoyuki, Suzuki, Toshiyasu, Morisaki, Hiroshi, Morimatsu, Hiroshi, Sakamoto, Atsuhiro·2020·Journal of Anesthesia

DOI 10.1007/s00540-020-02776-w

Open this paper in CoChat — free account

Abstract

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 efficacy and safety in vulnerable patients (ASA Class III) undergoing elective general surgery. Methods A 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. Results The 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). Conclusion Both induction regimens (6 and 12 mg kg -1 h -1 ) were equally efficacious a…

Integrity signals

Registry

Crossref · 10.1007/s00540-020-02776-w

Cites

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Numerous published clinical experiments have shown the safety and efficacy of remimazolam as an anesthetic during sedative procedures and general anesthesia compared with midazolam or propofol.
“Compared with midazolam or propofol, numerous published clinical experiments have shown the safety and efficacy of remimazolam as an anesthetic during sedative procedures and general anesthesia (9,10).”
From Hemodynamic Influences of Remimazolam Versus Propofol During the Induction Period of General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2023) · cites this paper as [10]

Sorted by citations

Remimazolam: non-clinical and clinical profile of a new sedative/anesthetic agent
Kilpatrick, G. J. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.690875 · Cited by 262 · see citing works
Remimazolam: pharmacological characteristics and clinical applications in anesthesiology
Kim, K. M. (2022) · Anesthesia and Pain Medicine · doi:10.17085/apm.21115 · Cited by 250 · see citing works
“Interestingly, both induction regimens (6 and 12 mg/kg/h) were equally efficient and safe in 67 high-risk surgical patients [42].”
Background
Remimazolam: An Updated Review of a New Sedative and Anaesthetic
Hu, Q.-X., Liu, X., Wen, C., Li, D., & Lei, X.-F. (2022) · Drug Design, Development and Therapy · doi:10.2147/dddt.s384155 · Cited by 185 · see citing works
“49,52 The safety data of ASA class III patients were in line with the corresponding data from patients with ASA class I and II.50 Remimazolam could reduce the incidence of postoperative nausea and vomiting in the patients after laparoscopic gynaecological surgery under general anaesthesia as compared with desflurane (…”
BackgroundResultInfluential
Remimazolam tosilate compared with propofol for gastrointestinal endoscopy in elderly patients: a prospective, randomized and controlled study
Guo, J., Qian, Y., Zhang, X., Han, S., Shi, Q., & Xu, J. (2022) · BMC Anesthesiology · doi:10.1186/s12871-022-01713-6 · Cited by 153 · see citing works
Effect of remimazolam induction on hemodynamics in patients undergoing valve replacement surgery: A randomized, double-blind, controlled trial
Liu, T., Lai, T., Chen, J., Lu, Y., He, F., Chen, Y., & Xie, Y. (2021) · Pharmacology Research & Perspectives · doi:10.1002/prp2.851 · Cited by 146 · see citing works
Pharmacodynamic analysis of intravenous bolus remimazolam for loss of consciousness in patients undergoing general anaesthesia: a randomised, prospective, double-blind study.
Chae, D., Kim, H.-C., Song, Y., Choi, Y. S., & Han, D.-W. (2022) · British Journal of Anaesthesia · doi:10.1016/j.bja.2022.02.040 · Cited by 133
Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery: A randomized non-inferiority trial
Choi, J. Y., Lee, H. S., Kim, J. Y., Han, D. W., Yang, J. Y., Kim, M. J., & Song, Y. (2022) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2022.110955 · Cited by 133 · see citing works
Current status of perioperative hypnotics, role of benzodiazepines, and the case for remimazolam: a narrative review.
Sneyd, J., Gambús, P., & Rigby-Jones, A. (2021) · British Journal of Anaesthesia · doi:10.1016/j.bja.2021.03.028 · Cited by 128 · see citing works
Quality of recovery after general anesthesia with remimazolam in patients' undergoing urologic surgery: A randomized controlled trial comparing remimazolam with propofol
Mao, Y., Guo, J., Yuan, J., Zhao, E., & Yang, J. (2022) · Drug Design, Development and Therapy · doi:10.2147/dddt.s359496 · Cited by 122 · see citing works
“However, it is worth noting that previous studies have proved the efficacy and safety of general anesthesia with remimazolam in ASA class III and elderly patients.(37,38) Even though the effect of age and ASA class was small on time to extubation with remimazolam anesthesia, lower doses of remimazolam were recommended…”
Result
Population pharmacokinetic/pharmacodynamic modeling for remimazolam in the induction and maintenance of general anesthesia in healthy subjects and in surgical subjects.
Zhou, J., Leonowens, C., Ivaturi, V. D., Lohmer, L., Curd, L., Ossig, J., Schippers, F., Petersen, K.-U., Stoehr, T., & Schmith, V. (2020) · Journal of clinical anesthesia · doi:10.1016/j.jclinane.2020.109899 · Cited by 112 · see citing works
Neurological sedative indicators during general anesthesia with remimazolam
Shirozu, K., Nobukuni, K., Tsumura, S., Imura, K., Nakashima, K., Takamori, S., Higashi, M., & Yamaura, K. (2022) · Journal of Anesthesia · doi:10.1007/s00540-021-03030-7 · Cited by 86 · see citing works
“0) with remimazolam in this study is similar to findings of previous studies (in the range of 40–82 or 46–68) [8, 10].”
Anaesthetic efficacy and postinduction hypotension with remimazolam compared with propofol: a multicentre randomised controlled trial
Fechner, J., El-Boghdadly, K., Spahn, D. R., Motsch, J., Struys, M. M. R. F., Duranteau, O., Ganter, M., Richter, T., Hollmann, M., Rossaint, R., et al. (2024) · Anaesthesia · doi:10.1111/anae.16205 · Cited by 82
A population pharmacokinetic model of remimazolam for general anesthesia and consideration of remimazolam dose in clinical practice
Masui, K., Stöhr, T., Pesic, M., & Tonai, T. (2022) · Journal of Anesthesia · doi:10.1007/s00540-022-03079-y · Cited by 79 · see citing works
“0) mg kg−1 h−1 during maintenance of anesthesia, resulting in an average BIS value ranging between 45 and 56 with SD of 6 to 14 [10].”
Influential
Re-sleeping after reversal of remimazolam by flumazenil
Yamamoto, T., Kurabe, M., & Kamiya, Y. (2021) · Journal of Anesthesia · doi:10.1007/s00540-021-02915-x · Cited by 74 · see citing works
Remimazolam for induction of anesthesia in elderly patients with severe aortic stenosis: a prospective, observational pilot study
Nakanishi, T., Sento, Y., Kamimura, Y., Tsuji, T., Kako, E., & Sobue, K. (2021) · BMC Anesthesiology · doi:10.1186/s12871-021-01530-3 · Cited by 70 · see citing works
“These results were similar to those of previous studies involving healthy patients with ASA-PS 1 or 2 and vulnerable patients with ASA-PS 3 [9, 10].”
BackgroundMethodResultInfluential
The Efficacy and Safety of Remimazolam Tosilate versus Etomidate-Propofol in Elderly Outpatients Undergoing Colonoscopy: A Prospective, Randomized, Single-Blind, Non-Inferiority Trial
Liu, X.-W., Ding, B.-H., Shi, F., Zhang, Y., Liu, L., Sha, Y.-W., & Zhao, T.-H. (2021) · Drug Design, Development and Therapy · doi:10.2147/dddt.s339535 · Cited by 65 · see citing works
“24) mg/kg in ASA Class III patients.(31) Thus, we administered an initial dose of 0.”
Method
Association between remimazolam and postoperative delirium in older adults undergoing elective cardiovascular surgery: a prospective cohort study
Aoki, Y., Kurita, T., Nakajima, M., Imai, R., Suzuki, Y., Makino, H., Kinoshita, H., Doi, M., & Nakajima, Y. (2022) · Journal of Anesthesia · doi:10.1007/s00540-022-03119-7 · Cited by 64 · see citing works
Self-citation
Remimazolam decreased the incidence of early postoperative nausea and vomiting compared to desflurane after laparoscopic gynecological surgery
Hari, Y., Satomi, S., Murakami, C., Narasaki, S., Morio, A., Kato, T., Tsutsumi, Y. M., Kakuta, N., & Tanaka, K. (2022) · Journal of Anesthesia · doi:10.1007/s00540-022-03041-y · Cited by 56 · see citing works
“During the first two hours after the surgery, the percentage of PONV in the REM group (27%) was slightly lower than the reported average PONV rate (30%) in the general surgical population [20].”
BackgroundResult
Differential effects of remimazolam and propofol on heart rate variability during anesthesia induction
Hasegawa, G., Hirata, N., Yoshikawa, Y., & Yamakage, M. (2022) · Journal of Anesthesia · doi:10.1007/s00540-022-03037-8 · Cited by 56 · see citing works
Self-citation
Comparison of Remimazolam–Flumazenil versus Propofol for Recovery from General Anesthesia: A Systematic Review and Meta-Analysis
Wu, Q., Xu, F.-C., Wang, J., & Jiang, M. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12237316 · Cited by 53 · see citing works
“…full-text articles of the remaining records, we excluded 13 studies for various reasons: they were not randomized controlled trials [32–37], did not set up a propofol group [38,39], did not have routine ﬂumazenil usage in the remimazolam group [19,40–42], or did not have outcomes we wanted [43].”
Background
Comparison of 95% effective dose of remimazolam besylate and propofol for gastroscopy sedation on older patients: A single‐centre randomized controlled trial
Ye, E.-C., Wu, K., Ye, H., Zhang, W., Chu, L., Zhang, K., Xie, G.-H., Jin, Y., & Fang, X. (2023) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.15839 · Cited by 49 · see citing works
Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups
Oh, J., Park, S. Y., Lee, S., Song, J., Lee, G.-Y., Park, J. H., & Joe, H. (2022) · Korean Journal of Anesthesiology · doi:10.4097/kja.22331 · Cited by 47
“mazolam dose for loss of consciousness (LOC) that was calculated from the continuous infusion of remimazolam (6 and 12 mg/kg/h) [15,16].”
Method
Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial
Xin, Y., Chu, T., Wang, J., & Xu, A. (2022) · BMC Anesthesiology · doi:10.1186/s12871-022-01805-3 · Cited by 45 · see citing works
Hypotension after general anaesthesia induction using remimazolam or propofol in geriatric patients undergoing sevoflurane anaesthesia with remifentanil: a single-centre, double-blind, randomised controlled trial.
Takaki, R., Yokose, M., Mihara, T., Saigusa, Y., Tanaka, H., Yamamoto, N., Masui, K., & Goto, T. (2024) · British Journal of Anaesthesia · doi:10.1016/j.bja.2024.04.013 · Cited by 45 · see citing works
Remimazolam anaphylaxis during anesthesia induction
Tsurumi, K., Takahashi, S., Hiramoto, Y., Nagumo, K., Takazawa, T., & Kamiyama, Y. (2021) · Journal of Anesthesia · doi:10.1007/s00540-021-02934-8 · Cited by 45 · see citing works
Efficacy and safety of remimazolam besylate in bronchoscopy for adults: A multicenter, randomized, double-blind, positive-controlled clinical study
Zhou, Y.-Y., Yang, S.-T., Duan, K.-M., Bai, Z., Feng, Y., Guo, Q.-L., Cheng, Z.-G., Wu, H.-Y., Shang-Guan, W.-N., Wu, X.-M., et al. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.1005367 · Cited by 44
“This has been reported in both surgical procedures with general anesthesia (Doi et al., 2020) and colonoscopies (Chen et al., 2020) in phase III clinical trials.”
BackgroundInfluential
Remimazolam – current status, opportunities and challenges
Sneyd, J. (2023) · Anesthesiology and Perioperative Science · doi:10.1007/s44254-023-00021-7 · Cited by 42
“Doi and co-workers used remimazolam to induce and maintain anaesthesia in surgical patients of American Society of Anesthesiologists physical status (ASA grade) of I or II [10] and also ASA III [9].”
Clinical effects of remimazolam alone or in combination with dexmedetomidine in patients receiving bronchoscopy and influences on postoperative cognitive function: a randomized-controlled trial
Gao, S.-Q., Wang, T., Cao, L., Li, L.-Y., & Yang, S.-Q. (2022) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-022-01487-4 · Cited by 38
“Remimazolam has been successfully used for the induction and maintenance of general anesthesia [8] and in colonoscopy [9].”
Method
Hemodynamic Influences of Remimazolam Versus Propofol During the Induction Period of General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Zhu, T. (2023) · Pain Physician Journal · doi:10.36076/ppj.2023.26.e761 · Cited by 37 · see citing works
“Compared with midazolam or propofol, numerous published clinical experiments have shown the safety and efficacy of remimazolam as an anesthetic during sedative procedures and general anesthesia (9,10).”
Effects of Remimazolam vs. Sevoflurane Anesthesia on Intraoperative Hemodynamics in Patients with Gastric Cancer Undergoing Robotic Gastrectomy: A Propensity Score-Matched Analysis
Lee, B., Kim, M., Kong, H.-J., Shin, H., Yang, S.-H., Kim, N. Y., & Chae, D. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11092643 · Cited by 36 · see citing works
“The amount of remifentanil administered was significantly higher in the remimazolam group than in the sevoflurane group, which is consistent with previous results [12,18].”
Result
Clinical Pharmacokinetics and Pharmacodynamics of Remimazolam
de Jong, B., Eleveld, D., Mason, K., & Struys, M. (2025) · Clinical Pharmacokinetics · doi:10.1007/s40262-025-01548-7 · Cited by 35 · see citing works
“Several studies report relative higher BIS values when using remimazolam for general anesthesia, compared with propofol [17, 18, 45].”
Influential
Effect of remimazolam vs propofol on emergence from general anesthesia in patients undergoing cerebral endovascular procedures: A randomized controlled, non-inferiority trial.
Zhang, J.-B., Zhang, J.-X., Wang, Y.-Y., Bai, X.-G., Guo, Q., Liu, W., Li, H., Zhu, F.-Q., Wang, X., Jiang, X.-F., et al. (2023) · Journal of clinical anesthesia · doi:10.1016/j.jclinane.2023.111356 · Cited by 33 · see citing works
Efficacy and safety of remimazolam tosilate versus propofol in patients undergoing day surgery: a prospective randomized controlled trial
Luo, W., Sun, M.-L., Wan, J., Zhang, Z.-Y., Huang, J., Zhang, J., Xiong, W.-X., Xia, L.-R., Xu, P., Miao, C., et al. (2023) · BMC Anesthesiology · doi:10.1186/s12871-023-02092-2 · Cited by 33 · see citing works
“Remimazolam besylate, an ultra-short-acting benzodiazepine agonist with propofol’s fast on- and offset characteristics [4], has been shown to be safe and effective in the induction and maintenance of general anesthesia [6, 7].”
Background
Remimazolam anesthesia for cardiac surgery with cardiopulmonary bypass: a case report
Saito, K., Ohno, S., Maeda, M., Hirata, N., & Yamakage, M. (2021) · JA Clinical Reports · doi:10.1186/s40981-021-00424-0 · Cited by 33 · see citing works
“Remimazolam is equally effective as propofol for induction and maintenance of general anesthesia [2].”
BackgroundSelf-citation
Remimazolam for Pediatric Procedural Sedation: Results of an Institutional Pilot Program
Hirano, T., Kimoto, Y., Kuratani, N., Cavanaugh, D., & Mason, K. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12185937 · Cited by 32 · see citing works
Profile of Remimazolam in Anesthesiology: A Narrative Review of Clinical Research Progress
Wang, M., Zhao, X., Yin, P., Bao, X.-X., Tang, H.-L., & Kang, X. (2022) · Drug Design, Development and Therapy · doi:10.2147/dddt.s375957 · Cited by 32 · see citing works
“Another study by Doi et al also revealed the safety and effectiveness of remimazolam used in the induction and maintenance of general anesthesia in ASA III patients.(19) All 67 patents included were at ASA III scheduled for general surgery under general anesthesia using remimazolam at an initial dose of 6 mg/kg/h or 1…”
Remimazolam Anesthesia for MitraClip Implantation in a Patient with Advanced Heart Failure
Satoh, T., Nishihara, N., Sawashita, Y., Ohno, S., Hirata, N., & Yamakage, M. (2021) · Case reports in anesthesiology · doi:10.1155/2021/5536442 · Cited by 32 · see citing works
Self-citation
Comparison of remimazolam-based and propofol-based total intravenous anesthesia on hemodynamics during anesthesia induction in patients undergoing transcatheter aortic valve replacement: a randomized controlled trial
Kotani, T., Ida, M., Naito, Y., & Kawaguchi, M. (2024) · Journal of Anesthesia · doi:10.1007/s00540-024-03311-x · Cited by 33 · see citing works
Remimazolam in a Pediatric Patient With a Suspected Family History of Malignant Hyperthermia
Petkus, H., Willer, B., & Tobias, J. (2022) · Journal of Medical Cases · doi:10.14740/jmc3977 · Cited by 31 · see citing works
“Remimazolam demonstrated similar hemodynamic stability in a prospective trial of 67 adults, ASA physical status III surgical patients undergoing general anesthesia [12].”
Background
Remimazolam and serious adverse events
Kempenaers, S., Hansen, T. G., & de Velde, M. V. (2023) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000001902 · Cited by 30 · see citing works
Effects of remimazolam combined with sufentanil on hemodynamics during anesthetic induction in elderly patients with mild hypertension undergoing orthopedic surgery of the lower limbs: a randomized controlled trial
Xu, Q.-M., Wu, J.-M., Shan, W., Duan, G.-C., & Lan, H.-Y. (2023) · BMC Anesthesiology · doi:10.1186/s12871-023-02249-z · Cited by 30 · see citing works
“Remimazolam is an ultrashort-acting intravenous benzodiazepine sedative/ anesthetic with the pharmacological properties of rapid onset, rapid recovery, and relatively small effects on hemodynamics [2].”
Background
Remimazolam as an Adjunct to General Anesthesia in Children: Adverse Events and Outcomes in a Large Cohort of 418 Cases
Kimoto, Y., Hirano, T., Kuratani, N., Cavanaugh, D., & Mason, K. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12123930 · Cited by 30
“Comparing the high (12 mg/kg/h) and low (6 mg/kg/h) remimazolam induction doses, the efficacy and adverse event profile have not been shown to differ, even in the high-risk ASA 3 adults [21].”
Background
Population Pharmacokinetics of Remimazolam in Procedural Sedation With Nonhomogeneously Mixed Arterial and Venous Concentrations
Zhou, J., Curd, L., Lohmer, L., Ossig, J., Schippers, F., Stoehr, T., & Schmith, V. (2020) · Clinical and Translational Science · doi:10.1111/cts.12875 · Cited by 30 · see citing works
Remimazolam besylate for the sedation of postoperative patients undergoing invasive mechanical ventilation in the ICU: a prospective dose‒response study
Chen, X., Zhang, J.-C., Yuan, S.-Y., & Huang, H.-Y. (2022) · Scientific Reports · doi:10.1038/s41598-022-20946-6 · Cited by 29
Long-term delayed emergence after remimazolam-based general anesthesia: a case report
Takemori, T., Oyama, Y., Makino, T., Hidaka, S., & Kitano, T. (2022) · JA Clinical Reports · doi:10.1186/s40981-022-00576-7 · Cited by 29
“However, a few percent of delayed emergence has been reported in clinical trials in Japan [1, 2], and coping with it is an important issue.”
Background
Remimazolam Compared to Propofol During Hysteroscopy: A Safety and Efficacy Analysis
Fan, S., Zhu, Y., Sui, C., Li, Q., Jiang, W., & Zhang, L. (2023) · Pain and Therapy · doi:10.1007/s40122-023-00483-4 · Cited by 28 · see citing works
Anaesthetic management using remimazolam in a patient with severe aortic stenosis: a case report
Furuta, M., Ito, H., & Yamazaki, M. (2021) · BMC Anesthesiology · doi:10.1186/s12871-021-01422-6 · Cited by 28
“In a clinical phase I trial targeting healthy Japanese volunteers, 95% of the subjects lost consciousness upon remimazolam infusion with a BIS value of 53, indicating that the BIS could be useful for the assessment of consciousness [9].”
Background
Remimazolam Requires Less Vasopressor Support during Induction and Maintenance of General Anesthesia in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Analysis from a Single Center
Miyoshi, H., Watanabe, T., Kido, K., Kamiya, S., Otsuki, S., Narasaki, S., Toyota, Y., Kondo, T., Horikawa, Y. T., Saeki, N., et al. (2022) · BioMed Research International · doi:10.1155/2022/6386606 · Cited by 27 · see citing works
“In earlier reports, the onset time was shorter at 12 mg/kg/h than at 6 mg/kg/h; higher doses of remimazolam may result in faster sedation [4, 5].”
Efficacy and Safety of Remimazolam Besylate versus Dexmedetomidine for Sedation in Non-Intubated Older Patients with Agitated Delirium After Orthopedic Surgery: A Randomized Controlled Trial
Deng, Y., Qin, Z., Wu, Q., Liu, L., Yang, X., Ju, X., Zhang, Y., & Liu, L. (2022) · Drug Design Development and Therapy · doi:10.2147/dddt.s373772 · Cited by 46 · see citing works
Anesthetic management of super-elderly patients with remimazolam: a report of two cases
Nakayama, J., Ogihara, T., Yajima, R., Innami, Y., & Ouchi, T. (2021) · JA Clinical Reports · doi:10.1186/s40981-021-00474-4 · Cited by 27 · see citing works
“Conversely, it is remarkable that the required maintenance dose could be much lower than the expected dose [2, 3].”
Background
A retrospective comparative study of anesthesia with remimazolam and remifentanil versus dexmedetomidine and remifentanil for transcatheter aortic valve replacement
Kitaura, A., Tsukimoto, S., Sakamoto, H., Hamasaki, S., Nakao, S., & Nakajima, Y. (2023) · Scientific Reports · doi:10.1038/s41598-023-43895-0 · Cited by 26
“Remimazolam has already been reported to be safe in high-risk patients with ASA-PS3 15 , but these results suggest that remimazolam may be safe in patients with ASA-PS4 who have severe aortic stenosis.”
Induction and maintenance of procedural sedation in adults: focus on remimazolam injection
Chen, W., Chen, S., & Huang, Y. (2021) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2021.1901575 · Cited by 25 · see citing works
“General anesthesia There are currently two published clinical trials reporting the use of remimazolam in general anesthesia in surgical patients, which were both conducted in Japan [98,99].”
BackgroundResultInfluential
Remimazolam-flumazenil provides fast recovery from general anesthesia compared to propofol during radiofrequency catheter ablation of atrial fibrillation
Lee, S., Lee, J., Hwang, S. Y., Ju, J., Nam, K., Ahn, H., Lee, S.-R., Choi, E., Jeon, Y., & Cho, Y. (2024) · Scientific Reports · doi:10.1038/s41598-024-63578-8 · Cited by 25
The Rise of Remimazolam: A Review of Pharmacology, Clinical Efficacy, and Safety Profiles
Dessai, S. R., Ninave, S. S., & Bele, A. N. (2024) · Cureus · doi:10.7759/cureus.57260 · Cited by 18 · see citing works
“Both induction regimens were equally safe and efficacious in high-risk surgical patients [28].”
Effect of remimazolam versus propofol for the induction of general anesthesia on cerebral blood flow and oxygen saturation in elderly patients undergoing carotid endarterectomy
Gao, J.-L., Yang, C., Ji, Q., & Li, J. (2023) · BMC Anesthesiology · doi:10.1186/s12871-023-02095-z · Cited by 24
“Remimazolam has the same efficacy as propofol in induction and maintenance of general anesthesia [12].”
Background
Comparison of the safety of remimazolam and propofol during general anesthesia in elderly patients: systematic review and meta-analysis
Liu, X.-C., Zhang, L.-Y., Zhao, L., Zhou, X., Mao, W., Chen, L., Zhu, H., Xie, Y., & Li, L.-J. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1409495 · Cited by 23 · see citing works
Efficacy and safety of remimazolam versus dexmedetomidine for patients undergoing flexible fiberoptic bronchoscopy: A randomized, clinical trial.
Zhou, L.-Y., Zou, J., Li, X., Zuo, X.-Z., Gu, M., Sun, K., Fan, W., Yao, Y.-X., & Yan, M. (2024) · Journal of clinical anesthesia · doi:10.1016/j.jclinane.2024.111677 · Cited by 23
Total intravenous anesthesia induced and maintained by a combination of remimazolam and remifentanil without a neuromuscular blocking agent: a prospective, observational pilot study
Park, I., Cho, M., Nam, S., Hwang, J.-W., Do, S., & Na, H. (2022) · BMC Anesthesiology · doi:10.1186/s12871-022-01779-2 · Cited by 23 · see citing works
“Although remimazolam is less hypotensive than propofol, it should be noted that the incidence of hypotension is high in vulnerable patients [17, 19].”
Background
Two cases of circulatory collapse due to suspected remimazolam anaphylaxis
Uchida, S., Takekawa, D., Kitayama, M., & Hirota, K. (2022) · JA Clinical Reports · doi:10.1186/s40981-022-00508-5 · Cited by 23 · see citing works
“Although the safety of remimazolam has been evaluated [2, 3], the frequency of related anaphylaxis is not yet known and one published report describes a case of remimazolam anaphylaxis [4].”
Background
Effect of remimazolam versus propofol on hypotension after anesthetic induction in patients undergoing coronary artery bypass grafting: A randomized controlled trial.
Ju, J., Lee, D.-J., Chung, J., Lee, S., Cho, Y., Jeon, Y., & Nam, K. (2024) · Journal of clinical anesthesia · doi:10.1016/j.jclinane.2024.111580 · Cited by 22
Effect of general anaesthesia with remimazolam versus propofol on postoperative quality of recovery in patients undergoing ambulatory arthroscopic meniscus repair: a randomised clinical trial
Tang, L., Sun, Y., Hao, X., Sun, X., Xie, C., Wang, T., Hu, C., Lu, Y., & Liu, X.-S. (2023) · BJA Open · doi:10.1016/j.bjao.2023.100237 · Cited by 22 · see citing works
“Similar to previous studies, 14 , 20 remimazolam anaesthesia provided stable haemodynamic conditions and a lower incidence of hypotension.”
MethodResult
Pediatric sedation using dexmedetomidine and remimazolam for magnetic resonance imaging
Shioji, N., Everett, T., Suzuki, Y., & Aoyama, K. (2021) · Journal of Anesthesia · doi:10.1007/s00540-021-02957-1 · Cited by 22 · see citing works
Remimazolam as the Primary Agent for Sedation During Cardiac Catheterization in Three Patients With Comorbid Cardiac Conduction Abnormalities
Kalsotra, S., Khan, S., McKee, C., & Tobias, J. (2023) · Cardiology Research · doi:10.14740/cr1477 · Cited by 21
“To date, there are limited data regarding its impact on electrophysiologic function; however, when compared to propofol in a prospective trial of 67 adult, ASA physical status III surgical patients undergoing general anesthesia, there was less hypotension with remimazolam compared to propofol when used as part of the…”
Background
Efficacy of remimazolam tosilate versus propofol for total intravenous anaesthesia in urological surgery
Lan, H., Cao, H., Liu, S., Gong, X., Huang, X., Rong, H., Xu, B., Chen, H.-H., Jiao, Z. Y., Lin, Y., et al. (2024) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000001938 · Cited by 20 · see citing works
Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial
He, M.-F., Gong, C.-J., Chen, Y.-N., Chen, R.-B., & Qian, Y.-N. (2023) · Journal of Biomedical Research · doi:10.7555/jbr.37.20230110 · Cited by 20
Efficacy and safety of remimazolam besilate for sedation in outpatients undergoing impacted third molar extraction: a prospective exploratory study
Oue, K., Oda, A., Shimizu, Y., Takahashi, T., Kamio, H., Sasaki, U., Imamura, S., Imado, E., Mukai, A., Doi, M., et al. (2023) · BMC Oral Health · doi:10.1186/s12903-023-03538-2 · Cited by 20 · see citing works
“However, processed EEG values (bispectral index value and PSi) were relatively higher during anesthesia with remima-zolam compared to propofol [6, 48, 49].”
ResultSelf-citation
Efficacy of Single-Bolus Administration of Remimazolam During Induction of Anesthesia in Patients Undergoing Cardiac Surgery: A Prospective, Single-Center, Randomized Controlled Study
Lee, S.-H., Nam, J.-S., Choi, D., Chin, J., Choi, I.-C., & Kim, K. (2024) · Anesthesia and Analgesia · doi:10.1213/ane.0000000000006861 · Cited by 19
Remimazolam Compared to Propofol for Total Intravenous Anesthesia with Remifentanil on the Recovery of Psychomotor Function: A Randomized Controlled Trial
Shimizu, T., Takasusuki, T., & Yamaguchi, S. (2023) · Advances in Therapy · doi:10.1007/s12325-023-02615-w · Cited by 19 · see citing works
“Owing to its rapid onset, predictable recovery, and minimal hemodynamic instability, remimazolam is increasingly used for anesthesia [4, 5].”
Background
Frequency and characteristics of patients with bispectral index values of 60 or higher during the induction and maintenance of general anesthesia with remimazolam
Choi, B.-M., Lee, J.-S., Kim, K. M., Bang, J., Lee, E.-K., & Noh, G.-J. (2023) · Scientific Reports · doi:10.1038/s41598-023-37150-9 · Cited by 19 · see citing works
Prevention of postoperative nausea and vomiting after gynaecological day surgery under remimazolam general anesthesia: a randomized double-blind controlled study
Yi, F.-X., Xiao, H.-H., Zhu, T., Man, Y., & Ji, F.-C. (2022) · BMC Anesthesiology · doi:10.1186/s12871-022-01835-x · Cited by 19 · see citing works
Remimazolam vs Etomidate: Haemodynamic Effects in Hypertensive Elderly Patients Undergoing Non-Cardiac Surgery
Chen, J.-J., Zou, X., Hu, B.-L., Yang, Y., Wang, F., Zhou, Q., & Shen, M. (2023) · Drug Design, Development and Therapy · doi:10.2147/dddt.s425590 · Cited by 18 · see citing works
“516 Urological surgery 11 (22) 8 (16) 12 (24) 0.”
Remimazolam’s Effects on Postoperative Nausea and Vomiting Are Similar to Those of Propofol after Laparoscopic Gynecological Surgery: A Randomized Controlled Trial
Matsumoto, A., Satomi, S., Kakuta, N., Narasaki, S., Toyota, Y., Miyoshi, H., Horikawa, Y. T., Saeki, N., Tanaka, K., & Tsutsumi, Y. M. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12165402 · Cited by 18 · see citing works
“REM is similar in chemical structure to midazolam and is believed to be as effective as midazolam in preventing PONV [27].”
Background
Hypotension after general anesthesia induction using remimazolam in geriatric patients: Protocol for a double-blind randomized controlled trial
Yokose, M., Takaki, R., Mihara, T., Saigusa, Y., Yamamoto, N., Masui, K., & Goto, T. (2022) · PLoS ONE · doi:10.1371/journal.pone.0275451 · Cited by 18 · see citing works
Remimazolam anesthesia for transcatheter mitral valve repair in a patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome: a case report
Kitaura, A., Kosumi, R., Iwamoto, T., & Nakao, S. (2022) · JA Clinical Reports · doi:10.1186/s40981-022-00528-1 · Cited by 18 · see citing works
“Remimazolam may be suitable for patients with depressed cardiac function, such as in MELAS syndrome, because it causes less circulatory depression than propofol [5].”
Background
Post-induction hypotension with remimazolam versus propofol in patients routinely administered angiotensin axis blockades: a randomized control trial
Song, S.-W., Kim, S., Park, J., Cho, Y., & Jeon, Y. (2023) · BMC Anesthesiology · doi:10.1186/s12871-023-02188-9 · Cited by 17
“However, no recall was instituted despite the higher BIS in previous studies [13, 27].”
Result
The difference in mean arterial pressure induced by remimazolam compared to etomidate in the presence of fentanyl at tracheal intubation: A randomized controlled trial
Huang, X., Cao, H., Zhang, C.-M., Lan, H., Gong, X., Li, R.-J., Lin, Y., Xu, B., Chen, H.-H., & Guan, X. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1143784 · Cited by 17 · see citing works
Electroencephalographic Features of Elderly Patients during Anesthesia Induction with Remimazolam: A Substudy of a Randomized Controlled Trial
Kim, H., Min, B.-K., Lee, U., Sim, J.-H., Noh, G.-J., Lee, E.-K., & Choi, B.-M. (2024) · Anesthesiology · doi:10.1097/aln.0000000000004904 · Cited by 15 · see citing works
“2 As remimazolam shows superior hemodynamic stability during anesthesia induction compared to propofol, 3,4 its usage is gradually increasing among elderly patients undergoing general anesthesia.”
Effect-site concentration of remimazolam at loss and recovery of responsiveness during general anesthesia: a simulation study
Kim, K. M., Bang, J.-Y., Lee, J.-M., Yang, H., Choi, B.-M., & Noh, G.-J. (2022) · Anesthesia and Pain Medicine · doi:10.17085/apm.21121 · Cited by 15
Remimazolam anaphylaxis confirmed by serum tryptase elevation and skin test
Yamaoka, M., Kuroda, K., Matsumoto, N., Okazaki, Y., Minami, E., Yamashita, C., & Kurasako, T. (2022) · Anaesthesia Reports · doi:10.1002/anr3.12167 · Cited by 15
Comparison of Remimazolam Tosilate and Propofol Sedation on the Early Postoperative Quality of Recovery in Patients Undergoing Day Surgery: A Prospective Randomized Controlled Trial
Zhang, L., Wang, Z., Liu, Y., Zhang, X., & Wu, Y. (2024) · Drug Design, Development and Therapy · doi:10.2147/dddt.s456675 · Cited by 14 · see citing works
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
Yan, L.-J., Wang, X., Chen, Z.-Y., Wu, N., Li, H., & Yang, B. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-079095 · Cited by 14 · see citing works
Safety and efficacy of remimazolam for general anesthesia in elderly patients undergoing laparoscopic cholecystectomy: a randomized controlled trial
So, K., Park, J., & Kim, S. H. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1265860 · Cited by 14 · see citing works
Comparative analysis of the effect of electromyogram to bispectral index and 95% spectral edge frequency under remimazolam and propofol anesthesia: a prospective, randomized, controlled clinical trial
Xin, Y., Ma, L., Xie, T., Liang, Y., Ma, M., Chu, T.-T., Liu, C., & Xu, A. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1128030 · Cited by 14
Determination of the 50% and 95% Effective Dose of Remimazolam Combined with Propofol for Intravenous Sedation During Day-Surgery Hysteroscopy
Tan, H., Lou, A.-F., Wu, J., Chen, X.-Z., & Qian, X. (2023) · Drug Design, Development and Therapy · doi:10.2147/dddt.s406514 · Cited by 14
“Although remimazolam is less hypotension than propofol, it should be noted that the incidence of hypotension is high in vulnerable patients.(23) The number of hypotension was only 1 in 0.”
Background
Unexpected tachycardia and hypertension during anesthetic induction with remimazolam in cardiac surgery: a case report
Sato, T., Ohno, S., Maeda, M., Sawashita, Y., Hirata, N., & Yamakage, M. (2021) · JA Clinical Reports · doi:10.1186/s40981-021-00462-8 · Cited by 14
Self-citation
Effects of Remimazolam versus Sevoflurane on Hemodynamics in Patients Undergoing Coil Embolization of Cerebral Aneurysm: A Prospective Randomized Controlled Trial
Ko, E., Je, L., Kim, J., Song, Y. J., & Lim, C. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13133958 · Cited by 13
Remimazolam-Induced Anaphylaxis and Cardiovascular Collapse: A Narrative Systematic Review of Eleven Cases
Lee, J., & Kim, S.-H. (2024) · Medicina · doi:10.3390/medicina60060971 · Cited by 13 · see citing works
“There have been reports of severe hypotension among the PAs occurring after the use of remimazolam [17–22], which contradicts the drug’s advantage of intraoperative hemodynamic stability [11,13–16].”
BackgroundInfluential
Preliminary Experience With Remimazolam for Procedural Sedation and as an Adjunct to General Anesthesia During Diagnostic and Interventional Cardiac Procedures
Gillis, H., McKee, C., Chenault, K., Corridore, M., & Tobias, J. D. (2024) · Cardiology Research · doi:10.14740/cr1595 · Cited by 13
“…compared to propofol in a prospective trial of 67 adult, American Society of Anesthesiologists (ASA) physical status III surgical patients undergoing general anesthesia, there was less hypotension with remimazolam compared to propofol when used as part of the regimen for general anesthesia [14].”
Background
Effect of converting from propofol to remimazolam with flumazenil reversal on recovery from anesthesia in outpatients with mental disabilities: a randomized controlled trial
Jeon, S., Kim, J., Karm, M.-H., & Kim, J.-T. (2024) · BMC Anesthesiology · doi:10.1186/s12871-024-02526-5 · Cited by 12
Benefits of remimazolam as an anesthetic sedative for older patients: A review
Jin, N., & Xue, Z.-Q. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e25399 · Cited by 12 · see citing works
“Additionally, remimazolam-induced postoperative nausea and vomiting is considerably less severe than when induced by inhaled anesthetics [72].”
Background
Delayed emergence after remimazolam induction in end-stage liver disease. Comment on Br J Anaesth 2021; 127: 415-23.
Singal, A., Naftalovich, R., Syed, A., Chaudhry, F. A., Discepola, P. J., & Rodriguez-Correa, D. T. (2022) · British Journal of Anaesthesia · doi:10.1016/j.bja.2022.09.006 · Cited by 12
Boletín informativo
Centroamericanos, C. D. E. M. Y. (2019) · REVISTA TRACE · doi:10.20882/adicciones.8 · Cited by 12
Remimazolam.
Teixeira, M. T., & Goyal, A. (2024) · Advances in Anesthesia · doi:10.1016/j.aan.2024.07.010 · Cited by 11 · see citing works
The Impact of Fentanyl on the Effective Dose of Remimazolam-Induced Sedation in Elderly Female Patients: An Up-and-Down Sequential Allocation Trial
Huang, X.-D., Chen, J.-B., Dong, X., Wang, W.-L., Zhou, J., & Zhou, Z.-F. (2024) · Drug Design, Development and Therapy · doi:10.2147/dddt.s473662 · Cited by 11
Remimazolam Use in Cardiac Anesthesia: A Narrative Review.
Muncan, B., & Bennett-Guerrero, E. (2024) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2024.07.045 · Cited by 11 · see citing works
Remimazolam anaphylaxis in a patient not allergic to brotizolam: a case report and literature review
Nakai, T., Kako, E., Ota, H., So, M., & Sobue, K. (2024) · BMC Anesthesiology · doi:10.1186/s12871-024-02591-w · Cited by 11 · see citing works
“In addition, remima-zolam is less likely to cause hypotension than propofol [4] and has been shown to be effective and safe for general anesthesia induction in high-risk surgical patients [5, 6].”
Background
Remimazolam for cardiovascular anesthesia
Hirata, N. (2023) · Journal of Anesthesia · doi:10.1007/s00540-023-03242-z · Cited by 11
Self-citation
An update on remimazolam and anaphylaxis.
Cinotti, R. (2023) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000001794 · Cited by 11 · see citing works
Remimazolam for a patient with myotonic dystrophy type 1 who underwent endoscopic retrograde cholangiopancreatography under general anesthesia: a case report
Fukuda, M., Tachibana, S., Nishihara, N., & Yamakage, M. (2021) · JA Clinical Reports · doi:10.1186/s40981-021-00422-2 · Cited by 11 · see citing works
Remimazolam-Based Anesthesia in Patients with Heart Failure Due to Mitral Regurgitation and Low Left Ventricular Function: A Case Series
Kitaura, A., Sakamoto, H., Hamasaki, S., Tsukimoto, S., & Nakajima, Y. (2023) · Medicina · doi:10.3390/medicina59122136 · Cited by 10 · see citing works

Authors: Doi, M., Hirata, N., Suzuki, T., Morisaki, H., Morimatsu, H., & Sakamoto, A.
Affiliations: Hamamatsu University Hospital (JP)
Sapporo Medical University (JP)
Tokai University (JP)
Keio University (JP)
Okayama University Hospital (JP)
Nippon Medical School (JP)
Corresponding author: Doi, Matsuyuki
ORCID: Doi, Matsuyuki
Hirata, Naoyuki
Suzuki, Toshiyasu
Morisaki, Hiroshi
Morimatsu, Hiroshi
Sakamoto, Atsuhiro
Venue: Journal of Anesthesia
Publisher: Springer Science and Business Media LLC
Published: 2020-04-17
Volume: 34
Issue: 4
Pages: 491-501
ISSN: 0913-8668 (ISSN-L)
1438-8359
DOI: 10.1007/s00540-020-02776-w
OpenAlex: W3016871582
Cited by: 242
References: 0
Citations by year: 2026: 23 · 2025: 35 · 2024: 57 · 2023: 56 · 2022: 47 · 2021: 22 · 2020: 2
FWCI: 37.12
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
Locations: Journal of Anesthesia (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Life Sciences › Neuroscience › Developmental Neuroscience › Anesthesia and Neurotoxicity Research
Keywords: remimazolam, general anesthesia induction, anesthesia maintenance, high-risk surgical patients, ultra-short-acting benzodiazepine, hemodynamic stability, bispectral index, adverse drug reactions, recovery profiles
MeSH terms: Adult, Anesthesia, General, Benzodiazepines, Double-Blind Method, Humans, Hypnotics and Sedatives, Japan, Maintenance, Midazolam, Propofol

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

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

Abstract

Integrity signals

Claims the paper makes

Claims other papers make about this one

Cited by

Record

About these checks