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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
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…
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“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).”
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Cited by
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
Remimazolam: pharmacological characteristics and clinical applications in anesthesiology
Kim, K. M. (2022) · Anesthesia and Pain Medicine · doi:10.17085/apm.21115 · Cited by 250
“Interestingly, both induction regimens (6 and 12 mg/kg/h) were equally efficient and safe in 67 high-risk surgical patients [42].”
BackgroundRemimazolam: 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
“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 (…”
BackgroundResultInfluentialGuo, J., Qian, Y., Zhang, X., Han, S., Shi, Q., & Xu, J. (2022) · BMC Anesthesiology · doi:10.1186/s12871-022-01713-6 · Cited by 153
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
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
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
Sneyd, J., Gambús, P., & Rigby-Jones, A. (2021) · British Journal of Anaesthesia · doi:10.1016/j.bja.2021.03.028 · Cited by 128
Mao, Y., Guo, J., Yuan, J., Zhao, E., & Yang, J. (2022) · Drug Design, Development and Therapy · doi:10.2147/dddt.s359496 · Cited by 122
“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…”
ResultZhou, 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
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
“0) with remimazolam in this study is similar to findings of previous studies (in the range of 40–82 or 46–68) [8, 10].”
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
Masui, K., Stöhr, T., Pesic, M., & Tonai, T. (2022) · Journal of Anesthesia · doi:10.1007/s00540-022-03079-y · Cited by 79
“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].”
InfluentialRe-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
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
“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].”
BackgroundMethodResultInfluentialLiu, 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
“24) mg/kg in ASA Class III patients.(31) Thus, we administered an initial dose of 0.”
MethodAoki, 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
Self-citationHari, 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
“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].”
BackgroundResultHasegawa, G., Hirata, N., Yoshikawa, Y., & Yamakage, M. (2022) · Journal of Anesthesia · doi:10.1007/s00540-022-03037-8 · Cited by 56
Self-citationWu, Q., Xu, F.-C., Wang, J., & Jiang, M. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12237316 · Cited by 53
“…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].”
BackgroundYe, 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
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].”
MethodXin, Y., Chu, T., Wang, J., & Xu, A. (2022) · BMC Anesthesiology · doi:10.1186/s12871-022-01805-3 · Cited by 45
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
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
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.”
BackgroundInfluentialRemimazolam – 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].”
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].”
MethodZhu, T. (2023) · Pain Physician Journal · doi:10.36076/ppj.2023.26.e761 · Cited by 42
“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).”
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
“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].”
ResultClinical 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
“Several studies report relative higher BIS values when using remimazolam for general anesthesia, compared with propofol [17, 18, 45].”
InfluentialZhang, 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
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
“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].”
BackgroundRemimazolam 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
“Remimazolam is equally effective as propofol for induction and maintenance of general anesthesia [2].”
BackgroundSelf-citationRemimazolam 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
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
“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
Self-citationKotani, T., Ida, M., Naito, Y., & Kawaguchi, M. (2024) · Journal of Anesthesia · doi:10.1007/s00540-024-03311-x · Cited by 34
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
“Remimazolam demonstrated similar hemodynamic stability in a prospective trial of 67 adults, ASA physical status III surgical patients undergoing general anesthesia [12].”
BackgroundRemimazolam 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 57
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
“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].”
BackgroundKimoto, 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].”
BackgroundZhou, 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
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.”
BackgroundRemimazolam 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
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].”
BackgroundMiyoshi, 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
“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].”
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
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
“Conversely, it is remarkable that the required maintenance dose could be much lower than the expected dose [2, 3].”
BackgroundKitaura, 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
“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].”
BackgroundResultInfluentialLee, 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
“Both induction regimens were equally safe and efficacious in high-risk surgical patients [28].”
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].”
BackgroundLiu, 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
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
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
“Although remimazolam is less hypotensive than propofol, it should be noted that the incidence of hypotension is high in vulnerable patients [17, 19].”
BackgroundTwo 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
“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].”
BackgroundJu, 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
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
“Similar to previous studies, 14 , 20 remimazolam anaesthesia provided stable haemodynamic conditions and a lower incidence of hypotension.”
MethodResultPediatric 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
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…”
BackgroundLan, 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
He, M., Gong, C., Chen, Y., Chen, R., & Qian, Y. (2023) · Journal of Biomedical Research · doi:10.7555/jbr.37.20230110 · Cited by 16
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
“However, processed EEG values (bispectral index value and PSi) were relatively higher during anesthesia with remima-zolam compared to propofol [6, 48, 49].”
ResultSelf-citationLee, 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
Shimizu, T., Takasusuki, T., & Yamaguchi, S. (2023) · Advances in Therapy · doi:10.1007/s12325-023-02615-w · Cited by 19
“Owing to its rapid onset, predictable recovery, and minimal hemodynamic instability, remimazolam is increasingly used for anesthesia [4, 5].”
BackgroundChoi, 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
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
Chen, J., Zou, X., Hu, B., Yang, Y., Wang, F., Zhou, Q., & Shen, M. (2023) · Drug Design Development and Therapy · doi:10.2147/dddt.s425590 · Cited by 27
“516 Urological surgery 11 (22) 8 (16) 12 (24) 0.”
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
“REM is similar in chemical structure to midazolam and is believed to be as effective as midazolam in preventing PONV [27].”
BackgroundYokose, M., Takaki, R., Mihara, T., Saigusa, Y., Yamamoto, N., Masui, K., & Goto, T. (2022) · PLoS ONE · doi:10.1371/journal.pone.0275451 · Cited by 21
Kitaura, A., Kosumi, R., Iwamoto, T., & Nakao, S. (2022) · JA Clinical Reports · doi:10.1186/s40981-022-00528-1 · Cited by 18
“Remimazolam may be suitable for patients with depressed cardiac function, such as in MELAS syndrome, because it causes less circulatory depression than propofol [5].”
BackgroundSong, S. W., Kim, S., Park, J.-H., Cho, Y. H., & Jeon, Y.-G. (2023) · BMC Anesthesiology · doi:10.1186/s12871-023-02188-9 · Cited by 18
“However, no recall was instituted despite the higher BIS in previous studies [13, 27].”
ResultHuang, 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
Kim, H., Min, B., Lee, U., Sim, J., Noh, G., Lee, E., & Choi, B. (2024) · Anesthesiology · doi:10.1097/aln.0000000000004904 · Cited by 15
“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.”
Kim, K. M., Bang, J., Lee, J. M., Yang, H. S., Choi, B., & Noh, G. (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
Zhang, L., Wang, Z., Liu, Y., Zhang, X., & Wu, Y. (2024) · Drug Design, Development and Therapy · doi:10.2147/dddt.s456675 · Cited by 14
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
So, K., Park, J., & Kim, S. H. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1265860 · Cited by 14
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
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.”
BackgroundSato, 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-citationKo, E., Je, L., Kim, J., Song, Y. J., & Lim, C. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13133958 · Cited by 13
Lee, J., & Kim, S.-H. (2024) · Medicina · doi:10.3390/medicina60060971 · Cited by 13
“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].”
BackgroundInfluentialGillis, 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].”
BackgroundJeon, 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
“Additionally, remimazolam-induced postoperative nausea and vomiting is considerably less severe than when induced by inhaled anesthetics [72].”
BackgroundSingal, 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
Centroamericanos, C. D. E. M. Y. (2019) · REVISTA TRACE · doi:10.20882/adicciones.8 · Cited by 12
Teixeira, M. T., & Goyal, A. (2024) · Advances in Anesthesia · doi:10.1016/j.aan.2024.07.010 · Cited by 11
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
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
“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].”
BackgroundRemimazolam for cardiovascular anesthesia
Hirata, N. (2023) · Journal of Anesthesia · doi:10.1007/s00540-023-03242-z · Cited by 11
Self-citationAn update on remimazolam and anaphylaxis.
Cinotti, R. (2023) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000001794 · Cited by 11
Fukuda, M., Tachibana, S., Nishihara, N., & Yamakage, M. (2021) · JA Clinical Reports · doi:10.1186/s40981-021-00422-2 · Cited by 11
Kitaura, A., Sakamoto, H., Hamasaki, S., Tsukimoto, S., & Nakajima, Y. (2023) · Medicina · doi:10.3390/medicina59122136 · Cited by 10
Metadata
- 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
- Venue
- Journal of Anesthesia
- Published
- 2020-04-17
- Volume
- 34
- Issue
- 4
- Pages
- 491-501
- ISSN
- 0913-8668 (ISSN-L)
- 1438-8359
- 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
- Locations
- Journal of Anesthesia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › 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
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