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Anesthetic Management Using Remimazolam in a Hemodialysis Patient
Yukiko NishiokaDDS, PhD,
Saki MiyakeDDS, PhD,
Midori HamaokaDDS,
Kota MiyakeDDS,
Maki FujimotoDDS, PhD,
Hitoshi HiguchiDDS, PhD, and
Takuya MiyawakiDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 70: Issue 2
Online Publication Date: Jun 28, 2023
DOI: 10.2344/anpr-70-02-06
Page Range: 65 – 69

INTRODUCTION Remimazolam, an ultra-short-acting benzodiazepine, was developed as a new intravenous (IV) agent for general anesthesia and sedation. It is rapidly metabolized by carboxylesterases (CES) in the liver and other tissues including the lung. Combined with its rapid onset, remimazolam's unique metabolism facilitates easy and accurate titration, quick recovery, and few adverse events. 1 In recent clinical trials, the pharmacokinetics and pharmacodynamics, efficacy, and safety of remimazolam were evaluated in patients undergoing

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Comparison of Remimazolam and Propofol for Intubated General Anesthesia for Oral and Maxillofacial Surgery
Yoshio HayakawaDDS, PhD,
Keiko Fujii-AbeDDS, PhD,
Sayaka AkitomiDDS,
Shihomi NiwaDDS,
Michiru AbeDDS,
Manami OtsukaDDS, PhD,
Maho IkedaDDS,
Takumi IshikawaDDS, PhD,
Manami YajimaDDS, PhD, and
Hiroshi KawaharaDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
DOI: 10.2344/523398
Page Range: 159 – 167

Remimazolam besylate (Anerem in Japan/Byfavo in United States; Paion AG, Aachen, Germany) is a new, ultra-short-acting intravenous (IV) sedative-hypnotic that has an imidazobenzodiazepine skeleton. It acts like other benzodiazepines to potentiate gamma aminobutyric acid (GABA) effects via positive allosteric modulation involving GABA A receptors. Its metabolic pathway does not involve cytochrome P450 as it is instead rapidly hydrolyzed by tissue esterases, primarily by carboxylesterase in the liver. 1 , 2 Due to its unique metabolism

Retrospective Study on the Incidence of Postoperative Nausea and Vomiting and Hypotension During Orthognathic Surgery Using Propofol or Remimazolam
Rumi KanekoDDS,
Kyotaro KoshikaDDS, PhD,
Mai ShionoyaDDS,
Kotaro ShimizuDDS,
Yuka SendaiDDS,
Nobutaka MatsuuraDDS, and
Tatsuya IchinoheDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
DOI: 10.2344/23-00002
Page Range: 3 – 7

reported that intraoperative hypotension is likely to occur due to sympathetic inhibitory effects and impairment of baroreflex regulatory mechanisms. 13 Conversely, remimazolam, a new ultrashort-acting intravenous (IV) benzodiazepine, provides improved hemodynamic stability and is less likely to lower blood pressure compared to propofol. 14 Although known PONV risk factors include females, nonsmokers, history of PONV/motion sickness, and postoperative opioid use, intraoperative hypotension may be another risk factor. 15 It is not clear whether remimazolam and

Figure 2.; Remimazolam Protocol Protocol of induction and maintenance of anesthesia with remimazolam. ① Baseline; ② Loss of consciousness; ③ Immediately after intubation; ④ Time out; ⑤ 1 minute after local anesthesia; ⑥ 10 minutes after the start of surgery; ⑦ End of surgery; ⑧ Immediately before extubation; ⑨ Before leaving the OR.
Yoshio Hayakawa,
Keiko Fujii-Abe,
Sayaka Akitomi,
Shihomi Niwa,
Michiru Abe,
Manami Otsuka,
Maho Ikeda,
Takumi Ishikawa,
Manami Yajima, and
Hiroshi Kawahara
Figure 2.
Figure 2.

Remimazolam Protocol

Protocol of induction and maintenance of anesthesia with remimazolam. ① Baseline; ② Loss of consciousness; ③ Immediately after intubation; ④ Time out; ⑤ 1 minute after local anesthesia; ⑥ 10 minutes after the start of surgery; ⑦ End of surgery; ⑧ Immediately before extubation; ⑨ Before leaving the OR.

Figure 6.; Comparisons of EEG Monitor EEG monitor (mean ± SD) comparisons were made between each group. No significant differences were noted between the groups for both BIS and PSI, suggesting that remimazolam can be used to evaluate the depth of anesthesia. ① Baseline; ② Loss of consciousness; ③ Immediately after intubation; ④ Time out; ⑤ 1 minute after local anesthesia; ⑥ 10 minutes after the start of surgery; ⑦ End of surgery; ⑧ Immediately before extubation; ⑨ Before leaving the OR.
Yoshio Hayakawa,
Keiko Fujii-Abe,
Sayaka Akitomi,
Shihomi Niwa,
Michiru Abe,
Manami Otsuka,
Maho Ikeda,
Takumi Ishikawa,
Manami Yajima, and
Hiroshi Kawahara
Figure 6.
Figure 6.

Comparisons of EEG Monitor

EEG monitor (mean ± SD) comparisons were made between each group. No significant differences were noted between the groups for both BIS and PSI, suggesting that remimazolam can be used to evaluate the depth of anesthesia. ① Baseline; ② Loss of consciousness; ③ Immediately after intubation; ④ Time out; ⑤ 1 minute after local anesthesia; ⑥ 10 minutes after the start of surgery; ⑦ End of surgery; ⑧ Immediately before extubation; ⑨ Before leaving the OR.

Remimazolam: The Next Evolutionary Step for Sedative-Hypnotics
Kyle J. KramerDDS, MS
Article Category: Editorial
Volume/Issue: Volume 69: Issue 1
Online Publication Date: Apr 04, 2022
DOI: 10.2344/anpr-69-01-07
Page Range: 1 – 2

Lost in the avalanche of pandemic-related news last year was the commercial release of remimazolam (Byfavo, Acacia Pharma), formally announced on January 28, 2021. The journey of this highly anticipated novel benzodiazepine from discovery to market has been long and arduous. However, its arrival seems to herald a significant advancement for sedation and anesthesia for dentistry. The goal of identifying an ultrashort-acting benzodiazepine began in the late 1990s in the wake of remifentanil's discovery by the pharmaceutical company

Figure 1.; Propofol Protocol Protocol of induction and maintenance of anesthesia with propofol. ① Baseline; ② Loss of consciousness; ③ Immediately after intubation; ④ Time out; ⑤ 1 minute after local anesthesia; ⑥ 10 minutes after the start of surgery; ⑦ End of surgery; ⑧ Immediately before extubation; ⑨ Before leaving the OR.
Yoshio Hayakawa,
Keiko Fujii-Abe,
Sayaka Akitomi,
Shihomi Niwa,
Michiru Abe,
Manami Otsuka,
Maho Ikeda,
Takumi Ishikawa,
Manami Yajima, and
Hiroshi Kawahara
Figure 1.
Figure 1.

Propofol Protocol

Protocol of induction and maintenance of anesthesia with propofol. ① Baseline; ② Loss of consciousness; ③ Immediately after intubation; ④ Time out; ⑤ 1 minute after local anesthesia; ⑥ 10 minutes after the start of surgery; ⑦ End of surgery; ⑧ Immediately before extubation; ⑨ Before leaving the OR.

Figure 5.; Comparisons of Heart Rate Heart rate (mean ± SD) comparisons were made between each group. A significant decrease in heart rate was observed in the propofol group (shown as *). ① Baseline; ② Loss of consciousness; ③ Immediately after intubation; ④ Time out; ⑤ 1 minute after local anesthesia; ⑥ 10 minutes after the start of surgery; ⑦ End of surgery; ⑧ Immediately before extubation; ⑨ Before leaving the OR.
Yoshio Hayakawa,
Keiko Fujii-Abe,
Sayaka Akitomi,
Shihomi Niwa,
Michiru Abe,
Manami Otsuka,
Maho Ikeda,
Takumi Ishikawa,
Manami Yajima, and
Hiroshi Kawahara
Figure 5.
Figure 5.

Comparisons of Heart Rate

Heart rate (mean ± SD) comparisons were made between each group. A significant decrease in heart rate was observed in the propofol group (shown as *). ① Baseline; ② Loss of consciousness; ③ Immediately after intubation; ④ Time out; ⑤ 1 minute after local anesthesia; ⑥ 10 minutes after the start of surgery; ⑦ End of surgery; ⑧ Immediately before extubation; ⑨ Before leaving the OR.

Figure 4.; Comparisons of Mean Arterial Blood Pressure Mean arterial pressure (MAP; mean ± SD) comparisons were made between each group. A significant decrease in MAP was observed in the propofol group (shown as *). ① Baseline; ② Loss of consciousness; ③ Immediately after intubation; ④ Time out; ⑤ 1 minute after local anesthesia; ⑥ 10 minutes after the start of surgery; ⑦ End of surgery; ⑧ Immediately before extubation; ⑨ Before leaving the OR.
Yoshio Hayakawa,
Keiko Fujii-Abe,
Sayaka Akitomi,
Shihomi Niwa,
Michiru Abe,
Manami Otsuka,
Maho Ikeda,
Takumi Ishikawa,
Manami Yajima, and
Hiroshi Kawahara
Figure 4.
Figure 4.

Comparisons of Mean Arterial Blood Pressure

Mean arterial pressure (MAP; mean ± SD) comparisons were made between each group. A significant decrease in MAP was observed in the propofol group (shown as *). ① Baseline; ② Loss of consciousness; ③ Immediately after intubation; ④ Time out; ⑤ 1 minute after local anesthesia; ⑥ 10 minutes after the start of surgery; ⑦ End of surgery; ⑧ Immediately before extubation; ⑨ Before leaving the OR.

Figure 3.; Comparisons of Blood Pressure Systolic and diastolic blood pressure (mean ± SD) comparisons were made between each group. A significant decrease in blood pressure was observed in the propofol group (shown as *). ① Baseline; ② Loss of consciousness; ③ Immediately after intubation; ④ Time out; ⑤ 1 minute after local anesthesia; ⑥ 10 minutes after the start of surgery; ⑦ End of surgery; ⑧ Immediately before extubation; ⑨ Before leaving the OR.
Yoshio Hayakawa,
Keiko Fujii-Abe,
Sayaka Akitomi,
Shihomi Niwa,
Michiru Abe,
Manami Otsuka,
Maho Ikeda,
Takumi Ishikawa,
Manami Yajima, and
Hiroshi Kawahara
Figure 3.
Figure 3.

Comparisons of Blood Pressure

Systolic and diastolic blood pressure (mean ± SD) comparisons were made between each group. A significant decrease in blood pressure was observed in the propofol group (shown as *). ① Baseline; ② Loss of consciousness; ③ Immediately after intubation; ④ Time out; ⑤ 1 minute after local anesthesia; ⑥ 10 minutes after the start of surgery; ⑦ End of surgery; ⑧ Immediately before extubation; ⑨ Before leaving the OR.