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Anesthetic Management Using Remimazolam in a Hemodialysis Patient
Yukiko Nishioka DDS, PhD,
 Saki Miyake DDS, PhD,
 Midori Hamaoka DDS,
 Kota Miyake DDS,
 Maki Fujimoto DDS, PhD,
 Hitoshi Higuchi DDS, PhD, and
 Takuya Miyawaki DDS, 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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Yoshio Hayakawa DDS, PhD,
 Keiko Fujii-Abe DDS, PhD,
 Sayaka Akitomi DDS,
 Shihomi Niwa DDS,
 Michiru Abe DDS,
 Manami Otsuka DDS, PhD,
 Maho Ikeda DDS,
 Takumi Ishikawa DDS, PhD,
 Manami Yajima DDS, PhD, and
 Hiroshi Kawahara DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
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

Rumi Kaneko DDS,
 Kyotaro Koshika DDS, PhD,
 Mai Shionoya DDS,
 Kotaro Shimizu DDS,
 Yuka Sendai DDS,
 Nobutaka Matsuura DDS, and
 Tatsuya Ichinohe DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
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.


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.


Kyle J. Kramer DDS, MS
Article Category: Editorial
Volume/Issue: Volume 69: Issue 1
Online Publication Date: Apr 04, 2022
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

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.


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.


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.


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.