How to administer remimazolam for anesthesia induction
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LETTER TO THE EDITOR
How to administer remimazolam for anesthesia induction Naoyuki Hirata1 · Kengo Hayamizu1 · Michiaki Yamakage1 Received: 11 August 2020 / Accepted: 3 October 2020 © Japanese Society of Anesthesiologists 2020
To the Editor: Remimazolam, a novel ultrashort-acting benzodiazepine, is now available for general anesthesia in Japan; it is expected to achieve more appropriate anesthesia induction and recovery compared to existing intravenous and volatile anesthetics [1, 2]. The package insert of remimazolam recommends an initial dose of 12 mg/kg/h for induction, followed by 1 mg/ kg/h for maintenance of general anesthesia. It should be prepared as a 1 mg/mL solution (50 mg remimazolam per 50 mL normal saline) and the manufacturer recommends use of a syringe pump for administration. Achieving the initial administration dose of 12 mg/kg/h requires a high flow rate (e.g. 600 mL/h for adults weighing 50 kg) with a syringe pump. However, the upper flow rate of most syringe pumps is limited to 150 to 300 mL/h for safety. Approval of institutional committees for medical safety might be required to change the limit. To the best of our knowledge, only a targetcontrolled infusion device (TE-371, Terumo, Tokyo, Japan) allows high infusion rates (upper limit: 1,200 mL/h) without adjustments. When syringe pumps with a high flow rate are unavailable, manual slow infusion for more than a minute
might be administered. However, the manual infusion can result in unstable administration. Bolus administration of remimazolam for anesthesia induction is currently not recommended because no clinical trials on bolus administration have been performed [1]. Future clinical studies on bolus administration of remimazolam for induction of general anesthesia are desired to establish a more practical remimazolam administration technique.
References 1. Doi M, Morita K, Takeda J, Sakamoto A, Yamakage M, Suzuki T. Efficacy and safety of remimazolam versus propofol for general anesthesia: a multicenter, single-blind, randomized, parallelgroup, phase IIb/III trial. J Anesth. 2020;34:543–53. 2. Masui K. Remimazolam besilate, a benzodiazepine, has been approved for general anesthesia!! J Anesth. 2020;34:479–82. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
* Naoyuki Hirata [email protected] 1
Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo‑ku, Sapporo, Hokkaido 060‑8543, Japan
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