After confirming LOR, the infusion rate of remimazolam was adjusted to 1 or 2 mg/kg/h and remifentanil was administered via target Ce controlled infusion using the Minto model. After starting remimazolam infusion, LOR, defined as the patient becoming unresponsive to loud verbal commands (open your eyes), was assessed frequently to determine the induction of anesthesia. Remimazolam (Byfavo™ Inj, Hana Pharm Co., Ltd, Korea) was administered as an initial induction dose of 6 or 12 mg/kg/h at the discretion of the attending anesthesiologist using a syringe pump (Perfusor ®, Space, B. After pre-oxygenation with 100% oxygen via facial mask, the anesthetic dosing strategies were employed in all patients as follows. All data were recorded continuously until the end of anesthesia. Upon arrival in the operating room, standard monitoring processes, including an electrocardiograph, pulse oximeter, noninvasive blood pressure monitor, train-of-four, end-tidal carbon dioxide partial pressure, and the bispectral index (BIS TM, Covidien, USA) were applied in all cases. The patients in this study fasted from midnight on the day of surgery and received no premedication. General anesthesia was identically conducted according to our institution’s standard anesthesia protocol for general surgery in all patients. Therefore, the pharmacologic effect can be determined based on either the plasma concentration (Cp) or effect-site concentration (Ce) however, Ce rather than the Cp reflects the clinical effects of intravenous anesthetics better. As most drugs act at sites remote from the bloodstream, hysteresis, a phenomenon denoting time lag between the measured plasma drug concentration and the observed drug effect may occur. ![]() Due to these pharmacologic properties, remimazolam concentration accurately represents its hypnotic effect thus, knowing accurate remimazolam concentrations is beneficial in anesthesia practice. Pharmacokinetics and pharmacodynamics of remimazolam were characterized by relatively high clearance, small steady-state volume of distribution, short elimination half-life, short context-sensitive half-life, linear kinetics, and dose-related depth and duration of sedation. It has advantages over currently used hypnotic agents including rapid onset/offset, predictable duration of action, organ-independent metabolism, availability of a reversal drug, and maintenance of stable hemodynamics, and is increasingly being used as a hypnotic component of total intravenous anesthesia (TIVA). Remimazolam, a novel ultra-short-acting benzodiazepine invented out of ‘soft drug’ development, has recently (January 2021) been approved as a general anesthetic by the Ministry of Food and Drug Safety (MFDS) in South Korea.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |