‘Remimazolam: a new string to the TIVA bow’

Context-sensitive half times represent an ongoing challenge in anaesthesia and sedation. Longer infusion durations increase the elimination half time of most agents - i.e. the longer they are infused for, the longer they take to wear off.

Since the discovery of remifentanil - a strong opioid whose elimination half time is largely independent of infusion duration - there has been hope that a hypnotic agent with a similar ‘context-independent half time’ might be discovered.

A new agent, remimazolam, appears to demonstrate these properties, with the additional benefit of being easily reversible by administration of flumazenil. This open access editorial in Journal of Anaesthesia describes this in more detail, including the potential benefits in a ‘Cannot Intubate, Cannot Oxygenate’ (CICO) scenario.

Read the article here: https://link.springer.com/article/10.1007/s00540-023-03186-4

For a more in-depth discussion of remimazolam, see this review article from Frontiers in Pharmacology: https://www.frontiersin.org/articles/10.3389/fphar.2021.690875/full