Gillis Holly, McKee Christopher, Chenault Kristin, Corridore Marco, Tobias Joseph D
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
Cardiol Res. 2024 Feb;15(1):12-17. doi: 10.14740/cr1595. Epub 2024 Feb 28.
Remimazolam is a benzodiazepine which, like midazolam, has sedative, anxiolytic, and amnestic properties. Ester metabolism results in a half-life of 5 - 10 min, a limited context sensitive half-life, and rapid recovery when the infusion is discontinued.
Following the Institutional Review Board (IRB) approval, we performed a retrospective chart review of patients who received remimazolam in the cardiac catheterization, cardiac magnetic resonance imaging (MRI), and electrophysiology suites. The primary objective was to assess efficacy and safety. The secondary objective was to describe bolus and infusion dosing of remimazolam and the need for adjunctive agents to optimize procedural sedation conditions.
The study cohort included 26 patients with a median age of 18 years and a total of 33 anesthetic encounters. The most common procedures were endomyocardial biopsy or isolated hemodynamic assessment (right or left heart catheterization). Remimazolam was the primary agent for sedation in 82% of the procedures. The majority of cases (25 encounters, 76%) included a bolus dose of remimazolam prior to the start of an infusion. For those patients who received a starting bolus dose, dosing typically ranged between 30 and 110 µg/kg. Continuous infusion rates of remimazolam varied from 5 to 20 µg/kg/min. No adverse hemodynamic or respiratory effects were noted. Midazolam, fentanyl, and dexmedetomidine were the most frequently used adjunctive agents. One patient required transition to general anesthesia due to the need for a surgical intervention based on the findings of the cardiac catheterization. All other patients were effectively sedated.
Our preliminary experience demonstrates that remimazolam effectively provided sedation for diagnostic and therapeutic cardiovascular procedures. Future studies are needed to further define dosing parameters for both bolus dosing and continuous infusion as well as to compare remimazolam to other commonly used for procedural sedation in patients with congenital and acquired heart disease.
瑞米唑仑是一种苯二氮䓬类药物，与咪达唑仑一样，具有镇静、抗焦虑和遗忘作用。酯代谢导致其半衰期为5 - 10分钟，上下文敏感半衰期有限，停止输注后恢复迅速。
在获得机构审查委员会（IRB）批准后，我们对在心脏导管插入术、心脏磁共振成像（MRI）和电生理室接受瑞米唑仑治疗的患者进行了回顾性病历审查。主要目的是评估疗效和安全性。次要目的是描述瑞米唑仑的推注和输注剂量以及优化手术镇静条件所需辅助药物的使用情况。
研究队列包括26例患者，中位年龄为18岁，共进行了33次麻醉。最常见的手术是心内膜心肌活检或单独的血流动力学评估（右心或左心导管插入术）。在82%的手术中，瑞米唑仑是主要的镇静药物。大多数病例（25次，76%）在开始输注前包括一次瑞米唑仑推注剂量。对于那些接受起始推注剂量的患者，剂量通常在30至110μg/kg之间。瑞米唑仑的持续输注速率为5至20μg/kg/分钟。未观察到不良血流动力学或呼吸影响。咪达唑仑、芬太尼和右美托咪定是最常用的辅助药物。一名患者因根据心脏导管检查结果需要进行手术干预而需要转为全身麻醉。所有其他患者均得到有效镇静。
我们的初步经验表明，瑞米唑仑有效地为诊断和治疗性心血管手术提供了镇静。未来需要进一步研究以进一步确定推注剂量和持续输注的给药参数，以及将瑞米唑仑与先天性和后天性心脏病患者手术镇静中常用的其他药物进行比较。
