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Neurological sedative indicators during general anesthesia with remimazolam

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A Letter to the Editor to this article was published on 11 April 2022

Abstract

Background

The bispectral index (BIS) value during general anesthesia with the newly developed anesthetic remimazolam is reported to be relatively high; however, the reason for this and the appropriate indicator for assessing the sedation level during remimazolam anesthesia have not been determined. In this study, the level of sedation during general anesthesia with remimazolam was evaluated using several different indicators.

Methods

Thirty patients who underwent breast surgery under general anesthesia with remimazolam were included. BIS®, Sedline® and the pupil resting diameters were measured simultaneously. The intraoperative dose of remimazolam was adjusted to obtain a BIS in the range of 40–60; if a BIS < 60 could not be achieved, the intraoperative dose was increased up to the maximal dose of 2 mg/kg/h.

Results

The mean intraoperative BIS and patient state index (PSI) in all patients was 50.6 ± 9.1 and 43.0 ± 11.8, respectively. Five patients showed a mean intraoperative BIS > 60 and eight patients showed mean intraoperative PSI > 50. The mean intraoperative spectral edge frequency (SEF) of BIS® or Sedline® was 15.3 ± 2.5 Hz or 10.6 ± 3.0 Hz, each. The mean intraoperative resting pupil diameter was 1.7 ± 0.2 mm. There were no patients with awareness during anesthesia.

Conclusions

Processed electroencephalograms (BIS and PSI), and SEF of BIS® were relatively high during anesthesia with remimazolam, but SEF of Sedline® or pupillary diameter could be a supportive indicator to confirm sedation level during remimazolam anesthesia.

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Acknowledgements

We would like to express our deepest appreciation to Mrs. Yoko Kondo, who works at the Kyushu University Hospital, for her assistance in this study. We also thank Editage® for English editing service.

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Kazuhiro Shirozu, Shota Tsumura, Kazuya Imura, Kosuke Nakashima & Shinnosuke Takamori

  2. Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Keiko Nobukuni

  3. Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Midoriko Higashi & Ken Yamaura

Authors
  1. Kazuhiro Shirozu
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  2. Keiko Nobukuni
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  3. Shota Tsumura
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  4. Kazuya Imura
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  5. Kosuke Nakashima
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  6. Shinnosuke Takamori
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  7. Midoriko Higashi
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  8. Ken Yamaura
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Contributions

KS: methodology, formal analysis, writing—original draft, writing—review and editing. KN, ST, KI, ST, KN: data curation, writing—review. MH, KY: writing—review and editing, supervision.

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Correspondence to Kazuhiro Shirozu.

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Shirozu, K., Nobukuni, K., Tsumura, S. et al. Neurological sedative indicators during general anesthesia with remimazolam. J Anesth 36, 194–200 (2022). https://doi.org/10.1007/s00540-021-03030-7

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  • DOI: https://doi.org/10.1007/s00540-021-03030-7

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