Remimazolam as an Adjunct to General Anesthesia During Spine Surgery in Adolescents

Background: Remimazolam is a benzodiazepine that has recently been released for clinical use. Similar to midazolam, it has sedative, anxiolytic, and amnestic properties. However, its metabolism is different as it undergoes metabolism by tissue esterases with a half-life of 5 - 10 min and a limited context-sensitive half-life. Methods: We retrospectively reviewed our experience with the use of remimazolam as an adjunctive to general anesthesia during spine surgery. Results: The study cohort included 40 patients, ranging in age from 11 to 35 years and in weight from 21 to 126 kg. Remimazolam was added as an adjunct to maintenance anesthesia with propofol, desflurane, or dexmedetomidine/ketamine at a starting dose of 2.5 - 10 µg/kg/min (median dose 5 µg/kg/min). Maintenance doses ranged from 1.5 to 30 µg/kg/min (median dose 8 µg/kg/min). Remimazolam was infused for an average of 5.1 h per patient or a total of 203 h of infusion in the 40 patients. With the infusion of remimazolam, the requirements for the volatile agent or propofol were decreased by approximately 40-50%. No adverse effects related to remimazolam were noted. Conclusions: Remimazolam is an effective adjunct to general anesthesia during spinal surgery, resulting in a significant decrease in requirements for propofol or volatile anesthetic agents. J Curr Surg. 2023;13(1):1-5 doi: https://doi.org/10.14740/jcs472