PDF(Pubmed)
Abstract：
Remimazolam is a novel benzodiazepine with sedative, anxiolytic, and amnestic properties similar to midazolam. Metabolism by tissue esterases results in a short clinical half-life of 5 - 10 min and a limited context sensitive half-life. We present initial retrospective clinical experience with the use of remimazolam as an intraoperative adjunct to sedation during awake craniotomy in a cohort of three adolescent patients. A remimazolam infusion was added to a combination of dexmedetomidine and remifentanil to deepen the level of sedation during surgical incision, craniotomy, duraplasty, and surgical dissection for exposure of the seizure foci. The remimazolam infusion was discontinued 30 min prior to the planned awake assessments and electrophysiology testing. The patients emerged calmly and were able to follow commands for intraoperative testing. Our anecdotal experience supports the efficacy of remimazolam for awake craniotomy and tumor resection using a standard asleep-awake-asleep technique. We noted adequate sedation, maintenance of spontaneous respiration, rapid awakening, and no limitations to intraoperative neuromonitoring or awake assessment in our three patients.
摘要：
雷米唑仑是一种新型的苯二氮卓类药物，具有镇静剂，抗焦虑药,和类似咪达唑仑的记忆特性。组织酯酶的代谢导致5-10分钟的短临床半衰期和有限的环境敏感半衰期。我们介绍了在三名青少年患者中，在清醒开颅手术期间使用瑞咪唑安定作为术中镇静辅助手段的初步回顾性临床经验。在右美托咪定和瑞芬太尼的组合中加入瑞咪唑安定输注以加深手术切口期间的镇静水平，开颅手术,硬膜成形术,和手术解剖以暴露癫痫发作病灶。在计划的清醒评估和电生理测试之前30分钟，停止了瑞咪唑仑输注。患者平静地出现，并能够遵循术中检查的命令。我们的轶事经验支持使用标准的睡眠-清醒-睡眠技术对瑞咪唑安定进行清醒开颅手术和肿瘤切除术的疗效。我们注意到足够的镇静，维持自主呼吸，快速觉醒,我们的3例患者的术中神经监测或清醒评估没有限制。
