Remimazolam is a medication that has the advantage of a short half-life and reversibility with flumazenil. In clinical situations, the use of flumazenil for the reversal of sedation is common, but there is no precise indication for its administration. In this study, we aim to investigate the necessity of routine flumazenil use after administering remimazolam for intravenous anesthesia.
Remimazolam is a medication that has the advantage of a short half-life and reversibility with flumazenil. Although there are advantages of using flumazenil, such as reduced recovery time and decreased occurrence of postoperative cognitive dysfunction (POCD), it can cause rebound sedation, ventricular arrhythmias, seizures, agitation, and gastrointestinal symptoms. Therefore, routine administration is not recommended. However, in actual clinical situations, it is common to use flumazenil as a routine reversal agent for benzodiazepines, but there is no research on the routine use of flumazenil for reversing the effects of remimazolam in anesthesia or sedation. Factors such as obesity, advanced age, and low plasma albumin concentration can prolong the time for extubation during anesthesia with remimazolam. Therefore, when considering the routine use of flumazenil in waking patients using remimazolam in elderly patients, these factors should be taken into account. However, there is also no specific indication for its accurate administration. Therefore, this study aims to investigate the effects of flumazenil on recovery after total intravenous anesthesia with remimazolam in elderly patients undergoing hip joint surgery
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
DOUBLE
Enrollment
24
During induction, patients will receive remimazolam 6mg/kg/h with remifentanil TCI 1\~4 nanogram/mL. After patient loses consciousness, anesthesia will be maintained with remimazolam 1-2mg/kg/h combined with remifentanil. When procedure ends, infusion remimazolam stops and 0.3mg of flumazenil according to allocated groups.
During induction, patients will receive remimazolam 6mg/kg/h with remifentanil TCI 1\~4 nanogram/mL. After patient loses consciousness, anesthesia will be maintained with remimazolam 1-2mg/kg/h combined with remifentanil. When procedure ends, infusion remimazolam stops and 0.9% normal saline according to allocated groups.
Pusan National University Yangsan Hospital
Yangsan, Gyeongsangnam-do, South Korea
RECRUITINGDifference in eye opening time between the two groups
Time, after stopping injection of remimazolam, to eye opening
Time frame: Up to two hours
Difference in extubation time between the two groups
Time, after stopping injection of remimazolam, to extubation
Time frame: Up to two hours
Actual dose of flumazenil
Actual dose of flumazenil
Time frame: Up to two hours, From end of anesthesia to discharge form the post-anestheic care unit
Occurrence of re-sedation
Richmond Agitation Sedation Scale (RASS) score of -3 or lower(Score range: -5\~+4, lower score means more sedated state)
Time frame: Up to two hours, From end of anesthesia to discharge form the post-anestheic care unit
Side effects of flumazenil usage
Number of Participants with Seizures, agitation, arrhythmias, gastrointestinal symptoms, post operative nausea and vomiting, and degree of pain
Time frame: Up to two hours, From end of anesthesia to discharge form the post-anestheic care unit
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