Switching Hypnotic Drugs to Remimazolam and Antagonizing With Flumazenil: A Rapid Method for Ending General Anesthesia

TL;DR

This paper explores using remimazolam and flumazenil to end anesthesia quickly and safely, improving recovery and reducing complications.

Contribution

A novel 'switch and antagonize' method for ending anesthesia using remimazolam and flumazenil is introduced and tested.

Findings

Rapid and smooth patient awakening was achieved with minimal complications.

Postoperative opioid and anti-emetic use was significantly reduced.

The method shows promise for increasing operating theater efficiency.

Abstract

The emergence from general anesthesia is currently difficult to predict and may be accompanied by respiratory complications. Switching all hypnotic drugs to remimazolam at the end of the operation and antagonizing it with flumazenil might lead to a rapid, smooth, and safe patient awakening, potentially increasing operating theater efficiency and reducing costs. In this case series of five patients, anesthesia with a combination of remimazolam, propofol, and sevoflurane was transitioned to remimazolam at 0.9-1.0 mg/kg/h as the sole hypnotic agent near the end of the operation. Subsequently, remimazolam was antagonized with 0.5 mg flumazenil. This approach resulted in a rapid, predictable, and smooth emergence and recovery, free from excitation or hemodynamic and respiratory disturbances. Additionally, postoperative opioid requirements were minimal, and no anti-emetic medication was necessary. The authors conclude that the "switch and antagonize" concept is feasible and promising, warranting further evaluation and refinement in the near future.

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