ORCID

Abstract

Anaesthesiologists and non-anaesthesiologist sedationists have a limited set of available i.v. hypnotics, further reduced by the withdrawal of thiopental in the USA and its near disappearance in Europe. Meanwhile, demand for sedation increases and new clinical groups are using what traditionally are anaesthesiologists' drugs. Improved understanding of the determinants of perioperative morbidity and mortality has spotlighted hypotension as a potent cause of patient harm, and practice must be adjusted to respect this. High-dose propofol sedation may be harmful, and a critical reappraisal of drug choices and doses is needed. The development of remimazolam, initially for procedural sedation, allows reconsideration of benzodiazepines as the hypnotic component of a general anaesthetic even if their characterisation as i.v. anaesthetics is questionable. Early data suggest that a combination of remimazolam and remifentanil can induce and maintain anaesthesia. Further work is needed to define use cases for this technique and to determine the impact on patient outcomes.

DOI

10.1016/j.bja.2021.03.028

Publication Date

2021-05-06

Publication Title

British Journal of Anaesthesia

Volume

127

Issue

1

ISSN

0007-0912

Embargo Period

2022-05-06

Keywords

benzodiazepine, hypnotic, hypotension, pharmacodynamics, pharmacokinetics, remimazolam, sedation

First Page

41

Last Page

55

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