Remimazolam-Flumazenil Combo Cuts Extubation Time in TAVI

TOPLINE:

Compared with sevoflurane, a combination of remimazolam and flumazenil significantly reduces extubation time and use of ephedrine, while maintaining similar hemodynamic stability, in patients undergoing transcatheter aortic valve implantation (TAVI).

METHODOLOGY:

• Researchers in Japan conducted a prospective, open-label, single-center clinical trial between June 2022 and August 2023 to compare emergence times with sevoflurane or remimazolam plus flumazenil in patients with severe aortic stenosis undergoing TAVI under general anesthesia.
• They randomly assigned 60 patients aged > 75 years to receive either IV remimazolam or sevoflurane for maintenance of general anesthesia (56 patients were included in the analysis). Both groups received remifentanil infusion throughout the procedure; in the remimazolam group, flumazenil was given immediately after discontinuation of remimazolam.
• The primary outcome was time to extubation, defined as the duration from cessation of anesthesia to extubation.

TAKEAWAY:

• The median time to extubation was significantly shorter in the remimazolam vs sevoflurane group (6.5 min vs 14.2 min; P
• Patients in the remimazolam group required lower bolus doses of ephedrine bolus than did those given sevoflurane (difference in medians, −4 mg).
• However, no significant differences between the two groups were observed in mean arterial pressure, heart rate, or use of other vasopressors. Intraoperative parameters such as operative time, blood loss, and fluid balance, and rates of complications during or after surgery were also comparable between the groups.
• The perfusion index and regional cerebral oxygen saturationwere significantly lower in the remimazolam group than in the sevoflurane group; however, the researchers did not consider these differences to be clinically significant.

IN PRACTICE:

“These results indicate that remimazolam may be a suitable choice for general anesthesia in patients undergoing TAVI,” the authors of the study wrote.

SOURCE:

The study was led by So Harimochi, MD, of the Department of Anesthesiology and Critical Care Medicine at Kagoshima University, in Japan. It was published online on December 23, 2024, in the Canadian Journal of Anesthesia.

LIMITATIONS:

The study was unable to fully blind the allocation due to the requirement of a vaporizer in the sevoflurane group. The findings from the single-center trial may not be generalizable to other settings. The researchers also noted that resedation events after flumazenil administration were not recorded.

DISCLOSURES:

The authors reported no relevant conflicts of interest and received no specific funding for this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.