Relationship between age and remimazolam dose required for inducing loss of consciousness in older surgical patients

Jin-Chao Song; Xiao-Xi Wang; Xiang Fu; Wei Chen; Shu-Heng Tang; Fang Deng; Hua Yang; Wen Liu

doi:10.3389/fmed.2024.1331103

Relationship between age and remimazolam dose required for inducing loss of consciousness in older surgical patients

Front Med (Lausanne). 2024 Apr 29:11:1331103. doi: 10.3389/fmed.2024.1331103. eCollection 2024.

Authors

Jin-Chao Song^#¹, Xiao-Xi Wang^#², Xiang Fu^#³, Wei Chen³, Shu-Heng Tang¹, Fang Deng¹, Hua Yang¹, Wen Liu¹

Affiliations

¹ Department of Anesthesiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China.
² Department of Anesthesiology, Eastern Hepatobillary Surgical Hospital, Naval Medical University, Shanghai, China.
³ Department of Pharmacy, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China.

^# Contributed equally.

Abstract

Background: Remimazolam is a new ultra-short-acting benzodiazepine for procedural sedation and general anaesthesia, characterised by rapid onset of action, quick recovery, and organ-independent metabolism. Older patients tend to sustain more treatment-emergent adverse events (TEAEs) and worse perioperative prognoses after receiving remimazolam. However, few studies have investigated the appropriate dose of remimazolam for loss of consciousness (LOC) in geriatric patients. We designed this study to provide evidence for dose references and elucidate the relationship between age and remimazolam requirement for inducing LOC during anaesthesia induction.

Methods: Exactly 120 patients scheduled for general surgery under general anaesthesia were included and divided into two groups: Group A (60 patients, 18-64 years) and Group B (60 patients, ≥ 65 years). LOC, defined as a Modified Observer's Assessment of Alertness and Sedation score at 1 had been reached, emerged after all participants received a continuous infusion of remimazolam at a rate of 0.05 mg/kg/min.

Results: The remimazolam required for inducing LOC was 0.26 and 0.19 mg/kg in groups A and B, respectively, and the remimazolam dose in group B decreased by 26.9% compared to group A. According to the bivariate linear correlation analysis, remimazolam requirement was negatively correlated with age. Multivariable linear regression models and further adjustments for potential impact factors indicated that age was an independent factor for the remimazolam dose required for LOC.

Conclusion: This study demonstrated that age was significantly and independently correlated with the remimazolam requirement for inducing LOC. To obtain haemodynamic stability during the induction of general anaesthesia, appropriately reducing the remimazolam dose is recommended for geriatric patients.

Keywords: anaesthetics; intravenous anesthesia; loss of consciousness; older surgical patients; remimazolam.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The Health Committee and the Science and Technology Commission of Yangpu District, Shanghai (YPM202318) supported this study.