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Current Drug Safety

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ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

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Case Report

Remimazolam and Remifentanil Use Induced Severe Respiratory Depression and Laryngeal Spasm During Intravenous Sedation and Analgesia: A Case Report

Author(s): Zhijun Xin*, Ning Wang and Huaizhou Wang

Volume 19, Issue 2, 2024

Published on: 21 June, 2023

Page: [277 - 281] Pages: 5

DOI: 10.2174/1574886318666230517101142

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Abstract

Introduction: Intravenous sedation and analgesia are widely used in minor surgeries. Remifentanil and remimazolam are advantageous in this setting because of their rapid onset of action, and short duration of action leading to a rapid recovery. However, the two drugs combined need to be titrated to avoid airway-related adverse events.

Case Presentation: This article reports a case of severe respiratory depression and severe laryngeal spasm induced by remifentanil and remimazolam when they were used for analgesia and sedation in a patient undergoing oral biopsy.

Conclusion: We aim to improve awareness about the safety of these drugs among anesthesiologists and increase their ability to manage the risk associated with their use.

Keywords: Intravenous sedation, analgesia, remifentanil, remimazolam, respiratory depression, laryngospasm.

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[1]
Birlie Chekol W, Yaregal Melesse D. Incidence and Associated Factors of Laryngospasm among Pediatric Patients Who Underwent Surgery under General Anesthesia, in University of Gondar Compressive Specialized Hospital, Northwest Ethiopia, 2019: A cross-sectional study. Anesthesiol Res Pract 2020; 2020: 3706106.
[http://dx.doi.org/10.1155/2020/3706106] [PMID: 32411216]
[2]
Haile M, Legesse S, Miressa S, Desalegn N. Magnitude and associated risk factors of perioperative pediatrics laryngospasm under general anesthesia. Intern Med Open Access 2015; 5(5): 203.
[3]
Quan XH, Xiao L, Yuan XG. Prophylactic analgesia and mild sedation should be used in oral outpatient treatment. J Pract Stomatol 2022; 38(1): 85-7.
[http://dx.doi.org/10.3969/j.issn.1001-3733.2022.01.017]
[4]
Christensen L, Svoboda L, Barclay J, Springer B, Voegele B, Lyu D. Outcomes with moderate and deep sedation in an oral and maxillofacial surgery training program. J Oral Maxillofac Surg 2019; 77(12): 2447-51.
[http://dx.doi.org/10.1016/j.joms.2019.07.007] [PMID: 31449763]
[5]
Wang CY, Yu YH. Progress in clinical research on remimazolam. Chinese J Anesthesiol 2019; 39(3): 261-3.
[http://dx.doi.org/10.3760/cma.j.issn.0254-1416.2019.03.003]
[6]
Zhang JB, Yang MP, Shi LW, et al. Progress in the perioperative application of remimazolam. Int J Anesthesiol Resuscitation 2022; 43(4): 396-400.
[http://dx.doi.org/10.3760/cma.j.cn321761-20210210-10004]
[7]
Dai G, Pei L, Duan F, et al. Safety and efficacy of remimazolam compared with propofol in induction of general anesthesia. Minerva Anestesiol 2021; 87(10): 1073-9.
[http://dx.doi.org/10.23736/S0375-9393.21.15517-8] [PMID: 34263581]
[8]
Liu M, Wu H, Yang D, et al. Effects of small-dose remifentanil combined with index of consciousness monitoring on gastroscopic polypectomy: A prospective, randomized, single-blinded trial. Trials 2018; 19(1): 392.
[http://dx.doi.org/10.1186/s13063-018-2783-4] [PMID: 30021625]
[9]
Liang J, Shang Y, Reng RG, et al. Safety of remifentanil combined with remifentanil anesthesia in painless gastroscopy and its influence on vital signs. Clin Med Res Pract 2022; 7(15): 90-4.
[http://dx.doi.org/10.19347/j.cnki.2096-1413.202215024]
[10]
Zhou J, Yin B, Xu YG, et al. Safety and efficacy of compound remifentanil laryngeal mask venous general anesthesia for senile ureteroscopic lithotripsy. Chin Med J 2022; 57(4): 405-8.
[http://dx.doi.org/10.3969/j.issn.1008-1070.2022.04.017]
[11]
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain-United States, 2016. JAMA 2016; 315(15): 1624-45.
[http://dx.doi.org/10.1001/jama.2016.1464] [PMID: 26977696]
[12]
Boon M, van Dorp E, Broens S, Overdyk F. Combining opioids and benzodiazepines: Effects on mortality and severe adverse respiratory events. Ann Palliat Med 2020; 9(2): 542-57.
[http://dx.doi.org/10.21037/apm.2019.12.09] [PMID: 32036672]
[13]
Shirota Y, Hirase Y, Suda T, Miyazawa M, Hodo Y, Wakabayashi T. More than half of hypoxemia cases occurred during the recovery period after completion of esophagogastroduodenoscopy with planned moderate sedation. Sci Rep 2020; 10(1): 4312.
[http://dx.doi.org/10.1038/s41598-020-61120-0] [PMID: 32152344]
[14]
Hu B, Jiang K, Shi W, et al. Effect of remimazolam tosilate on respiratory depression in elderly patients undergoing gastroscopy: A multicentered, prospective, and randomized study. Drug Des Devel Ther 2022; 16: 4151-9.
[http://dx.doi.org/10.2147/DDDT.S391147] [PMID: 36506792]
[15]
Chae D, Kim HC, Song Y, Choi YS, Han DW. Pharmacodynamic analysis of intravenous bolus remimazolam for loss of consciousness in patients undergoing general anaesthesia: A randomised, prospective, double-blind study. Br J Anaesth 2022; 129(1): 49-57.
[http://dx.doi.org/10.1016/j.bja.2022.02.040] [PMID: 35562226]
[16]
Antonik LJ, Goldwater DR, Kilpatrick GJ, Tilbrook GS, Borkett KM. A placebo- and midazolam-controlled phase I single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamics of remimazolam (CNS 7056): Part I. Safety, efficacy, and basic pharmacokinetics. Anesth Analg 2012; 115(2): 274-83.
[http://dx.doi.org/10.1213/ANE.0b013e31823f0c28] [PMID: 22190555]
[17]
Sheng X, Liang Y, Yang X, et al. Safety, pharmacokinetic and pharmacodynamic properties of single ascending dose and continuous infusion of remimazolam besylate in healthy Chinese volunteers. Eur J Clin Pharmacol 2020; 76(3): 383-91.
[http://dx.doi.org/10.1007/s00228-019-02800-3] [PMID: 31873765]
[18]
Kops MS, Pesic M, Petersen KU, Schmalix WA, Stöhr T. Impact of concurrent remifentanil on the sedative effects of remimazolam, midazolam and propofol in cynomolgus monkeys. Eur J Pharmacol 2021; 890: 173639.
[http://dx.doi.org/10.1016/j.ejphar.2020.173639] [PMID: 33065095]
[19]
Lacombe GF, Leake JL, Clokie CML, Haas DA. Comparison of remifentanil with fentanyl for deep sedation in oral surgery. J Oral Maxillofac Surg 2006; 64(2): 215-22.
[http://dx.doi.org/10.1016/j.joms.2005.10.026] [PMID: 16413892]
[20]
Baboneo HD, Conard PF, Gross JB. The effect of a remifontanil bolus on ventilatory conthrol. Anesthesiology 2000; 92(2): 393-8.
[http://dx.doi.org/10.1097/00000542-200002000-00020] [PMID: 10691225]
[21]
Bouillon T, Bruhn J, Radu-Radulescu L, Andresen C, Cohane C, Shafer SL. A model of the ventilatory depressant potency of remifentanil in the non-steady state. Anesthesiology 2003; 99(4): 779-87.
[http://dx.doi.org/10.1097/00000542-200310000-00007] [PMID: 14508307]
[22]
Lobb D, Ameli N, Ortiz S, Lai H. Comparison of the effects of target-controlled infusion-remifentanil/midazolam and manual fentanyl/midazolam administration on patient parameters in dental procedures. J Dent Anesth Pain Med 2022; 22(2): 117-28.
[http://dx.doi.org/10.17245/jdapm.2022.22.2.117] [PMID: 35449782]
[23]
Hou J, Wang JY. Advances in the immune microenvironment of multiple myeloma. Cancer Prev Treat Res 2022; 49(5): 375-8.
[24]
Gonçalves NP, Vægter CB, Andersen H, Østergaard L, Calcutt NA, Jensen TS. Schwann cell interactions with axons and microvessels in diabetic neuropathy. Nat Rev Neurol 2017; 13(3): 135-47.
[http://dx.doi.org/10.1038/nrneurol.2016.201] [PMID: 28134254]
[25]
van Sloten TT, Sedaghat S, Carnethon MR, Launer LJ, Stehouwer CDA. Cerebral microvascular complications of type 2 diabetes: stroke, cognitive dysfunction, and depression. Lancet Diabetes Endocrinol 2020; 8(4): 325-36.
[http://dx.doi.org/10.1016/S2213-8587(19)30405-X] [PMID: 32135131]
[26]
Zhou L, Yang Y, Yang L, et al. Point-of-care ultrasound defines gastric content in elective surgical patients with type 2 diabetes mellitus: A prospective cohort study. BMC Anesthesiol 2019; 19(1): 179.
[http://dx.doi.org/10.1186/s12871-019-0848-x] [PMID: 31601180]
[27]
Bouvet L, Chassard D, Desgranges FP. Risk of pulmonary aspiration of gastric contents in patients with diabetes mellitus. Br J Anaesth 2022; 128(1): e19-20.
[http://dx.doi.org/10.1016/j.bja.2021.10.010] [PMID: 34749992]
[28]
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures. Anesthesiology 2017; 126(3): 376-93.
[http://dx.doi.org/10.1097/ALN.0000000000001452] [PMID: 28045707]
[29]
Steve H, Larry C, Sara G, et al. Emergency manual:cognitive aids for perioperative critical events. (2nd ed.). San Francisco: Alpha Graphics 2014; pp. 1-26.
[30]
Finsnes KD. Laryngeal spasm after general anaesthesia due to Ascaris lumbricoides. Acta Anaesthesiol Scand 2013; 57(7): 944-5.
[http://dx.doi.org/10.1111/aas.12128] [PMID: 23679043]
[31]
Pearce H. Laryngeal spasm. Anaesth Intensive Care 1983; 11(4): 389-90.
[PMID: 6650815]
[32]
Nawfa IM, Baraka A. ProPofol for relief of extubationlaryngospasm. Anesthesia 2002; 57: 1028-44.
[33]
Ma TH, Wang QJ, Yang H. Analysis of the causes and countermeasures of laryngospasm in the anesthesia recovery room. Nurs Res 2014; (36): 4562-3.
[http://dx.doi.org/10.3969/j.issn.10096493.2014.36.036]

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