Current status of perioperative hypnotics, role of benzodiazepines, and the case for remimazolam: a narrative review.
Br J Anaesth
; 127(1): 41-55, 2021 07.
Article
em En
| MEDLINE
| ID: mdl-33965206
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.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Benzodiazepinas
/
Assistência Perioperatória
/
Hipnóticos e Sedativos
Limite:
Humans
Idioma:
En
Revista:
Br J Anaesth
Ano de publicação:
2021
Tipo de documento:
Article