Remimazolam: Revolutionizing Tiva

Drugs having a short duration of action and early recovery are often the preferred choice for sedation. Propofol fits into this category but it has safety issues such as decrease of blood pressure, respiratory depression, vascular pain and a high susceptibility of the drug to bacterial growth.(1,2) It also lacks a reversal agent. Midazolam has a weaker circulatory suppressive effect than propofol, but it is rarely used for the induction and maintenance of general anaesthesia because of its longer duration of action (40 min), variable onset and offset of sedative effect. (3,4,5) Remimazolam (CNS 7056, C₂₁H₁₉BrN₄O₂) is a novel benzodiazepine created out of a soft drug development technique known as rational drug designing. It is an ultrashort-acting intravenous sedative-anesthetic currently in Phase III clinical trials as a safe and effective option for procedural sedation. Remimazolam does not produce injection site pain. Its safety of clinical use is further increased by the availability of benzodiazepine antagonist Flumazenil. High extra hepatic clearance also confers little scope for metabolic interactions with other drugs in the liver and its propensity to cause apnea is very low.(6)