Remimazolam: sigurnost i zadovoljstvo bolesnika za proceduralnu sedaciju

Matteo Škrtić, Lada Lijović, Nataša Kovač, Iva Pažur, Bruna Bodulica, Nikola Periša, Ognjen Ožegić, Marinko Vučić, Tomislav Radočaj

Remimazolam je novi intravenski anestetik iz skupine benzodiazepina. Molekularna struktura remimazolama omogućuje mu poseban farmakokinetički profil te ga izdvaja od drugih lijekova u istoj skupini. Zbog bočnoga esterskog lanca u strukturi remimazolam metaboliziraju nespecifične esteraze na inaktivne metabolite, što rezultira njegovim ultrakratkim djelovanjem i brzim oporavkom koji nije ovisan o funkciji niti jednog organskog sustava. S mehanizmom djelovanja nalik klasičnim benzodiazepinima, prvenstveno midazolamu, i jedinstvenom farmakokinetikom u ovoj skupini lijekova, remimazolam se čini kao idealan sedativ za proceduralnu sedaciju za vrijeme kratkih zahvata. Učinkovitost remimazolama za proceduralne sedacije ispitivana je u tri multicentrična klinička istraživanja. Sva tri ispitivanja pokazala su učinkovitost remimazolama u proceduralnoj sedaciji, s visokim stopama uspjeha, brzim početkom i kratkim vremenom oporavka uočenim u skupinama s remimazolamom. U našoj ustanovi ispitivali smo djelovanje remimazolama za proceduralnu sedaciju za dijagnostičke gastroskopije i kolonoskopije. Cilj istraživanja bio je ustanoviti djelotvornost i sigurnost remimazolama kao sedativa za proceduralnu sedaciju. Iako na manjem uzorku, naši rezultati su u skladu s rezultatima velikih kliničkih studija.

Remimazolam is a new intravenous anesthetic from the benzodiazepine group. The molecular structure of remimazolam enables it to have a special pharmacokinetic profile and sets it apart from other drugs in the same group. Due to the ester side chain in the structure, remimazolam is metabolized by non-specific esterase into inactive metabolites resulting in its ultra-short action and rapid recovery, which is not dependent on the function of any organ system. With a mechanism of action similar to classic benzodiazepines, primarily midazolam, and unique pharmacokinetics in this group of drugs, remimazolam appears to be an ideal sedative for procedural sedation during short procedures. The efficacy of remimazolam for procedural sedation was investigated in three multicenter clinical trials. All three trials demonstrated the efficacy of remimazolam in procedural sedation with a high success rates and rapid onset and short recovery times observed in the remimazolam groups. In our institution, we examined the effect of remimazolam for procedural sedation for diagnostic gastroscopies and colonoscopies. The goal of our study was to establish the effectiveness and safety of remimazolam as a sedative for procedural sedation. Although based on a smaller sample, our results are consistent with the results of large clinical studies.