TABLE 5.

Case reports on the use of remimazolam besylate in clinical practice. NA = Not available/applicable, ECRP = Endoscopic retrograde cholangiopancreatography, MEP = Motor evoked potentials, EEG = electroencephalograph.

Procedure	Dose	Salt	Co-treatment	Comment	Ref
Spine surgery	Induction: 6 or 12 mg/kg/h; maintenance 0.5–1.5 mg/kg/h	Besylate	Remifentanil, rocuronium	MEP monitoring by EEG. Successful	Kondo et al. (2020)
Craniotomy	Induction 12 mg/kg/h; maintenance 1 mg/kg/h	Besylate	Remifentanil, fentanyl	Awake when infusion stopped. Successful	Sato et al. (2020)
ECRP	Induction 12 mg/kg/h; maintenance 1 mg/kg/h	Besylate	Remifentanil, rocuronium	High risk: Myotonic dystrophy. Successful	Fukuda et al. (2021)
Cardiac surgery	Induction 6 mg/kg/h; maintenance 0.6–1 mg/kg/h	Besylate	Remifentanil, fentanyl, rocuronium	Cardiopulmonary bypass. Successful	Saito et al. (2021)
Laminoplasty for spinal stenosis	Induction 12 mg/kg/h; maintenance 1 mg/kg/h	Besylate	Rocuronium	Re-sleeping observed after flumazenil reversal	Yamamoto et al. (2021b)
Craniotomy	Induction 6 mg/kg/h; maintenance 0.75–1 mg/kg/h	Besylate	Remifentanil flumazenil	Awakening during surgery with flumazenil. Successful	Yoshida et al., (2021b)
Craniotomy	NA	Besylate	NA	Concerns around pharyngeal reflex, blood pressure, and agitation on flumazenil reversal	Tachibana, Hayamizu and Yamakage, (2021)
Surgery: 1) stent removal and 2) tumor resection	Initially 10 and 13 mg bolus respectively plus additional doses	Besylate	Remifentanil/fentanyl, rocuronium	Reduced effect in long-term benzodiazepine users	Yoshikawa et al. (2021)
Cataract surgery, rigid laryngoscopy, bronchoscopy, intramedullary nailing, and hemiarthroplasty/hip fracture	5–20 mg	Besylate	NA	Reduced impact on neuropsychiatric function compared to existing sedative agents	Henson and Thompson, (2021)
Thyroid surgery	Induction 12 mg/kg/h; maintenance 1 mg/kg/h	Besylate	Remifentanil, rocuronium	Comparable anesthesia to existing drugs for neuromonitoring during thyroid surgery	Hayamizu et al. (2021)
Hand surgery	Induction 6 mg/kg/h	Besylate	Remifentanil, fentanyl, rocuronium	Anaphylaxis to remimazolam	Tsurumi et al. (2021)
MitraClip implantation in a patient with advanced heart failure	Induction 6 mg/kg/h; maintenance 0.15 mg/kg/h	Besylate	Remifentanil, rocuronium	Appropriate anesthetic management in a patient with severe cardiovascular disease	Satoh et al. (2021)
Cochlear implant in a patient with mitochondrial encephalomyopathy	Induction 0.2 mg/kg (1 min); maintenance 1 mg/kg/h	Besylate	Remifentanil	Successful use for general anesthesia in a patient with mitochondrial myopathy	Suzuki, Doi and Nakajima, (2021)