Three cases of difficulty in achieving definitive loss of consciousness with remimazolam

Background Remimazolam is a novel, ultra-short-acting benzodiazepine used for general anesthesia. Because remimazolam is an emerging drug, the tolerance to remimazolam in benzodiazepine-taking patients has been unclear. Also, the efficacy of remimazolam in different races is not fully elucidated so far. Case presentation Here we experienced three cases in which high dose of remimazolam was needed for attempting to achieve appropriate anesthetic depth. Two of the three cases were of preoperatively benzodiazepine-taking patients. The other was a case of a Chinese patient. In all three cases, conversion to general anesthesia with propofol was necessitated. Conclusions When signs of inadequate sedative effect of remimazolam are observed in patients of benzodiazepine users or of different races, conversion to another sedative agent such as propofol should be considered.

Can changes in skin impedance be used to monitor sedation after midazolam and during recovery from anesthesia?

It has been suggested that sympathetic activity, measured as changes in electrical skin impedance (SI), can be used to assess the adequacy of general anesthesia. Our prospective study investigated if measurements of skin impedance can determine levels of sedation induced by midazolam. Twenty-seven patients scheduled for arthroscopy requiring general anesthesia were served as their own control. These were blinded to the order of injections by telling them that they will be randomly administered a placebo (saline) or sedative agent. A DM 3900 multimeter was used for SI measurements. The degree of sedation was measured using the modified Observer’s Assessment of Alertness and Sedation (mOAAS) scale. Resting SI values were noted, and all participants were then administered the placebo followed 5 min later by midazolam 2 mg i.v. Five min after that, patients were administered standard general anesthesia with propofol, oxygen, nitrous oxide 60 %, and isoflurane 1 MAC via a laryngeal mask, and sufentanil 5 – 10 µg. SI significantly increased after administration of midazolam and induction of anesthesia. There were no significant differences between pre-administration (baseline) and placebo and end of surgery and end of anesthesia with closed eyes. There were highly significant differences (p<0.001) between pre-administration vs. midazolam, placebo vs. midazolam, pre-administration vs. induction of anesthesia. We found slight correlation between mOAAS and SI. There were no significant changes between the end of surgery and the end of anesthesia with closed eyes, but SI significantly decreased (p<0.01) after eyes opened.

A REVIEW ON POTENTIAL BIOACTIVE CHEMICAL FROM RAUWOLFIA SERPENTINA: RESERPINE

The drug Rauwolfia serpentina is known to Indian system of medicine since last many centuries. Because of snake like shape of drug, it has been known as sarpgandha. Although Rauwolfia serpentina contain more than 50 alkaloids but Reserpine is the principal alkaloid of Rauwolfia serpentina. Reserpine has a success application in antihypertensive even at a smaller dose. Rhizomes of Rauwolfia serpentine also have hepatoprotective activity including antihypertensive, hepatoprotective, Rauwolfia serpentina have many other medicinal uses like: Antidiahoerreal, antipsychotic, sedative, anticancer (in breast) etc. Although Rauwolfia serpentina contains major four Indole alkaloids but main object of this context is to provide knowledge about the main active alkaloid Reserpine, having more concentration in the root of plant, play a major role in antihypertensive activity of Rauwolfia serpentina. A much lesser dose of Reserpine is required to provide an antihypertensive effect otherwise it can cause some serious adverse effect like- lethargy, sedation, psychiatric depression, hypotension, nausea, bradycardia, bronchospasm and withdrawal psychosis. Because of its potent activity Reserpine is still used as antihypertensive and sedative agent.

Sedation Characteristics of Intranasal Alfaxalone in Adult Yucatan Swine

Compared with intravenous and intramuscular methods, intranasal administration of sedatives is a less invasive and nonpainful technique. In this prospective, randomized, crossover study, we evaluated the sedative characteristics of 2 doses(1 and 2 mg/kg) of alfaxalone administered intranasally to 7 adult Yucatan swine. We compared sedation scores before andafter administration of alfaxalone and between groups by using a composite sedation scoring system (range, 0 to 12, with12 being the highest level of sedation)). Pigs were randomly assigned to receive 2 doses of intranasal alfaxalone (1 mg/kg[A1]); 2 mg/kg [A2]) as 2 separate events in a crossover design with a 60-d washout period. Categories scored were posture,palpebral droop, uninhibited behavior, drowsiness, and acceptance of anesthetic facemask. Sedation scores were collected before sedation was administered and then every 3 min for 30 min afterward. Instilled volumes (mean ± 1 SD) were 5.7 ± 0.5 and 11.3 ± 0.8 mL for A1 and A2, respectively. Both alfaxalone doses produced significant increases in sedation scores compared with baseline. Median sedation scores for A1 (6; range, 4–12) were not different from those for A2 (6; range, 6 to 12). Intranasal administration of alfaxalone as the sole sedative agent increased sedation scores from baseline, achieving peak sedation at 6 to 9 min after instillation of A2. However, sedation scores were similar between the 2 groups, and neither dose produced sufficient sedation to facilitate handling or the performance of any clinical procedures. Given the concentration of alfaxalone solution currently available, volume is the major limiting factor regarding testing higher doses of this drug for its use as a sole sedative agent in swine.