• Kazuhiro Shirozu, Keiko Nobukuni, Shota Tsumura, Kazuya Imura, Kosuke Nakashima, Shinnosuke Takamori, Midoriko Higashi, and Ken Yamaura.
• Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. shirozu.kazuhiro.334@m.kyushu-u.ac.jp.
• J Anesth. 2022 Apr 1; 36 (2): 194-200.

BackgroundThe bispectral index (BIS) value during general anesthesia with the newly developed anesthetic remimazolam is reported to be relatively high; however, the reason for this and the appropriate indicator for assessing the sedation level during remimazolam anesthesia have not been determined. In this study, the level of sedation during general anesthesia with remimazolam was evaluated using several different indicators.MethodsThirty patients who underwent breast surgery under general anesthesia with remimazolam were included. BIS®, Sedline® and the pupil resting diameters were measured simultaneously. The intraoperative dose of remimazolam was adjusted to obtain a BIS in the range of 40-60; if a BIS < 60 could not be achieved, the intraoperative dose was increased up to the maximal dose of 2 mg/kg/h.ResultsThe mean intraoperative BIS and patient state index (PSI) in all patients was 50.6 ± 9.1 and 43.0 ± 11.8, respectively. Five patients showed a mean intraoperative BIS > 60 and eight patients showed mean intraoperative PSI > 50. The mean intraoperative spectral edge frequency (SEF) of BIS® or Sedline® was 15.3 ± 2.5 Hz or 10.6 ± 3.0 Hz, each. The mean intraoperative resting pupil diameter was 1.7 ± 0.2 mm. There were no patients with awareness during anesthesia.ConclusionsProcessed electroencephalograms (BIS and PSI), and SEF of BIS® were relatively high during anesthesia with remimazolam, but SEF of Sedline® or pupillary diameter could be a supportive indicator to confirm sedation level during remimazolam anesthesia.© 2021. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.

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