Does the Sensitivity of Intravenous Anesthetic of Remimazolam Increase in Patients With Obstructive Jaundice?

Abstract BackgroundIt is well known that obstructive jaundice could affect the pharmacodynamics of some anesthetics, and the sensitivity of some anesthetics would increase among icteric patients. Remimazolam is a new ultra-short-acting intravenous benzodiazepine sedative/anesthetic, which is a high-selective and affinity ligand for the benzodiazepine site on the GABAA receptor. However, very few studies have been reported the pharmacodynamics of remimazolam in patients with obstructive jaundice. We hypothesize that obstructive jaundice affects the pharmacodynamics of remimazolam, and the sensitivity of remimazolam increases among icteric patients.Methods/designThe study will be performed as a prospective, controlled, multicenter trial. The study design is a comparison of remimazolam requirements to reach a Bispectral Index of 50 in patients with obstructive jaundice versus non-jaundiced patients with chronic cholecystitisor intrahepatic bile duct stones. Remimazolam was infused at 0.03 mg/kg/min until this end point was reached.DiscussionRemimazolam could be suitable for anesthesia of patients with obstructive jaundice, because remimazolam is not biotransformed in the liver. Hyperbilirubinemia has been well-described toxic effects in the brain, which causes the increasing of sensitivity to some anesthetics, such as desflurane, isoflurane and etomidate. Furthmore, remimazolam and etomidate have the same mechanism of action when exerting an anesthetic effect. We aim to demonstrate that obstructive jaundice affects the pharmacodynamics of remimazolam, and the dose of remimazolam when administered to patients with obstructive jaundice should be modified.Trial registrationChinese Clinical Trial Registry ChiCTR2100043585. Date of registration: February 23, 2021.