Single-Agent Total Intravenous Anesthesia With Remimazolam for an Elderly Man Undergoing Ambulatory Oral Surgery: A Case Report

Remimazolam is an ultrashort-acting benzodiazepine approved for procedural sedation in 2020 by the US Food and Drug Administration; however, dosing information originating from the US is limited. No existing literature details infusion rates of remimazolam delivered by manually adjusted infusion pumps. This case report describes the administration of manually infused remimazolam to an 86-year-old man for the surgical extraction of third molars under procedural sedation. Following an initial dose of 4 mg delivered over 1 minute, the remimazolam infusion was titrated according to the patient's response from a starting rate of 15 mg/h to achieve deep sedation/general anesthesia. The maximum infusion rate was 30 mg/h, and a total dose of 14.1 mg of remimazolam was administered over 28 minutes. The surgery was successfully completed, the patient was satisfied with the anesthetic postoperatively, and he recovered and was discharged home without incident. Further studies are needed to fully characterize remimazolam infusions for a variety of patients using manually adjusted infusion pumps for use in the US.