{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T11:57:23Z","timestamp":1790510243860,"version":"4.1.0"},"reference-count":10,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,4,2]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:p>Remimazolam besylate is an ultra-short-acting benzodiazepine derivative recently approved in Japan for general anaesthesia. However, less attention has been paid to the compatibility of remimazolam with infusion solutions, and the mechanism underlying the incompatibility remains unknown. The patient was a 65-year-old man who underwent a high tibial osteotomy. After the induction of general anaesthesia using remimazolam solution (5\u2009mg\/mL), we noticed precipitate completely blocking the lumen of the intravenous tube connected to a Ringer\u2019s acetate Physio140 drip. The mixture of remimazolam solution (5\u2009mg\/mL) with Physio140 solution immediately resulted in the formation of substantial precipitate. Nuclear magnetic resonance analysis revealed that the precipitate was remimazolam. Ultraviolet spectrophotometry revealed that the mixture of remimazolam solution with higher ratios of Physio140 resulted in significantly lower solubility, concomitant with an increase in pH. It would be important to consider the remimazolam concentration and infusion solution pH to avoid the production of precipitates.<\/jats:p>","DOI":"10.1136\/bcr-2021-241622","type":"journal-article","created":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T13:20:52Z","timestamp":1618492852000},"page":"e241622","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Incompatibility of remimazolam besylate with Ringer\u2019s acetate infusion resulting in total occlusion of an intravenous catheter"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9041-9590","authenticated-orcid":false,"given":"Mitsuhiro","family":"Matsuo","sequence":"first","affiliation":[{"name":"Anesthesiology, University of Toyama Faculty of Medicine Graduate School of Medicine and Pharmaceutical Science for Education, Toyama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kotaro","family":"Okada","sequence":"additional","affiliation":[{"name":"Laboratory of Pharmaceutical Technology, University of Toyama Faculty of Medicine Graduate School of Medicine and Pharmaceutical Science for Education, Toyama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Onuki","sequence":"additional","affiliation":[{"name":"Laboratory of Pharmaceutical Technology, University of Toyama Faculty of Medicine Graduate School of Medicine and Pharmaceutical Science for Education, Toyama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuaki","family":"Yamazaki","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of Toyama Faculty of Medicine Graduate School of Medicine and Pharmaceutical Science for Education, Toyama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,4,15]]},"reference":[{"key":"2025082710574582000_14.4.e241622.1","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1007\/s00540-020-02755-1","article-title":"Remimazolam besilate, a benzodiazepine, has been Approved for general anesthesia!!","volume":"34","author":"Masui","year":"2020","journal-title":"J Anesth"},{"key":"2025082710574582000_14.4.e241622.2","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/j.clinthera.2020.02.006","article-title":"Psychomotor recovery following remimazolam-induced sedation and the effectiveness of flumazenil as an antidote","volume":"42","author":"Chen","year":"2020","journal-title":"Clin Ther"},{"key":"2025082710574582000_14.4.e241622.3","unstructured":"Mundipharma KK . Anerem\u00ae 50 mg for IV injection, Package insert, 2nd version. Tokyo: 2020 (in Japanese). Available: https:\/\/mundipharma.co.jp\/medical-assets\/anerem\/anerem-pi.pdf [Accessed 28 Mar 2021]."},{"key":"2025082710574582000_14.4.e241622.4","unstructured":"Tilbrook GS , Schumacher A , Emmenegger R . United States patent 9512078 B2.."},{"key":"2025082710574582000_14.4.e241622.5","unstructured":"Mundipharma KK . Anerem\u00ae 50 mg for IV injection, interview form, 2nd version. Tokyo: 2020 (in Japanese). Available: https:\/\/mundipharma.co.jp\/medical-assets\/anerem\/anerem-if.pdf [Accessed 28 Mar 2021]."},{"key":"2025082710574582000_14.4.e241622.6","first-page":"1449","article-title":"Factors affecting diazepam infusion: solubility, administration-set composition, and flow rate","volume":"38","author":"Mason","year":"1981","journal-title":"Am J Hosp Pharm"},{"key":"2025082710574582000_14.4.e241622.7","doi-asserted-by":"publisher","DOI":"10.1016\/0731-7085(91)80246-6"},{"key":"2025082710574582000_14.4.e241622.8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s40780-014-0009-9","article-title":"Supersaturated state of diazepam injection following dilution with infusion fluid","volume":"1","author":"Onuki","year":"2015","journal-title":"J Pharm Health Care Sci"},{"key":"2025082710574582000_14.4.e241622.9","doi-asserted-by":"crossref","first-page":"e87","DOI":"10.1016\/j.bja.2020.11.021","article-title":"Ringer's acetate solution-induced precipitation of remimazolam","volume":"126","author":"Sasaki","year":"2021","journal-title":"Br J Anaesth"},{"key":"2025082710574582000_14.4.e241622.10","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-3080"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-241622","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:57:55Z","timestamp":1756317475000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-241622"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":10,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,15]]},"published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1136\/bcr-2021-241622"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-241622","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4]]}}}