{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:21:51Z","timestamp":1792603311908,"version":"4.5.0"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T00:00:00Z","timestamp":1652832000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>To analyze the cause of prolonged recovery from general anesthesia with remimazolam.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We studied 65 patients under general anesthesia with remimazolam. According to time to extubation, patients were divided into short period (SP) (n = 34, &lt; 15 min) and long period (LP) (n = 31, \u2265 15 min) groups. Variables affecting time to extubation such as age, sex, height, body weight, body mass index (BMI), plasma albumin concentration, ASA class, duration of surgery, and total duration of general anesthesia, and total dose of remimazolam were compared between SP and LP groups. At the end of remimazolam infusion and upon extubation, predictive remimazolam concentrations were calculated using pharmacokinetic\/pharmacodynamic three compartment modeling.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>LP group showed significantly higher BMI, older age, and lower plasma albumin concentration compared with those of SP group. Logistic regression analysis showed that the probability of time to extubation of \u2265 15 min was higher in patients with BMI greater than 22.0 kg\/m<jats:sup>2<\/jats:sup> (AUC 0.668, 95% CI 0.533\u20120.803), ages older than 79.0 years (AUC 0.662, 95% CI 0.526\u20120.798), and plasma albumin concentrations lower than 3.60 g\/dl (AUC 0.720, 95% CI 0.593\u20120.847). LP group showed significantly lower predicted remimazolam concentration than SP group upon extubation despite no difference in concentration between both groups at the end of infusion. Pharmacological analysis estimates that LP group is more sensitive to remimazolam than SP group through amplified responses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Lower remimazolam doses should be considered for the overweight patients, elderly, and those with lower plasma albumin concentration.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0268568","type":"journal-article","created":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T17:31:24Z","timestamp":1652895084000},"page":"e0268568","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":46,"title":["Factors affecting prolonged time to extubation in patients given remimazolam"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3355-0661","authenticated-orcid":true,"given":"Yoko","family":"Shimamoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiyoshi","family":"Sanuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeaki","family":"Kurita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaya","family":"Ueki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshie","family":"Kuwahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayumu","family":"Matsumoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,5,18]]},"reference":[{"key":"pone.0268568.ref001","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/01.anes.0000267503.85085.c0","article-title":"CNS 7056: a novel ultra-short-acting benzodiazepine","volume":"107","author":"GJ Kilpatrick","year":"2007","journal-title":"Anesthesiology"},{"key":"pone.0268568.ref002","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1213\/ANE.0b013e31823f0c28","article-title":"A placebo- and midazolam-controlled phase I single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamics of remimazolam (CNS 7056): Part I. Safety, efficacy, and basic pharmacokinetics","volume":"115","author":"LJ Antonik","year":"2012","journal-title":"Anesth Analg"},{"key":"pone.0268568.ref003","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1097\/ALN.0000000000003103","article-title":"Pharmacokinetics and pharmacodynamics of remimazolam (CNS 7056) after continusous infusion in healthy male volunteers; part 1. Pharmacokinetics and clinical pharmacodynamics","volume":"132","author":"J Sch\u00fcttler","year":"2020","journal-title":"Anesthesiology"},{"key":"pone.0268568.ref004","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1007\/s00540-021-02915-x","article-title":"Re\u2012sleeping after reversal of remimazolam by flumazenil","volume":"35","author":"T Yamamoto","year":"2021","journal-title":"J Anesth"},{"key":"pone.0268568.ref005","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1213\/ANE.0b013e3181b5dcb7","article-title":"Statistical modeling of average and variability of time to extubation for meta-analysis comparing desflurane to sevoflurane","volume":"110","author":"F Dexter","year":"2010","journal-title":"Anesth Analg"},{"key":"pone.0268568.ref006","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1213\/ANE.0b013e3181d58052","article-title":"Meta-analysis of average and variability of time to extubation comparing isoflurane with desflurane or isoflurane with sevoflurane","volume":"110","author":"A Agoliati","year":"2010","journal-title":"Anesth Analg"},{"key":"pone.0268568.ref007","doi-asserted-by":"crossref","first-page":"860","DOI":"10.2199\/jjsca.34.860","article-title":"Remimazolam","volume":"34","author":"M Doi","year":"2014","journal-title":"J Jpn Soc Clin Anesth"},{"key":"pone.0268568.ref008","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the freely available easy\u2012to\u2012use software \u2018EZR\u2019 for medical statistics","volume":"48","author":"Y. Kanda","year":"2013","journal-title":"Bone Marrow Transplant"},{"key":"pone.0268568.ref009","doi-asserted-by":"crossref","first-page":"109899","DOI":"10.1016\/j.jclinane.2020.109899","article-title":"Population pharmacokinetic \/ pharmacodynamic modeling for remimazolam in the induction and maintenance of general anesthesia in healthy subjects and in surgical subjects","volume":"66","author":"J Zhou","year":"2020","journal-title":"J Clin Anesth"},{"key":"pone.0268568.ref010","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1097\/00000542-199809000-00002","article-title":"Does size matter?","volume":"89","author":"T Bouillon","year":"1998","journal-title":"Anesthesiology"},{"key":"pone.0268568.ref011","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/S0009-9236(98)90106-0","article-title":"Pharmacokinetics and the pharmacodynamic action of midazolam in young and elderly patients undergoing tooth extraction","volume":"63","author":"HP Platten","year":"1998","journal-title":"Clin Pharmacol Ther"},{"key":"pone.0268568.ref012","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1046\/j.1365-2125.2003.01964.x","article-title":"Modelling acute tolerance to the EEG effect of two benzodiazepines","volume":"57","author":"H Ihmsen","year":"2004","journal-title":"Br J Clin Pharmacol"},{"key":"pone.0268568.ref013","first-page":"1317","article-title":"Alprazolam in young and elderly men: sensitivity and tolerance to psychomotor, sedative and memory effects","volume":"281","author":"RJ Bertz","year":"1997","journal-title":"J Pharmacol Exp Ther"},{"key":"pone.0268568.ref014","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1093\/bja\/aen251","article-title":"Effects of age and gender on intravenous midazolam premedication: a randomized double-blind study","volume":"101","author":"G-C Sun","year":"2008","journal-title":"Br J Anaesth"},{"key":"pone.0268568.ref015","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1002\/jcph.1552","article-title":"Time-to-Event Modeling for Remimazolam for the Indication of Induction and Maintenance of General Anesthesia","volume":"60","author":"LL Lohmer","year":"2020","journal-title":"J Clin Pharmacol"},{"key":"pone.0268568.ref016","unstructured":"US Food and Drug Administration [Internet]. Byfavo: Highlights of prescribing information. [cited 2020 July 2]. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/nda\/2020\/212295Orig1s000lbl.pdf."},{"key":"pone.0268568.ref017","doi-asserted-by":"crossref","first-page":"690875","DOI":"10.3389\/fphar.2021.690875","article-title":"Remimazolam: Non-Clinical and Clinical Profile of a New Sedative\/Anesthetic Agent","volume":"12","author":"GJ Kilpatrick","year":"2021","journal-title":"Front Pharmacol"},{"key":"pone.0268568.ref018","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1213\/ANE.0000000000002732","article-title":"Sources of Variation in Anesthetic Drug Costs","volume":"126","author":"JP Wanderer","year":"2018","journal-title":"Anesth Analg"},{"key":"pone.0268568.ref019","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1097\/00000542-200006000-00017","article-title":"Response surface model for anesthetic drug interactions","volume":"92","author":"CF Minto","year":"2000","journal-title":"Anesthesiology"},{"key":"pone.0268568.ref020","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1213\/00000539-198908000-00013","article-title":"Midazolam\u2012alfentanil synergism for anesthetic induction in patients","volume":"69","author":"HR Vinik","year":"1989","journal-title":"Anesth Analg"},{"key":"pone.0268568.ref021","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.ejphar.2007.11.011","article-title":"Opioid receptors are involved in the sedative and antinociceptive effects of hesperidin as well as in its potentiation with benzodiazepines","volume":"580","author":"LM Loscalzo","year":"2008","journal-title":"Eur J Pharmacol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0268568","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T17:31:39Z","timestamp":1652895099000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0268568"}},"subtitle":[],"editor":[{"given":"Ehab","family":"Farag","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,5,18]]},"references-count":21,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0268568","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,18]]}}}