Remimazolam is a novel ultrashort-acting benzodiazepine that produces sedation by acting as a positive allosteric modulator of the gamma-amino butyric acid-A receptor. Its high water solubility and metabolism via tissue esterases allow for a rapid onset of sedation/anesthesia and prompt arousal despite prolonged use. In addition, the effects of remimazolam can be reversed with flumazenil. This narrative review discusses the role of remimazolam in patients undergoing neurosurgical and neuroradiological procedures, specifically its role during awake craniotomies and compatibility with neuromonitoring. Considerations for remimazolam use in patients with neurological diseases are also highlighted. In addition, the impact of remimazolam on postoperative excitation, risk for postoperative delirium, and delayed neurocognitive recovery are discussed. Although there seems to be a clinical promise for remimazolam based on limited case studies and our own institutional experience of its use, further clinical investigation is warranted to understand the potential impact of remimazolam on surgical and neurological outcomes.

中文翻译：

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Remimazolam 在神经外科和神经系统疾病患者中的作用：叙述性回顾。

Remimazolam 是一种新型超短效苯二氮卓类药物，通过作为 γ-氨基丁酸-A 受体的正变构调节剂产生镇静作用。它的高水溶性和通过组织酯酶的新陈代谢允许快速起效的镇静/麻醉和迅速唤醒，尽管长时间使用。此外，氟马西尼可以逆转瑞马唑仑的作用。这篇叙述性综述讨论了瑞马唑仑在接受神经外科和神经放射学手术的患者中的作用，特别是它在清醒开颅手术中的作用以及与神经监测的相容性。还强调了在神经系统疾病患者中使用瑞马唑仑的注意事项。此外，还讨论了瑞马唑仑对术后兴奋、术后谵妄风险和神经认知恢复延迟的影响。