case_images: PMC10559696_01
case_images: Time courses of remimazolam effect-site concentration (RzCe, black curve), propofol effect-site concentration (PCe, grey curve), remifentanil effect-site concentration (RfCe, dotted curve), systolic blood pressure ( ), diastolic blood pressure ( ), heart rate ( ), and patient state index (:) in Case 1. Fentanyl 100 microg was administered at time 2 min. To calculate RzCe, we converted the fentanyl effect-site concentrations simulated using the Shafer model
  
   toremifentanil equivalents
  
   using a remifentanil:fentanyl equivalency ratio of 1:1.. OP: start and end of surgery; T: tracheal intubation and extubation; X: start and end of anesthesia.
case_images: 10.1177_2050313X231204574-fig1.jpg
case_images: PMC10559696_01_10.1177_2050313X231204574-fig1.jpg
case_images: fig1-2050313X231204574
case_images: After performing a brachial plexus block, general anesthesia was induced with remimazolam 12 mg/kg/h (Figure 1).
case_images: Raw electroencephalograms before anesthesia induction, after loss of responsiveness, during anesthesia maintenance, and after recovery of responsiveness (Case 2).
case_images: 10.1177_2050313X231204574-fig2.jpg
case_images: PMC10559696_01_10.1177_2050313X231204574-fig2.jpg
case_images: fig2-2050313X231204574
case_images: Alertness and Sedation [MOAA/S]   of <3), and his PSI value decreased from 95 to 39. After confirming MOAA/S <3 and spindle wave EEG (Figure 2), the remimazolam dose was lowered to 1 mg/kg/h, and remifentanil 0.14 microg/kg/min, fentanyl 100 microg, and rocuronium 50 mg were administered. After tracheal intubation, remifentanil was reduced to 0.04 microg/kg/min.
case_images: PMC10559696_02
case_images: Time courses of remimazolam effect-site concentration (RzCe, black curve), propofol effect-site concentration (PCe, gray curve), remifentanil effect-site concentration (RfCe, dotted curve), systolic blood pressure ( ), diastolic blood pressure ( ), heart rate ( ), and patient state index ( ) in Case 2. Remimazolam dose was reduced from 1 to 0.5 mg/kg/h at 13 min, 0.5 to 0.4 mg/kg/h at 17 min, and 0.4 to 0.3 mg/kg/h at 21 min; not all of which are shown in the dosing history on the upper part of this graph. Fentanyl 100 microg was administered at times 2 min and 215 min. To calculate RzCe, we converted the fentanyl effect-site concentrations simulated using the Shafer model
  
   to remifentanil equivalents
  
   using a remifentanil:fentanyl equivalency ratio of 1:1.. OP: start and end of surgery; T: tracheal intubation and extubation; X: start and end of anesthesia.
case_images: 10.1177_2050313X231204574-fig3.jpg
case_images: PMC10559696_02_10.1177_2050313X231204574-fig3.jpg
case_images: fig3-2050313X231204574
case_images: General anesthesia was induced with remimazolam 12 mg/kg/h (Figure 3) and his PSI value decreased from 95 to 42.
case_images: PMC10559696_03
case_images: Time courses of remimazolam effect-site concentration (RzCe, black curve), propofol effect-site concentration (PCe, gray curve), remifentanil effect-site concentration (RfCe, dotted curve), systolic blood pressure ( ), diastolic blood pressure ( ), heart rate ( ), and patient state index ( ) in Case 3. Fentanyl 100 microg was administered for 3 min. To calculate RzCe, we converted the fentanyl effect-site concentrations simulated using the Shafer model
  
   to remifentanil equivalents
  
   using a remifentanil:fentanyl equivalency ratio of 1:1.. OP: start and end of surgery; T: tracheal intubation and extubation; X: start and end of anesthesia.
case_images: 10.1177_2050313X231204574-fig4.jpg
case_images: PMC10559696_03_10.1177_2050313X231204574-fig4.jpg
case_images: fig4-2050313X231204574
case_images: General anesthesia was induced with remimazolam 12 mg/kg/h (Figure 4), and her PSI value decreased from 91 to 50.