[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-418696-105":59,"doc-detail-418696-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","flumazenil-reversal-of-remimazolam-sedation-during-posterior-spinal-fusion-in-two-adolescents","Flumazenil Reversal of Remimazolam Sedation During Posterior Spinal Fusion in Two Adolescents","","Two adolescent patients underwent posterior spinal fusion (PSF) under total intravenous anesthesia with adjunct remimazolam, and flumazenil was used to reverse remimazolam’s clinical effects. The report highlights remimazolam’s short-acting, tissue-esterase metabolism and the rationale for reversal when timely recovery is needed. In one case, flumazenil enabled an intraoperative wake-up test; in the second, it reversed residual effects to support faster awakening and tracheal extubation. Clinical uses of remimazolam and the role of flumazenil reversal during PSF with neurophysiologic monitoring are reviewed.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/flumazenil-reversal-of-remimazolam-sedation-during-posterior-spinal-fusion-in-two-adolescents/418696/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/flumazenil-reversal-of-remimazolam-sedation-during-posterior-spinal-fusion-in-two-adolescents/418696.png","ImageObject",300,407,{"name":92,"@type":93},"Aria Callaghan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was flumazenil used during posterior spinal fusion in these adolescent cases?","Question",{"text":112,"@type":113},"Flumazenil was used to reverse the clinical effects of remimazolam when reversal was needed to support intraoperative goals and timely recovery, including awakening and extubation.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What was the purpose of reversing remimazolam in the first case?",{"text":117,"@type":113},"Flumazenil reversal in the first case was used to facilitate an intraoperative wake-up test.",{"name":119,"@type":110,"acceptedAnswer":120},"How did flumazenil affect recovery in the second case?",{"text":121,"@type":113},"Flumazenil reversed residual remimazolam effects, helping speed awakening and tracheal extubation at the end of surgery.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},418696,1790718308,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962084926284,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Case Report J Med Cases. 2026;17(1):32-36  \nFlumazenil Reversal of Remimazolam Sedation During Posterior Spinal Fusion in Two Adolescents  \nNikole Leea, Kelly Moona, Joshua C. Uffmana, b, Joseph D. Tobiasa, b, c  \nAbstract  \nRemimazolam is a novel, ester-metabolized benzodiazepine, which received approval by the United States Food and Drug Administration (FDA) for procedural sedation in adults in 2020. Since then, its clinical uses have expanded to intraoperative use both as the primary agent or as an adjunct to general anesthesia. Although its novel route of metabolism through tissue esterases generally results in a rapid resolution of its effects when the infusion is discontinued; in certain clinical scenarios, reversal of its clinical effects may be achieved with flumazenil. We present two clinical cases outlining the use of flumazenil to reverse the effects of remimazolam, which was used as an adjunct to total intravenous anesthesia during posterior spinal fusion (PSF) in two adolescent patients. In our first case, to facilitate an intraoperative wake-up test, the clinical effects of remimazolam were reversed with flumazenil. In the second case, flumazenil reversed the residual effects of remimazolam to speed awakening and tracheal extubation at the completion of the surgical procedure. The clinical uses of remimazolam are reviewed, experience with its use as an adjunct during PSF is discussed, and the clinical role of reversal with flumazenil is presented.  \nKeywords: Remimazolam; Flumazenil; Benzodiazepine; Neurophysiologic monitoring; Wake-up test  \nIntroduction  \nRemimazolam is an ultra-short acting benzodiazepine that, similar to midazolam, provides anxiolysis, amnesia, and sedation through agonism at the γ-aminobutyric acid (GABA)A receptors [1] . Its novel metabolic pathway, through tissue es-  \nManuscript submitted October 7, 2025, accepted December 4, 2025 Published online December 24, 2025  \naDepartment of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA  \nbDepartment of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA  \ncCorresponding Author: Joseph D. Tobias, Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA.  \nEmail: [Joseph.Tobias@Nationwidechildrens.org](Joseph.Tobias@Nationwidechildrens.org)  \ndoi: [https://doi.org/10.14740/jmc5221](https://doi.org/10.14740/jmc5221)  \nterases, results in a shorter half-life and a limited context-sensitive half-time (CSHT) [2-5] . As a benzodiazepine, it shares the advantage that its clinical effects can be reversed by the competitive antagonist, flumazenil, as needed to speed awakening time [6] . Remimazolam was first approved in China in 2019 for sedation during upper gastrointestinal (GI) endoscopy and was subsequently approved in 2020 by the United States Food and Drug Administration (FDA) for procedural sedation in adults [2] .  \nIn addition to its use for procedural sedation, remimazolam has been used as a primary agent or as an adjunct to both volatile and intravenous anesthetic agents during general anesthesia [7-9] . Although remimazolam is not approved by the FDA for use in pediatric patients, there is increasing off-label experience in pediatric patients for various clinical scenarios including general anesthesia during posterior spinal fusion (PSF) with neurophysiologic monitoring [10, 11] . We describe two case studies using remimazolam as part of total intravenous anesthesia (TIVA) for PSF where flumazenil was useful for two clinical indications.  \nThis review was conducted in compliance with the ethical standards of the responsible institution on human subjects as well as with the Helsinki Declaration.  \nCase Reports  \nCase 1  \nThe patient was a 12-year-old, 40.3-kg adolescent with early onset idiopathic scoliosis and no other relevant comorbid conditions, who presented for T2-L4 instrumented PSF. Following premedication wi","cbCaia6vn8eWUBIp","https://ap.wps.com/l/cbCaia6vn8eWUBIp","pdf",301440,"English","# Abstract\n# Introduction\n# Case Reports\n## Case 1\n## Case 2","[{\"question\":\"Why was flumazenil used during posterior spinal fusion in these adolescent cases?\",\"answer\":\"Flumazenil was used to reverse the clinical effects of remimazolam when reversal was needed to support intraoperative goals and timely recovery, including awakening and extubation.\"},{\"question\":\"What was the purpose of reversing remimazolam in the first case?\",\"answer\":\"Flumazenil reversal in the first case was used to facilitate an intraoperative wake-up test.\"},{\"question\":\"How did flumazenil affect recovery in the second case?\",\"answer\":\"Flumazenil reversed residual remimazolam effects, helping speed awakening and tracheal extubation at the end of surgery.\"}]","Flumazenil Reversal of Remimazolam Sedation During Posterior Spinal Fusion in Two Adolescents | PDF",1790613980,13]