LAUSR

I read with great interest the article “Re‐sleeping after rever‐ sal of remimazolam by flumazenil” by Yamamoto et al. [1]. I think that this report is important, because rare phenomena only appear after a large amount of the new drug is used. I believe, however, that several issues need to be discussed. First, what are mechanisms of re‐sedation caused by remi‐ mazolam? The authors provide little information about the case. Remimazolam package insert says “half‐life is pro‐ longed with increasing severity of hepatic impairment”. I think that the following information would be useful for the readers, perioperative opioids usage, patient’s past history including liver/kidney functions, sedation score and respira‐ tory rate when the patient was under re‐sedation. Second, the authors used flumazenil 0.5 mg immediately after remi‐ mazolam cessation. Why did the authors select the timing and dosage of flumazenil? The authors state that “all recom‐ mended dosages are used”. There is, however, no recommen‐ dation dosage about flumazenil [2]. Third, the authors seem to be confused about drug half‐life. CSHT is defined as “the time required for the plasma drug concentration to decline by 50% after terminating each infusion” [3]. Although elimi‐ nation half‐life of remimazolam is about 40 min, CSHT is less than 10 min [4]. Acknowledgements None.