remimazolam + etomidate

Remimazolam + etomidate is a combination of two intravenous anesthetic agents used for the induction and maintenance of general anesthesia or procedural sedation. Remimazolam is an ultra-short-acting benzodiazepine that acts as a positive allosteric modulator at the GABA(A) receptor, enhancing inhibitory neurotransmission in the central nervous system. It is rapidly metabolized by tissue esterases, allowing for quick onset and recovery, and has minimal dependence on hepatic or renal function for clearance[2][3][9]. Etomidate is a non-barbiturate hypnotic agent that also acts primarily through positive allosteric modulation of GABA(A) receptors but binds at a distinct site from benzodiazepines. It provides rapid induction with minimal cardiovascular depression but can cause myoclonus and transient adrenocortical suppression[8][10]. The combination may be used to leverage the rapid onset and hemodynamic stability of both drugs while potentially minimizing individual side effects; however, clinical data on this specific combination are limited to case reports or small studies[4].