BYFAVO (remimazolam)(Information obtained and shared from product website https://byfavo.com/ )

Byfavo®: A Short-Acting Sedative for Procedures 30 Minutes or Less

 

Rapid Onset of Action

Onset of sedative effects of 1.0-1.5 minutes1,* and median time to peak sedation was 3.0-3.5 minutes after initial 5 mg dose.2

 

Rapid Offset of Action

Median time to fully alert was 11.0-14.0 minutes following last dose.2

 

Rapidly Metabolized

CYP450-independent metabolism with no active metabolite resulting in a terminal half-life of 37-53 minutes.2

The soft drug approach is a strategy where compounds are specifically designed to be vulnerable to rapid biotransformation into inactive metabolites.3,5

Mechanism of Action

Byfavo is a benzodiazepine. Like other benzodiazepines, Byfavo binds to GABAA receptors in the brain, while its carboxylic acid metabolite (CNS7054) has a 300 times lower affinity for the receptor. Byfavo, like other benzodiazepines, did not show clear selectivity between subtypes of the GABAA receptor.2

Soft, Ester-Based Drug Design

Remimazolam was derived from midazolam.3 The molecular structure of remimazolam differs from midazolam, and all other benzodiazepines, due to the addition of the carboxylic ester linkage.4 The addition of a carboxylic ester linkage creates a “soft drug.”5 The soft drug approach is a strategy where compounds are specifically designed to be vulnerable to rapid biotransformation into inactive metabolites.3,5 This approach was used for the development of remifentanil, a nonhepatically metabolized fentanyl derivative.5,6

byfavo success rate table

Characteristic Benzodiazepine Safety Profile

Established Safety in a Diverse Range of Adult Patients Across 3 Clinical Trials

Common Adverse Reactions Occurring at >2% in Any Treatment Group

Data reflect exposure to Byfavo in 630 ASA I-IV patients pooled from the three placebo-controlled Phase 3 studies.1

 The most common adverse reactions (>10%) in patients receiving Byfavo for procedural sedation were hypotension, hypertension, diastolic hypertension, systolic hypertension, hypoxia, and diastolic hypotension1

Patients receiving Byfavo experienced less hypotension than those receiving placebo with midazolam1

 

https://byfavo.com/dosing-and-administration/

Airway Adjuncts

Airway adjuncts are a class of equipment designed to assist practitioners maintain a patent airway during sedation and or emergency situations.  Nomenclature exists to help distinguish between the different types. There are simple upper airway devices, supraglottic airway aids, and infraglottic airway aids, and endotracheal tubes as well as aids to secure the airway with an endotracheal tube. While there is a range of products to choose from, they all require some understanding, practice, and experience that is essential to gain prior to employing in an emergency or urgent situation. The DSTAR sedation course covers these airway tools and you can practice using them in the live in person sessions.

 The DSTAR sedation course covers these airway tools and you can practice using them in the live in person sessions.

Simple Upper Airway Devices

Simple upper airway adjuncts are utilized to help maintain a patent airway, providing unobstructed air flow to the lungs, either via spontaneous ventilation or Bag Valve Mask ventilation (BVM). Often used as rescue techniques/devices when unable to intubate with standard techniques and difficult to mask ventilate. The two most common and familiar are the Oral Airway (OA) and the Nasal Airway or nasal trumpet. They basically work by stenting open the obstruction in the upper airway which invariably occurs with a reduced level of consciousness, unconsciousness, and general anesthesia, when the base of the tongue falls backwards against the posterior pharyngeal wall in the supine patient.  Oropharyngeal airway placement requires absent gag reflex while Nasopharyngeal airway may be used with an intact gag reflex.

The standard oral or oropharyngeal airways are rigid plastic tubes which are shaped according to the outline of the hard and soft palate as well as the tongue. They have a flange that should rest against the patient’s lips and prevent the device from being inserted too deeply into the mouth. Most manufacturers adhere to a standardized color-coding system of sizes. The typical adult sizes are green (80mm), yellow (90mm), and red (100mm) by increasing size. and treatment planning.