A pharmacokinetic reconstruction is not a direct concentration measurement.
What the study found
A case report described persistent hiccups during remimazolam anesthesia, becoming apparent after muscle relaxation waned and stopping when the anesthetic was discontinued. The authors retrospectively simulated blood concentrations to explore their hypothesis.
Visibility and cause must be distinguished
The patient was undergoing corneal transplantation. Hiccups became visible after the effects of neuromuscular blockade waned, persisted despite interventions and stopped when remimazolam was discontinued. Muscle relaxation can conceal a movement without identifying its origin. The concentration curve added afterward was generated from a pharmacokinetic model; it was not a laboratory assay of the patient’s blood during each event.
Limits of interpretation
No controlled comparison isolated remimazolam, and the model could not establish the patient’s actual concentration. Neuromuscular blockade can affect visibility of movements without resolving their cause.
Implications for case review
Separate symptom observation, drug timing and modeled exposure. The case supports considering a possible adverse effect but does not define a hiccup threshold. An individual causation opinion needs competing causes and the full anesthetic record rather than treating a predicted curve as measured toxicology.
Source and related reading
Source: PMC11126544, supplied full-text paper. Findings are paraphrased; forensic implications are an interpretation.
Related: Benzodiazepine Driving Concentrations Were Estimated Rather Than Measured in an Exploratory Study.
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