Abstract
BackgroundRemimazolam has less cardiovascular depressant effects than propofol in non-cardiac surgical patients. However, the efficacy and safety of remimazolam in cardiac surgery with cardiopulmonary bypass (CPB) have not been reported. We present a case of successful anesthetic management using remimazolam in cardiac surgery with CPB.Case presentationA 76-year-old female was scheduled for mitral valve repair, tricuspid annuloplasty, maze procedure, and left atrial appendage closure. We used remimazolam in induction (6.0 mg/kg/h) and maintenance (0.6–1.0 mg/kg/h) of general anesthesia, and the bispectral index value was maintained in the range of 36 to 48 including the period of CPB. Hemodynamics, mixed venous oxygen saturation, and bilateral regional cerebral oxygen saturation were maintained within acceptable ranges. There was no intraoperative awareness/recall or serious complications associated with remimazolam throughout the perioperative period.ConclusionsRemimazolam can be used the same as other existing anesthetics in cardiac surgery with CPB.
Highlights
Remimazolam has less cardiovascular depressant effects than propofol in non-cardiac surgical patients
Remimazolam is effective as propofol for induction and maintenance of general anesthesia [2]
It has been reported that benzodiazepine sedatives have less cardiovascular depressant effects in cardiac surgery [3] and that flumazenil can antagonize the action of benzodiazepine sedatives [4]
Summary
Remimazolam is a new ultra-short-acting benzodiazepine sedative, and its simulated context-sensitive half-time after infusion for 4 h is 6.8 ± 2.4 min [1]. Patients undergoing cardiac surgery are vulnerable to hemodynamic instability such as hypotension, especially during the induction of anesthesia, and anesthesiologists should administer anesthetic agents carefully to avoid cardiovascular depressant effects. Considering its advantage of less cardiovascular depressant effect, In this case report, we present a case in which remimazolam was used in cardiac surgery with CPB. A 76-year-old female (height, 155 cm; weight, 59.6 kg) had chronic heart failure with severe mitral regurgitation (MR), mild tricuspid regurgitation (TR), and chronical atrial fibrillation Her comorbidities included hypertension and old cerebral infarction at the right medulla oblongata. Remimazolam was adjusted by 0.6–1.0 mg/kg/h according to the BIS value until the end of the surgery, and the depth of sedation was stable when the BIS value ranged from 30 to 50, even in the period of undergoing CPB. We did not antagonize remimazolam with flumazenil because of the
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
