Background Remimazolam 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 presentation A 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. Conclusions Remimazolam can be used the same as other existing anesthetics in cardiac surgery with CPB.

Background: Psoriasis vulgaris, a chronic inflammatory skin disease, rarely causes temporomandibular arthritis. We report a case of difficult airway management of a patient with limited range of motion in the temporomandibular joint and cervical extension caused by psoriatic arthritis. Case presentation: A 33-year-old man was scheduled to undergo laparoscopic colectomy. On admission, he was diagnosed with psoriatic arthritis. After induction of general anesthesia, we attempted intubation using Pentax Airway Scope® with a thin intlock blade and using a bronchoscope, but it was impossible because of the limited oral space and mandibular elevation. Because of concerns about cannot intubate, cannot ventilate, we antagonized the neuromuscular block and he emerged from general anesthesia. Finally, we succeeded in awake intubation via the nasal cavity using a bronchoscope under spontaneous respiration. Conclusions: Although psoriasis vulgaris is very rarely associated with temporomandibular arthritis, anesthesiologists should consider that it can cause perioperative difficult airways.

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BackgroundThe aim of this retrospective observational study was to explore the early predictive parameters for maximum amplitude in the kaolin with heparinase (HKH) assay (MA HKH ) of TEG6s Platelet Mapping in cardiovascular surgery including cardiopulmonary bypass (CPB) period. The relationship between each parameter of the assay and laboratory data was also assessed. MethodsWe included the patients who underwent TEG6s Platelet Mapping during cardiovascular surgery under CPB between November 2021 and May 2022. The correlation between MA HKH and the early parameters was assessed. The association between each parameter of Platelet Mapping and a combination of fibrinogen concentration > 150 mg/dL and platelet count > 100,000µL was also evaluated by the receiver operating characteristic (ROC) curve. ResultsIn 23 patients who underwent TEG6s Platelet Mapping during the study period, 62 HKH assay data including 59 pairs of data (HKH assay and laboratory data) were analyzed. K and angle, but not R, were significantly correlated with MA HKH (r [95% CI]: -0.90 [-0.94, -0.83], p < 0.0001 for K, and 0.87 [0.79, 0.92], p < 0.0001 for angle). Furthermore, ROC curves suggested that these parameters predicted a combination of fibrinogen concentration > 150 mg/dL and platelet count > 100,000/µL with high accuracy. Similar results were confirmed in the heparinized blood samples obtained during CPB. ConclusionThese findings suggest that not only MA KHK but also K and angle, which are early parameters in the HKH assay, provide clinically significant information that will facilitate rapid decision-making regarding coagulation strategies during cardiovascular surgery including the CPB period.