Background Remimazolam is an intravenous ultra-short-acting benzodiazepine with the benefit of hemodynamic stability, including blood pressure and pulse rate. We report a case in which remimazolam was used in living donor liver transplantation with stable hemodynamics. Case presentation A 19-year-old woman underwent living donor liver transplantation due to end-stage liver disease, which is associated with a hyperdynamic state and hemodynamic instability. The patient’s sister had a history of malignant hyperthermia, so we chose total intravenous anesthesia with remimazolam. Intraoperative bleeding of seven liters occurred, but she had mild intraoperative blood pressure changes, and continuous catecholamine administration was not necessary. The patient had no memories or discomfort during the surgery. Conclusions We maintained stable hemodynamics using remimazolam for anesthetic management of a patient undergoing a liver transplantation, which is characterized by a hyperdynamic state and circulatory instability.

Background There is no standardized storage temperature of whole blood for acute normovolemic hemodilution (ANH). Study Design and Methods We conducted a prospective observational study to examine the difference in platelet function between short‐term whole blood storage at 4 and 22°C. Venous blood (40 ml) was collected from seven healthy subjects who gave prior written consent. The samples were divided into three groups: before storage (group Pre), cold (4°C) storage (group C), and room temperature (22°C) storage (group R). Groups C and R were tested after 6 h of blood storage. Platelet aggregability, platelet factor 4 (PF4), β‐thromboglobulin (β‐TG), P‐selectin expression, pH, PO2, PCO2, glucose, lactate, blood count, and thromboelastography (TEG) parameters were measured. The percentage change in each parameter in groups C and R was calculated using the value in group Pre as a reference. These data were then compared between groups C and R using a Wilcoxon matched pairs test. p < 0.05 was considered to be statistically significant. Results Compared with group R, group C showed significantly higher platelet aggregability with adenosine diphosphate (ADP) 2, 4, and 6 μM (all p = 0.016) and collagen 1 μg/ml (p = 0.047) stimulation, and significantly lower PF4 and β‐TG elevation (both p = 0.031), glucose consumption (p = 0.031), and lactate production (p = 0.016). The ADP channel in TEG showed a significant increase in platelet aggregation rate in group C compared to group R. Discussion Cold storage of whole blood in ANH may provide improved storage conditions for platelets and contribute to improved hemostasis compared to room temperature storage.