A Case of Decreased Amplitude in Motor Evoked Potentials Under Remimazolam Anesthesia

Abstract

Remimazolam is a newly developed benzodiazepine derivative. Although one case report on the use of remimazolam for motor evoked potential (MEP) monitoring has been reported, there has been no report of changes in the MEP response under remimazolam anesthesia, which is associated with impairment of the corticospinal motor track. This is a case of a 54-year-old woman who was diagnosed with an extradural extramedullary tumor. The patient reported being allergic to chicken eggs. We used remimazolam instead of propofol for anesthesia management. During tumor resection, the amplitudes of MEP responses at the left quadriceps femoris, left tibialis anterior, and left abductor hallucis muscle decreased. The surgery was scaled down and the tumor was removed in a reduced size. The patient had muscle weakness immediately after surgery but eventually recovered. In this case, we could detect changes in MEP response under remimazolam anesthesia, which suggested impairment of the motor tracts during surgery.

Remimazolam: its clinical pharmacology and evolving role in anesthesia and sedation practice

“…In infants, the monitoring of somatosensory-evoked potentials was suboptimal under remimazolam or propofol anesthesia [51]. Additionally, a case report indicated a potential decrease in the amplitude of motor-evoked potentials with remimazolam [52]. Further studies are required to determine whether remimazolam permits the reliable monitoring of evoked potentials.…”