Anaesthetic management using remimazolam in a patient with severe aortic stenosis: a case report

Furuta, Minako; Ito, Hisakatsu; Yamazaki, Mitsuaki

doi:10.1186/s12871-021-01422-6

Cited by 29 publications

(26 citation statements)

References 17 publications

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“…The most common cardiovascular events in the present study were hypotension and tachycardia, and no significant differences were observed between the two groups. Studies have shown that remimazolam besylate was expected to be relatively safe with regard to potential risks of cardiovascular depression complications [11 , 12] .…”

Section: Discussionmentioning

confidence: 99%

Remimazolam besylate versus propofol for long-term sedation during invasive mechanical ventilation: a pilot study

Tang

Yang

et al. 2022

Crit Care

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Objective The aim of this study was to evaluate the efficacy and safety of remimazolam besylate compared with propofol in maintaining mild-to-moderate sedation in patients receiving long-term mechanical ventilation. Methods In this single-centered randomized pilot study, adult patients mechanically ventilated longer than 24 h were randomized to receive remimazolam besylate or propofol. The target sedation range was − 3 to 0 on the Richmond Agitation and Sedation Scale (RASS). The primary outcome was the percentage of time in the target sedation range without rescue sedation. The secondary outcomes were ventilator-free days at day 7, the length of ICU stay and 28-day mortality. Results Thirty patients were assigned to each group. No difference was identified between the remimazolam group and propofol group in median age [60.0 (IQR, 51.5–66.3) years vs. 64.0 (IQR, 55.0–69.3) years, respectively, p = 0.437] or the median duration of study drug infusion [55.0 (IQR, 28.3–102.0) hours vs. 41.0 (IQR, 24.8–74.3) hours, respectively, p = 0.255]. The median percentage of time in the target RASS range without rescue sedation was similar in remimazolam and propofol groups [73.2% (IQR, 41.5–97.3%) vs. 82.8% (IQR, 65.6–100%), p = 0.269]. No differences were identified between the two groups in terms of ventilator-free days at day 7, length of ICU stay, 28-day mortality or adverse events. Conclusions This pilot study suggested that remimazolam besylate was effective and safe for long-term sedation in mechanically ventilated patients compared with propofol.

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Section: Discussionmentioning

confidence: 99%

Remimazolam besylate versus propofol for long-term sedation during invasive mechanical ventilation: a pilot study

Tang

Yang

et al. 2022

Crit Care

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“…To the best of our knowledge, there is only one case report on the use of remimazolam in an elderly patient with severe AS [ 12 ]. Thus, the hemodynamic changes, required vasopressor dosage, time to loss of consciousness (LoC), and bispectral index (BIS) changes when remimazolam is used as an induction agent in this fragile population have not yet been elucidated.…”

Section: Introductionmentioning

confidence: 99%

Remimazolam for induction of anesthesia in elderly patients with severe aortic stenosis: a prospective, observational pilot study

et al. 2021

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Background Remimazolam, a novel benzodiazepine, has been reported to cause less hypotension than propofol during induction of anesthesia. Therefore, remimazolam might be a valuable option in elderly patients with severe aortic stenosis who are considered to be the most vulnerable to hemodynamic instability. We aimed to evaluate the feasibility and hemodynamic effects of remimazolam as an induction agent in elderly patients with severe aortic stenosis. Methods This prospective, open-label, single-arm, observational pilot study was conducted in a university hospital between November 2020 and April 2021. We included 20 patients aged 65 years or older scheduled for transcatheter or surgical aortic valve replacement for severe aortic stenosis under general anesthesia. Patients were administered intravenous remimazolam infusion at 6 mg/kg/h combined with 0.25 μg/kg/min of remifentanil infusion. The primary outcome was the vasopressor dosage between the induction of anesthesia and the completion of tracheal intubation. The secondary outcomes included hemodynamic changes, bispectral index changes, and the time from the start of remimazolam infusion to loss of consciousness. We also recorded awareness during anesthesia induction and serious adverse events related to death, life-threatening events, prolonged hospitalizations, and disability due to permanent damage. Results Twenty patients aged 84 [79–86] (median [interquartile range]) with American Society of Anesthesiologists physical status 4 were analyzed. Ephedrine 0 [0–4] mg and phenylephrine 0.1 [0–0.1] mg were administered to 14/20 patients (3 doses in 1 patient, 2 doses in 4 patients, and one dose in 9 patients). Loss of consciousness was achieved at 80 [69–86] s after the remimazolam infusion was started. The mean arterial pressure decreased gradually after loss of consciousness but recovered immediately after tracheal intubation. The bispectral index values gradually decreased and reached < 60 at 120 s after loss of consciousness. Neither awareness during induction of anesthesia nor serious adverse events, such as severe bradycardia (< 40 bpm), life-threatening arrhythmia, myocardial ischemia, or anaphylactic reactions were observed. Conclusions Remimazolam could be used as an induction agent with timely bolus vasopressors in elderly patients with severe aortic stenosis. Trial registration UMIN Clinical Trials Registry, identifier UMIN000042318.

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“…Others reported that TIVA 10 using remimazolam and remifentanil or induction 11 using remimazolam can be used safely in patients with severe cardiovascular diseases, although there was one report of unexpected hypertension and tachycardia after induction with initial doses of remimazolam (6 mg/kg/h), remifentanil, and fentanyl. 12 One study reported fewer hypotensive events with TIVA using remimazolam and remifentanil compared to propofol and remifentanil.…”

Section: Discussionmentioning

confidence: 99%

Total Intravenous Anesthesia Using Remimazolam and Continuous Cardiac Output Monitoring for Dental Anesthesia in a Patient With Takayasu’s Arteritis: A Case Report

et al. 2022

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Takayasu’s arteritis is a persistent chronic progressive inflammation of the large- and medium-caliber arteries. Controlling cardiovascular variability during anesthesia and overcoming difficulties of cardiovascular monitoring due to the impaired vessels are important in patients with Takayasu’s arteritis. Remimazolam is a novel short-acting benzodiazepine with mild effects on hemodynamics. We report the case of a patient with Takayasu’s arteritis who underwent oral surgery under general anesthesia. This report highlights the use of remimazolam and remifentanil to reduce hemodynamic perturbations using estimated continuous cardiac output monitoring.

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Anaesthetic management using remimazolam in a patient with severe aortic stenosis: a case report

Cited by 29 publications

References 17 publications

Remimazolam besylate versus propofol for long-term sedation during invasive mechanical ventilation: a pilot study

Remimazolam besylate versus propofol for long-term sedation during invasive mechanical ventilation: a pilot study

Remimazolam for induction of anesthesia in elderly patients with severe aortic stenosis: a prospective, observational pilot study

Total Intravenous Anesthesia Using Remimazolam and Continuous Cardiac Output Monitoring for Dental Anesthesia in a Patient With Takayasu’s Arteritis: A Case Report

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