General anesthesia with remimazolam in a patient with clinically suspected malignant hyperthermia

Uchiyama, Keita; Sunaga, Hiroshi; Katori, Nobuyuki; Uezono, Shoichi

doi:10.1186/s40981-021-00482-4

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…Despite exposure to 100fold higher concentrations than used clinically, neither remimazolam nor propofol promoted the caffeine-induced increase in intracellular calcium concentrations in cells expressing the mutant RYR1 receptor. This laboratory investigation is supported by an anecdotal report of the use of remimazolam in a 26-year-old with a suspected prior MH reaction [17]. Anesthesia was induced and maintained with fentanyl, remifentanil, and an infusion of remimazolam starting at 12 mg/kg/h.…”

Section: Discussionmentioning

confidence: 75%

Remimazolam in a Pediatric Patient With a Suspected Family History of Malignant Hyperthermia

2022

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Malignant hyperthermia (MH) is an acute hypermetabolic crisis, triggered in susceptible patients by the administration of succinylcholine or a volatile anesthetic agent. When providing anesthetic care for MH-susceptible patients, a total intravenous anesthetic technique with propofol or other sedative hypnotic is frequently chosen. Remimazolam is a novel benzodiazepine which, like midazolam, has sedative, anxiolytic, and amnestic properties. Ester metabolism results in a half-life of 5-10 min and a limited context sensitive half-life. We present anecdotal experience with its use as an adjunct to propofol anesthesia in a patient with a suspected family history of MH. Previous reports of the use of remimazolam in MH-susceptible patients are reviewed and its potential role in such patients discussed.

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Section: Discussionmentioning

confidence: 75%

Remimazolam in a Pediatric Patient With a Suspected Family History of Malignant Hyperthermia

2022

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“…Although exposure to remimazolam increased Ca 2+ levels in myotubes cultured from CICR-accelerated patients, like this case, the concentration of remimazolam was reported to be 80 times higher than the clinical concentration [ 8 ]. In addition, a few clinical cases have been reported in which remimazolam was safely used under general anesthesia in patients with suspected MH [ 9 – 11 ]. However, these cases were not definitively diagnosed as MH.…”

Section: Discussionmentioning

confidence: 99%

“…We have demonstrated in cellular studies that remimazolam does not increase intracellular calcium concentrations in the range of concentrations for clinical use in RYR1 mutant cells, which cause MH [ 7 , 8 ]. Moreover, remimazolam has been reported safe for use in patients with suspected MH [ 9 – 11 ], but there remains a lack of case reports on using remimazolam in patients with a definitive diagnosis of MH. Here, we present the first case report of genetically confirmed MH in which remimazolam was used for TIVA without the development of MH.…”

Section: Introductionmentioning

confidence: 99%

Remimazolam-based total intravenous anesthesia in a patient with a confirmed diagnosis of malignant hyperthermia: a case report

Kondo,

Mukaida,

Sasai

et al. 2024

JA Clin Rep

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Background Malignant hyperthermia (MH) is a rare, life-threatening disorder of calcium homeostasis in skeletal muscle cells that is triggered by volatile anesthetics and succinylcholine, leading to a hypermetabolic reaction. The pathogenic ryanodine receptor 1 (RYR1) gene variant is critical. Patients susceptible to MH should avoid triggering agents, and total intravenous anesthesia (TIVA) is preferred. Remimazolam is safe in patients with suspected MH. Case presentation We present the first case of remimazolam treatment in a genetically confirmed patient with MH without MH development. A 72-year-old man with a family history of MH underwent remimazolam-based TIVA. After informed consent was obtained, a muscle biopsy and genetic testing were performed. Intraoperatively and postoperatively, the patient exhibited no signs of MH. An enhanced function of the RYR1 channel into releasing calcium was indicated, and the genetic testing revealed a pathogenic variant of RYR1. Conclusions Remimazolam-based TIVA is safe in patients confirming the diagnosis of MH.

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“…Remimazolam is approved in Japan for induction and maintenance of general anesthesia and is under regulatory assessment in the USA and the European Union for procedure sedation [ 1 , 2 ]. Remimazolam is safe for use in patients with malignant hyperthermia at the basic research level, and there are reports of its successful clinical use [ 5 , 6 ]. In the present case, no muscle biopsy was performed, but the patient’s older sister had developed malignant hyperthermia, and considering that the patient was at risk, we needed to use intravenous anesthetics to avoid inhalation agents.…”

Section: Discussionmentioning

confidence: 99%

Use of remimazolam in living donor liver transplantation: a case report

et al. 2022

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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.

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General anesthesia with remimazolam in a patient with clinically suspected malignant hyperthermia

Cited by 5 publications

References 5 publications

Remimazolam in a Pediatric Patient With a Suspected Family History of Malignant Hyperthermia

Remimazolam in a Pediatric Patient With a Suspected Family History of Malignant Hyperthermia

Remimazolam-based total intravenous anesthesia in a patient with a confirmed diagnosis of malignant hyperthermia: a case report

Use of remimazolam in living donor liver transplantation: a case report

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