Year: 2024
Type: article
Study design: Case Report
Abstract: BACKGROUND: Remimazolam, an ultra-short-acting anesthetic with flumazenil as a reversal agent, typically facilitates patient awakening postoperatively. However, our case reveals an unusual occurrence: despite flumazenil initially restoring consciousness, re-sedation due to remimazolam ensued six hours later. CASE: A 65-year-old woman underwent total intravenous general anesthesia with remimazolam and remifentanil during the 140-min surgery. Despite an initially smooth recovery, she progressively became drowsy upon transfer to the general ward, eventually reaching a stuporous state. Multiple interventions, including opioid reversal (intravenous patient-controlled analgesia discontinuation, and naloxone administration) were attempted. Neurological consultation revealed no issues; however, immediate improvement after flumazenil administration suggested remimazolam's involvement. The patient was discharged without complications. CONCLUSIONS: This case challenges our understanding of remimazolam's dynamics, emphasizing the necessity for vigilant post-anesthesia monitoring, even in seemingly low-risk cases. It advocates for standardized response protocols to promptly manage unforeseen events and ensure patient safety.
Source: Anesthesia and Pain Medicine
DOI: 10.17085/apm.24009
Authors: Soo Jee Lee, Insik Jung, Seongmin Park, Seunghee Ki
Institutions: Inje University, Inje University Busan Paik Hospital
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $250
OpenAlex ID: W4404051232