Case report of atypical re-sedation after general anesthesia using remimazolam.

Anesthesia and pain medicine Pub Date : 2024-10-01 Epub Date: 2024-10-25 DOI:10.17085/apm.24009
Soo Jee Lee, Insik Jung, Seongmin Park, Seunghee Ki
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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.

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使用remimazolam进行全身麻醉后非典型再镇静的病例报告。
背景:雷马唑仑是一种超短效麻醉剂,以氟马唑尼为逆转剂,通常有助于患者术后苏醒。然而,我们的病例却揭示了一个不寻常的现象:尽管氟马唑尼最初恢复了意识,但六小时后,瑞马唑仑又导致患者再次昏迷:一名 65 岁的女性在 140 分钟的手术中接受了全静脉全身麻醉,使用了瑞马唑仑和瑞芬太尼。尽管最初恢复顺利,但转入普通病房后她逐渐变得昏昏欲睡,最终达到昏迷状态。医生尝试了多种干预措施,包括阿片类药物逆转(停止静脉注射患者自控镇痛药和纳洛酮)。神经科会诊未发现任何问题,但服用氟马西尼后病情立即得到改善,这表明与雷马唑仑有关。患者出院时未出现并发症:本病例挑战了我们对瑞马唑仑动力学的理解,强调了即使在看似低风险的病例中也有必要对麻醉后监测保持警惕。它倡导制定标准化的应对方案,以便及时处理意外事件,确保患者安全。
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