Anesthetic management with remimazolam in very elderly patients undergoing hybrid surgery of transcatheter aortic valve implantation plus off-pump coronary artery bypass grafting: report of two cases.

Pub Date : 2023-10-25 DOI:10.1186/s40981-023-00662-4

Takafumi Oyoshi, Yuki Mitsuta, Yumiko Uemura, Koichiro Tajima, Naoyuki Hirata

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Abstract

Background: Remimazolam is a short-acting benzodiazepine with small circulatory depression. We used remimazolam for general anesthesia management in two very elderly patients undergoing hybrid surgery of transcatheter aortic valve implantation (TAVI) plus off-pump coronary artery bypass grafting (OPCABG).

Case presentation: A 96-year-old man (case 1) and a 92-year-old woman (case 2) had complex coronary artery disease (CAD) and severe aortic stenosis (AS) and were scheduled for TAVI plus OPCAB. Anesthesia in both patients was induced with 6 mg/kg/h remimazolam and fentanyl and maintained with 0.3 mg/kg/h and 0.5 mg/kg/h remimazolam and fentanyl, respectively. Although catecholamines were required, we successfully maintained circulation during the induction of anesthesia and the procedures of OPCAB and TAVI. Both patients were discharged without complications.

Conclusion: Remimazolam can be a useful option for safe general anesthesia in very elderly patients when performing hybrid surgery.

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雷马唑仑在高龄经导管主动脉瓣植入联合非体外循环冠状动脉搭桥术中的麻醉处理:附2例报告。

背景：雷米唑仑是一种具有小循环抑制作用的短效苯二氮卓类药物。我们对两名接受经导管主动脉瓣植入术（TAVI）加非体外循环冠状动脉旁路移植术（OPCABG）混合手术的高龄患者进行了雷米唑仑全身麻醉管理。病例介绍：一名96岁男性（病例1）和一名92岁女性（病例2）患有复杂冠状动脉疾病（CAD）和严重主动脉狭窄（AS），计划接受TAVI加OPCAB。两名患者均采用6mg/kg/h的雷米唑仑和芬太尼诱导麻醉，并分别采用0.3mg/kg/h和0.5mg/kg/h雷米唑兰和芬太尼维持麻醉。尽管需要儿茶酚胺，但我们在麻醉诱导和OPCAB和TAVI程序中成功地维持了循环。两名患者均出院，无并发症。结论：在高龄患者进行混合手术时，雷米唑仑是一种安全的全麻选择。

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