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Remimazolam Anesthesia for MitraClip Implantation in a Patient with Advanced Heart Failure

Tomoe Satoh1, Noriaki Nishihara1, Yasuaki Sawashita1

  • 1Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan.

Case Reports in Anesthesiology
|May 26, 2021
PubMed

Insights

Remimazolam, an ultrashort-acting benzodiazepine, offers safe anesthesia for severe heart failure patients undergoing MitraClip procedures. It demonstrated minimal cardiovascular effects and rapid recovery, with flumazenil effectively reversing its action.

Area of Science:

  • Anesthesiology
  • Cardiology
  • Pharmacology

Background:

  • Remimazolam is an ultrashort-acting benzodiazepine approved for general anesthesia.
  • It is known for minimal injection pain, reduced cardiovascular depression, and flumazenil antagonism.
  • Previous trials excluded patients with severe heart failure or cardiac surgery.

Observation:

  • This case report details anesthetic management using remimazolam for a patient with severe mitral regurgitation and advanced heart failure undergoing MitraClip implantation.
  • Remimazolam was used for both induction and maintenance of anesthesia.
  • The patient experienced less cardiovascular depression during the procedure.

Findings:

  • Anesthetic induction and maintenance with remimazolam were successfully achieved.
  • The patient exhibited minimal cardiovascular depressant effects.
  • Post-procedure, the patient recovered smoothly and was extubated shortly after flumazenil administration.

Implications:

  • Remimazolam may be a suitable anesthetic option for patients with severe cardiovascular diseases.
  • This case suggests potential benefits in high-risk cardiac surgical patients.
  • Further research is warranted to explore remimazolam's role in complex cardiac anesthesia.

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