Long-term delayed emergence after remimazolam-based general anesthesia: a case report.

Area of Science:

• Anesthesiology
• Pharmacology

Background:

• Remimazolam is an ultra-short-acting benzodiazepine anesthetic.
• It is typically used to facilitate early postoperative recovery.
• Flumazenil is its antagonist.

Purpose of the Study:

• To report a case of delayed emergence and re-sedation with remimazolam anesthesia.
• To highlight potential challenges in patient recovery despite flumazenil administration.

Main Methods:

• A 71-year-old male patient received remimazolam for robotic-assisted laparoscopic radical prostatectomy.
• Intraoperative bispectral index (BIS) was maintained between 30-50.
• Flumazenil was administered due to delayed emergence, but re-sedation occurred.

Main Results:

• Delayed emergence persisted for up to 12 hours post-surgery.
• The patient eventually awakened on postoperative day 2.
• Re-sedation was observed despite multiple doses of flumazenil.

Conclusions:

• Long-term delayed emergence and re-sedation can occur with remimazolam, even after flumazenil.
• Anesthesia management with remimazolam necessitates individualized approaches.
• Monitoring the bispectral index (BIS) is important for managing remimazolam anesthesia.