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

Tsubasa Takemori1, Yoshimasa Oyama2, Takenori Makino1

  • 1Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Oita University, 1-1 Idaigaoka-Hasamamachi, Yufu City, Oita, 879-5593, Japan.

JA Clinical Reports
|October 19, 2022
PubMed
Abstract

Insights

Remimazolam, an ultra-short-acting anesthetic, can cause prolonged delayed emergence and re-sedation even after flumazenil administration. Careful anesthesia management considering individual patient factors is crucial for safe use.

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.
Keywords:
BenzodiazepinesFlumazenilProstatectomyProstatic neoplasmsRemimazolam

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