Postoperative Heart Failure with Preserved Ejection Fraction Induced by Flumazenil Administered for Remimazolam...

Area of Science:

• Anesthesiology
• Cardiology
• Pharmacology

Background:

• Remimazolam is an ultrashort-acting benzodiazepine anesthetic known for rapid recovery.
• Clinical administration guidelines for remimazolam, especially in specific patient populations, require further clarification.
• Heart failure with preserved ejection fraction (HFpEF) presents unique challenges in anesthetic management.

Observation:

• An 82-year-old woman with pre-existing diastolic dysfunction underwent lumbar laminectomy under remimazolam anesthesia.
• Remimazolam was administered for induction and maintenance, followed by flumazenil for antagonism before extubation.
• The patient developed acute pulmonary edema secondary to HFpEF post-extubation.

Findings:

• Antagonizing remimazolam with flumazenil in an elderly patient with HFpEF precipitated acute heart failure.
• The patient's underlying left ventricular diastolic dysfunction likely contributed to the adverse event.
• Standard remimazolam dosing may not be appropriate for elderly patients with cardiac compromise.

Implications:

• Anesthesiologists should exercise caution when using remimazolam and flumazenil in elderly patients with cardiac dysfunction.
• Individualized titration of remimazolam maintenance dose is recommended to minimize flumazenil requirements and associated risks.
• Further research is needed to establish optimal remimazolam administration protocols for patients with HFpEF.