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Updated: Jul 22, 2025

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Successful reversal of remimazolam anesthesia in a "cannot intubate, can ventilate" situation: a case report
Shota Sekimoto1, Shuya Kiyama2, Shoichi Uezono1
1Department of Anesthesiology, School of Medicine, The Jikei University, Nishi-Shimbashi 3-25-8, Minato-Ku, Tokyo, 105-8461, Japan.
Background:
Compared to other intravenous anesthetics, availability of a specific antagonist flumazenil is a clear advantage of remimazolam. We report a patient who could be rapidly woken up when laryngoscopy and tracheal intubation were unexpectedly difficult.
Case Presentation:
A 62-year-old man was scheduled to have resection of a small gingival tumor. Preoperative airway examination was unremarkable except for an omega-shaped epiglottis. Anesthesia was induced with remifentanil/remimazolam infusion and rocuronium. A small omega-shaped edematous epiglottis precluded identification of glottis. Consciousness and spontaneous ventilation were rapidly restored after administration of flumazenil and sugammadex. Tracheostomy was done under local anesthesia while the patient breathed spontaneously.
Conclusions:
Remimazolam can be a reasonable induction agent when there are concerns regarding airway management. Avoiding repeated airway manipulations is extremely important to prevent deterioration into a "cannot intubate, cannot ventilate (CICV)" emergency.
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