Remimazolam Use in Awake Craniotomy for Patient with Morbid Obesity and Recurrent Glioma

BACKGROUND Awake craniotomy is a neurosurgical procedure that is used when it is necessary for a patient to be conscious during resection of a tumor. In neurosurgical operations conducted within the eloquent cortex, it is essential to administer anesthesia to ensure that the patient does not experience pain or fear during the procedure and to ensure their full cooperation with the neurophysiologist and neurosurgeon in stimulating this cortex. The asleep-awake-asleep method was used in this case of awake craniotomy. In this case report, we evaluate remimazolam, a drug with ultra-short-acting properties and suitability for use in anesthesia during awake craniotomies, for its exceptional utility in this type of treatment. CASE REPORT The case report describes the anesthetic management of a 32-year-old man with morbid obesity (body mass index, 44 kg/m²) who underwent resection of a recurrent tumor (low-grade glioma) in the temporoparietal region. The patient was anesthetized with remimazolam, fentanyl, and remifentanil and underwent a scalp block. The patient did not experience any pain during the surgical procedure and was able to actively cooperate with the neuropsychologist during the crucial phase of tumor resection, once the effects of the anesthetic wore off. The patient's circulatory parameters remained within normal ranges, and no signs of respiratory depression were observed during 225 min of anesthesia. CONCLUSIONS Remimazolam offers an intriguing alternative to conventional sedatives used for sedation during awake craniotomies, particularly for patient groups at high risk of airway obstruction when heavily sedated, such as individuals with severe obesity.