Remimazolam for hemodynamic stabilization in patients with perioperative arrhythmia: report of two cases

Intraoperative arrhythmias pose significant risks during surgical procedures, occurring not only in patients with preexisting cardiac conditions, but also in response to anesthetic agents or surgical stimuli. Remimazolam, an ultra-short-acting benzodiazepine, demonstrates rapid recovery and stable hemodynamic properties; however, clinical evidence of its efficacy in patients with perioperative arrhythmias remains limited. Herein, we report two cases in which remimazolam was successfully used for hemodynamic stabilization in patients with perioperative arrhythmias. In both patients, conventional inhalational anesthesia was converted to remimazolam-based anesthesia because of arrhythmia-related hemodynamic instability. Conversion to remimazolam resulted in stable heart rate and blood pressure maintenance in patients with existing or intraoperative arrhythmias. No additional arrhythmic episodes or uncontrolled tachyarrhythmias occurred during the remainder of the anesthesia and surgery. This hemodynamic stability may be partly attributed to the minimal cardiac depressant effects of remimazolam and limited sympathetic nervous system stimulation. Therefore, remimazolam may be a viable anesthetic alternative for patients with preexisting or newly developed arrhythmias, providing stable cardiovascular control during the induction and maintenance phases. Although larger prospective studies are warranted, these cases demonstrate the clinical utility of remimazolam in high-risk cardiac patients requiring surgical intervention.