Tracheal Stent Placement Under Remimazolam Sedation With Preserved Spontaneous Respiration: A Case Report

Anesthetic management for tracheal stent placement is challenging due to a shared airway and risk of hypoxemia. Propofol-based total intravenous anesthesia (TIVA) with preserved spontaneous ventilation is commonly used. Remimazolam, an ultrashort-acting benzodiazepine, may be an alternative; however, clinical experience is limited. A man in his 50s (170 cm in height, weighing 79 kg; BMI 27.3 kg/m²) with critical tracheal compression from an anterior mediastinal tumor underwent rigid bronchoscopy-guided tracheal stent placement. Anesthesia was induced with remimazolam (0.5 mg/kg/hour) and remifentanil (0.25 μg/kg/minute). Transient hypoxemia occurred twice, requiring manual ventilation and temporary interruption. The regimen was adjusted to a 7 mg remimazolam bolus followed by reduced doses (0.2 mg/kg/hour; remifentanil 0.15 μg/kg/minute), providing adequate sedation while preserving spontaneous respiration for most of the 25-minute procedure. The patient awoke promptly after flumazenil and was discharged on day 2. Remimazolam-remifentanil TIVA is feasible, but careful titration is required to avoid respiratory depression and patient movement.