Korean J Anesthesiol.  2022 Oct;75(5):449-452. 10.4097/kja.22242.

Psychogenic coma after general anesthesia with remimazolam and remifentanil -a case report-

• Kim SH
• Kim KM
• Lim YH
• Yoo BH
• Cho J
• Jun IJ

• KMID: 2533444
• DOI: http://doi.org/10.4097/kja.22242

Abstract

Background
Delayed emergence from general anesthesia is associated with life-threatening conditions with pharmacological, neurological, metabolic, and rarely, psychiatric causes. This case report was presented to report psychogenic coma after recovery from anesthesia with remimazolam and remifentanil. Case: An elderly woman was unresponsive after recovery from anesthesia with remimazolam and remifentanil. Physical examination, laboratory testing, and radiographic imaging did not reveal any obvious organic causes. Pharmacological or metabolic abnormalities were not found. Absence of those causes strongly suggests that prolonged unconsciousness is related to psychiatric origin. The patient spontaneously regained consciousness after 48 h without any neurological complications.
Conclusions
Anesthesiologists should be aware of the possibility of psychogenic coma for patients with unexplained delay in emergence from anesthesia after the exclusion of other causes.

Keyword

Coma; Delayed emergence from anesthesia; General anesthesia; Postoperative complications; Remimazolam; Unconsciousness