Anesth Pain Med.  2024 Oct;19(4):320-325. 10.17085/apm.24009.

Case report of atypical re-sedation after general anesthesia using remimazolam

• Lee SJ
• Jung I
• Park S
• Ki S

• KMID: 2563574
• DOI: http://doi.org/10.17085/apm.24009

Abstract

Background
Remimazolam, an ultra-short-acting anesthetic with flumazenil as a reversal agent, typically facilitates patient awakening postoperatively. However, our case reveals an unusual occurrence: despite flumazenil initially restoring consciousness, re-sedation due to remimazolam ensued six hours later. Case: A 65-year-old woman underwent total intravenous general anesthesia with remimazolam and remifentanil during the 140-min surgery. Despite an initially smooth recovery, she progressively became drowsy upon transfer to the general ward, eventually reaching a stuporous state. Multiple interventions, including opioid reversal (intravenous patient-controlled analgesia discontinuation, and naloxone administration) were attempted. Neurological consultation revealed no issues; however, immediate improvement after flumazenil administration suggested remimazolam’s involvement. The patient was discharged without complications. Conclusions: This case challenges our understanding of remimazolam’s dynamics, emphasizing the necessity for vigilant post-anesthesia monitoring, even in seemingly low-risk cases. It advocates for standardized response protocols to promptly manage unforeseen events and ensure patient safety.

Keyword

Remimazolam; Sedation; Flumazenil; Anesthesia; General anesthesia; Intravenous

Figure

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  Fig. 1. Changes in the BIS levels over time. BIS: bispectral index.

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  Fig. 2. Postoperative changes in the level of consciousness. Arrows show the actions taken in this case. IV-PCA: intravenous patient-controlled analgesia.

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