Nakayama Junko, Ogihara Tomomi, Yajima Rui, Innami Yasushi, Ouchi Takashi
Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa City, Chiba, 272-8513, Japan.
Department of Anesthesiology, Itakura Hospital, Chiba, Japan.
JA Clin Rep. 2021 Sep 15;7(1):71. doi: 10.1186/s40981-021-00474-4.
Remimazolam is a newly developed benzodiazepine with more rapid onset and offset of sedation effects than midazolam. We report elderly patients in whom a small dose of remimazolam was successfully used for general anesthesia.
Two elderly women (patients 1 and 2, aged 95 and 103 years, respectively) underwent hip fracture surgery under general anesthesia guided by bispectral index (BIS). Anesthesia was induced with 1.2 and 1.0 mg/kg/h and maintained with 0.2 and 0.1 mg/kg/h remimazolam, combined with fentanyl and remifentanil in patients 1 and 2, respectively. Their hemodynamics were stable with a small dose of vasopressor, and they awoke soon after the discontinuation of remimazolam without flumazenil reversal. Their postoperative courses were uneventful without any complications. Conversely, the remimazolam dose required to achieve adequate sedation were much lower than expected.
Remimazolam could be useful in general anesthesia, particularly for super-elderly patients. However, the appropriate dose for induction and maintenance of anesthesia should be carefully considered based on BIS or vital signs.
瑞马唑仑是一种新开发的苯二氮䓬类药物，其镇静作用起效和消退比咪达唑仑更快。我们报告了成功使用小剂量瑞马唑仑进行全身麻醉的老年患者。
两名老年女性（患者1和患者2，分别为95岁和103岁）在脑电双频指数（BIS）引导下接受全身麻醉下的髋部骨折手术。患者1和患者2分别以1.2和1.0mg/kg/h的剂量诱导麻醉，并分别以0.2和0.1mg/kg/h的剂量维持麻醉，同时分别联合使用芬太尼和瑞芬太尼。她们在小剂量血管升压药的作用下血流动力学稳定，停用瑞马唑仑后很快苏醒，无需氟马西尼拮抗。她们的术后病程顺利，无任何并发症。相反，达到充分镇静所需的瑞马唑仑剂量远低于预期。
瑞马唑仑可用于全身麻醉，特别是对于超高龄患者。然而，应根据BIS或生命体征仔细考虑诱导和维持麻醉的合适剂量。
