Oyoshi Takafumi, Mitsuta Yuki, Uemura Yumiko, Tajima Koichiro, Hirata Naoyuki
Department of Anesthesiology, Kumamoto University, Graduate School of Medical Sciences, Kumamoto, Japan.
Department of Anesthesiology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
JA Clin Rep. 2023 Oct 25;9(1):69. doi: 10.1186/s40981-023-00662-4.
Remimazolam is a short-acting benzodiazepine with small circulatory depression. We used remimazolam for general anesthesia management in two very elderly patients undergoing hybrid surgery of transcatheter aortic valve implantation (TAVI) plus off-pump coronary artery bypass grafting (OPCABG).
A 96-year-old man (case 1) and a 92-year-old woman (case 2) had complex coronary artery disease (CAD) and severe aortic stenosis (AS) and were scheduled for TAVI plus OPCAB. Anesthesia in both patients was induced with 6 mg/kg/h remimazolam and fentanyl and maintained with 0.3 mg/kg/h and 0.5 mg/kg/h remimazolam and fentanyl, respectively. Although catecholamines were required, we successfully maintained circulation during the induction of anesthesia and the procedures of OPCAB and TAVI. Both patients were discharged without complications.
Remimazolam can be a useful option for safe general anesthesia in very elderly patients when performing hybrid surgery.
瑞马唑仑是一种短效苯二氮䓬类药物，对循环系统的抑制作用较小。我们在两名接受经导管主动脉瓣植入术（TAVI）加非体外循环冠状动脉搭桥术（OPCABG）的高龄患者的全身麻醉管理中使用了瑞马唑仑。
一名96岁男性（病例1）和一名92岁女性（病例2）患有复杂冠状动脉疾病（CAD）和严重主动脉瓣狭窄（AS），计划接受TAVI加OPCAB手术。两名患者均用6mg/kg/h的瑞马唑仑和芬太尼诱导麻醉，分别用0.3mg/kg/h和0.5mg/kg/h的瑞马唑仑和芬太尼维持麻醉。尽管需要使用儿茶酚胺，但我们在麻醉诱导以及OPCAB和TAVI手术过程中成功维持了循环。两名患者均无并发症出院。
在进行杂交手术时，瑞马唑仑对于高龄患者安全实施全身麻醉可能是一种有用的选择。
