Department of Anesthesia, the Fourth hospital of Hebei Medical University, Shijiazhuang, PR China.
Medicine (Baltimore). 2024 Mar 1;103(9):e37199. doi: 10.1097/MD.0000000000037199.
The goal of anesthesia in patients with hypertrophic obstructive cardiomyopathy (HOCM) is to reduce the risk of left ventricular outflow tract obstruction triggered by anesthetics. Remimazolam is a newly developed anesthetic that has been reported to have superior hemodynamic stability. There have been no reports on the completion of non-cardiac surgery with remimazolam in patients with HOCM.
Here we report the case of a 49-year-old man diagnosed with hypertrophic obstructive cardiomyopathy who underwent resection of colon cancer with remimazolam and remifentanil anesthesia. A bolus 0.3 mg/kg remimazolam was administered for anesthesia induction, and then adjusted to 2 mg/kg/h to maintain anesthesia. Set the pain threshold index to 50 to auto-control the infusion speed of remifentanil.
No hypotension occurred during anesthesia, and norepinephrine was not administered. After conversion to open surgery, the patient's blood pressure elevated and reduced with urapidil and esmolol.
In this patient with HOCM, remimazolam and remifentanil provided adequate anesthesia for induction and maintenance to complete the right hemicolectomy.
肥厚型梗阻性心肌病（HOCM）患者的麻醉目标是降低麻醉触发左心室流出道梗阻的风险。瑞马唑仑是一种新开发的麻醉剂，据报道其血流动力学稳定性更优。目前尚未有关于瑞马唑仑在 HOCM 患者中完成非心脏手术的报道。
我们在此报告一例 49 岁男性患者，该患者被诊断为肥厚型梗阻性心肌病，接受瑞马唑仑和瑞芬太尼麻醉下行结肠癌切除术。麻醉诱导时给予 0.3mg/kg 瑞马唑仑负荷剂量，然后调整至 2mg/kg/h 以维持麻醉。将疼痛阈值指数设置为 50 以自动控制瑞芬太尼的输注速度。
麻醉过程中未发生低血压，未给予去甲肾上腺素。转为开腹手术后，患者的血压随优泌乐和艾司洛尔的使用而升高和降低。
在这名 HOCM 患者中，瑞马唑仑和瑞芬太尼为诱导和维持提供了足够的麻醉，以完成右半结肠切除术。
