Lee Soo Jee, Jung Insik, Park Seongmin, Ki Seunghee
Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Anesth Pain Med (Seoul). 2024 Oct;19(4):320-325. doi: 10.17085/apm.24009. Epub 2024 Oct 25.
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.
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.
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.
瑞马唑仑是一种超短效麻醉剂，以氟马西尼作为苏醒剂，通常有助于患者术后苏醒。然而，我们的病例显示了一种不寻常的情况：尽管氟马西尼最初恢复了意识，但6小时后瑞马唑仑导致再次镇静。
一名65岁女性在140分钟的手术中接受了瑞马唑仑和瑞芬太尼全静脉全身麻醉。尽管最初恢复顺利，但转至普通病房后她逐渐变得嗜睡，最终达到昏迷状态。尝试了多种干预措施，包括阿片类药物逆转（停用静脉自控镇痛和给予纳洛酮）。神经科会诊未发现问题；然而，给予氟马西尼后立即改善提示与瑞马唑仑有关。患者出院时无并发症。
该病例挑战了我们对瑞马唑仑动力学的理解，强调即使在看似低风险的病例中，麻醉后密切监测的必要性。它提倡制定标准化的应对方案，以迅速处理意外事件并确保患者安全。
