Key result
Flumazenil reversal of remimazolam anesthesia triggers acute postoperative HFpEF and pulmonary edema.
Why the study?
The optimal method for administering remimazolam in clinical practice remains unclear.
Case Report (n=1)
No
Flumazenil used for rapid remimazolam antagonism may precipitate acute HFpEF and pulmonary edema in elderly patients with pre-existing diastolic dysfunction due to sympathetic surging.
Caution with flumazenil reversal after remimazolam in elderly patients with diastolic dysfunction; single case leaves open causality and need for prospective data.
Remimazolam is an ultrashort-acting benzodiazepine intravenous anesthetic characterized by rapid awakening after anesthesia. However, the method for administering remimazolam in clinical practice remains unclear. Here, we report a case of postoperative heart failure with preserved ejection fraction (HFpEF) after antagonizing remimazolam with flumazenil. An 82-year-old woman was scheduled to undergo lumbar laminectomy for lumbar spinal canal stenosis. Preoperative echocardiography revealed normal left ventricular systolic function, left atrial enlargement, and impaired left ventricular diastolic function. General anesthesia was induced with 10 mg/kg/h remimazolam and maintained with 0.8 mg/kg/h remimazolam intraoperatively. Before extubation, a total of 1.0 mg of flumazenil was administered. After extubation, the patient developed pulmonary edema due to HFpEF. When remimazolam is administered in elderly patients with cardiac dysfunction, the maintenance dose should be customized according to the patient's general condition to minimize the dosage of flumazenil.
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Koh et al. (2022) conducted a case report in Postoperative heart failure with preserved ejection fraction (HFpEF) (n=1). Flumazenil for remimazolam antagonism was evaluated on Development of postoperative pulmonary edema due to HFpEF. An 82-year-old woman developed postoperative heart failure with preserved ejection fraction (HFpEF) and pulmonary edema after receiving flumazenil to antagonize remimazolam anesthesia.
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