Can remimazolam be safely used in cardiac tamponade?: A case report

RATIONALE: Remimazolam, a benzodiazepine drug, has recently been developed and is currently used for the induction and maintenance of anesthesia. Remimazolam provides hemodynamic stability during anesthesia induction. However, in patients with cardiac tamponade, it is unclear how hemodynamic stability is maintained during the induction and maintenance of general anesthesia with remimazolam. PATIENT CONCERNS: An 88-year-old male patient had developed hemopericardium due to penetration of a pigtail catheter into the left ventricle during pericardiocentesis, which was performed to treat massive pericardial effusion. DIAGNOSES: The patient was diagnosed with acute cardiac tamponade and a hemothorax. Hemopericardium and hemothorax were confirmed on chest radiography and computed tomography performed immediately after pericardiocentesis. INTERVENTIONS: Decompressive pericardiostomy was performed through a left anterolateral thoracotomy with 1-lung ventilation under general anesthesia. Remimazolam was administered for total intravenous anesthesia. OUTCOMES: Severe hypotension and bradycardia occurred during the induction of anesthesia with remimazolam (6 mg/kg/hours). LESSONS: Remimazolam may induce severe hemodynamic instability during induction of general anesthesia in patient with cardiac tamponade.