More vasopressors were required during anesthesia maintenance with sevoflurane than remimazolam in a high-risk patient: a case report

Background Remimazolam besilate is known to cause less hypotension than other anesthetics. We experienced an anesthetic switch from remimazolam to sevoflurane in a high-risk patient, allowing us to compare the intra-individual hemodynamic effects of the two anesthetics. Case presentation A 57-year-old woman with multiple cardiovascular complications underwent a lower-limb amputation. We selected remimazolam anesthesia with peripheral nerve blocks to minimize the risk of intraoperative hypotension. During the closure of the surgical site after deflating the tourniquet, we switched anesthetics from remimazolam to sevoflurane because the attending anesthesiologist had to leave for other duties. Then, repeated doses of phenylephrine were required throughout the remainder of the surgery, despite comparable surgical and other anesthetic conditions before and after the switch. After discontinuation of sevoflurane and remifentanil, noradrenaline was no longer required. Conclusions This case report has shown that additional vasopressors were required during anesthesia maintenance with sevoflurane after switching from remimazolam.