Key result
Remimazolam successfully maintained hemodynamic stability during general anesthesia in two very elderly patients undergoing high-risk hybrid surgery of TAVI plus OPCABG.
Why the study?
Remimazolam is a short-acting benzodiazepine with small circulatory depression, but its use for general anesthesia in very elderly patients undergoing hybrid TAVI plus OPCABG required evaluation.
Does remimazolam provide safe general anesthesia in very elderly patients undergoing hybrid TAVI and OPCABG?
Case Report (n=2)
No
Does remimazolam provide safe general anesthesia in very elderly patients undergoing hybrid TAVI and OPCABG?
Remimazolam may be a safe and useful option for general anesthesia in very elderly patients undergoing complex hybrid cardiac surgeries like TAVI plus OPCABG.
May support remimazolam consideration in select elderly hybrid cardiac cases; leaves open prospective trials before wider adoption.
BACKGROUND: Remimazolam is a short-acting benzodiazepine with small circulatory depression. We used remimazolam for general anesthesia management in two very elderly patients undergoing hybrid surgery of transcatheter aortic valve implantation (TAVI) plus off-pump coronary artery bypass grafting (OPCABG). CASE PRESENTATION: A 96-year-old man (case 1) and a 92-year-old woman (case 2) had complex coronary artery disease (CAD) and severe aortic stenosis (AS) and were scheduled for TAVI plus OPCAB. Anesthesia in both patients was induced with 6 mg/kg/h remimazolam and fentanyl and maintained with 0.3 mg/kg/h and 0.5 mg/kg/h remimazolam and fentanyl, respectively. Although catecholamines were required, we successfully maintained circulation during the induction of anesthesia and the procedures of OPCAB and TAVI. Both patients were discharged without complications. CONCLUSION: Remimazolam can be a useful option for safe general anesthesia in very elderly patients when performing hybrid surgery.
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Oyoshi et al. (2023) conducted a case report in Severe aortic stenosis and complex coronary artery disease (n=2). Remimazolam was evaluated on Hemodynamic stability and successful completion of surgery. Remimazolam successfully maintained hemodynamic stability during general anesthesia in two very elderly patients undergoing high-risk hybrid surgery of TAVI plus OPCABG.
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