Remimazolam for General Anesthesia in an Elderly Patient with Severe Heart Failure and Aortic Stenosis: A Case Report

Background: It is challenging to perform general anesthesia in patients with severe heart failure. Remimazolam, a recently approved benzodiazepine for general anesthesia, may be very useful for these patients because of less cardiovascular depression compared to other anesthetics. Case: An 85-year-old male patient with severe heart failure (left ventricular ejection fraction, 16%) and aortic stenosis was scheduled for general anesthesia for femur fracture surgery. Anesthesia was performed with remimazolam and remifentanil, and a stable hemodynamic state was maintained with continuous administration of phenylephrine and dobutamine. He did not wake up even 30 minutes after discontinuation of remimazolam administration. Flumazenil was administered intravenously. After 5 minutes, he was awakened and recovered without any events. Conclusions: Remimazolam can be a safe anesthetic for patients with severely impaired cardiac function. For rapid awakening from anesthesia in elderly patients, lowering dose of remimazolam should be considered and flumazenil can be used as necessary.