Key result
Remimazolam preserves cardiac index but triggers marked hypotension via vasodilation in compensated low-output states.
Why the study?
The hemodynamic effects and safety of remimazolam anesthesia in patients with reduced ejection fraction undergoing transcatheter edge-to-edge mitral valve repair were not well described.
Does remimazolam anesthesia maintain hemodynamic stability in patients with reduced ejection fraction undergoing transcatheter edge-to-edge repair of the mitral valve?
Case Report (n=2)
No
Does remimazolam anesthesia maintain hemodynamic stability in patients with reduced ejection fraction undergoing transcatheter edge-to-edge repair of the mitral valve?
Remimazolam anesthesia during transcatheter edge-to-edge repair in patients with reduced ejection fraction may cause significant hypotension in those with low cardiac output compensated by high peripheral vascular resistance.
Remimazolam may cause marked hypotension in low-output patients during TEER; case reports leave open its hemodynamic safety in reduced EF.
Remimazolam is an ultrashort-acting benzodiazepine that causes minimal hemodynamic changes. We present two patients, with reduced ejection fraction, who underwent remimazolam anesthesia for transcatheter edge-to-edge repair of the mitral valve with the MitraClip system. In case 1, the patient's vitals were stable throughout the surgery. However, in case 2, which had a lower cardiac output, the patient's blood pressure decreased remarkably after anesthesia induction. Though remimazolam does not alter the cardiac output, it reportedly has vasodilatory effects. Since remimazolam can reduce blood pressure in patients where the reduction in cardiac output is compensated for by high peripheral vascular resistance, caution should be exercised.
No takes yet. Share an insight, caveat, or question.
Ito et al. (2022) conducted a case report in Mitral regurgitation with reduced ejection fraction (n=2). Remimazolam was evaluated on Hemodynamic parameters (blood pressure, cardiac index, systemic vascular resistance index). Remimazolam maintained cardiac index but caused significant hypotension due to vasodilation in a patient with low cardiac output compensated by high vascular resistance.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: