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Delayed emergence after general anesthesia using remimazolam for induction agent in laparoscopic cholecystectomy: a case report

  • Eun-Jin Ahn1,2
  • Je Jin Lee1,3
  • Chan Su Park3
  • Min Kyoung Kim1,2,*,

1Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, 14353 Gwangmyeong-si, Republic of Korea

2Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, 06911 Seoul, Republic of Korea

3Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, 06973 Seoul, Republic of Korea

DOI: 10.22514/sv.2023.125 Vol.20,Issue 5,May 2024 pp.107-111

Submitted: 23 August 2023 Accepted: 10 October 2023

Published: 08 May 2024

*Corresponding Author(s): Min Kyoung Kim E-mail: ddolpaki86@naver.com

Abstract

Remimazolam’s ultrashort-acting properties, including reduced injection discomfort, minimal impact on respiratory and cardiovascular functions and rapid metabolism, have garnered significant attention in the field of anesthesia. However, despite its widespread acclaim, we encountered an unusual case in which a patient without hepatic or renal impairment experienced unexpected delays in regaining consciousness following a single intravenous induction dose of remimazolam. The patient, a 63-year-old undergoing laparoscopic cholecystectomy for gallbladder stones, had preoperative tests revealing atrial fibrillation and a reduced ejection fraction observed in an echocardiogram. Anesthesia induction included the administration of remimazolam (0.3 mg/kg), sufentanil and rocuronium. The surgery proceeded uneventfully and was maintained with desflurane and sufentanil. However, after the surgery, the patient experienced delayed emergence from anesthesia. Opioid overdose was ruled out, and we suspected a metabolic delay associated with remimazolam. In response to this suspicion, we administered flumazenil, which promptly restored consciousness and normal breathing. Subsequent post-anesthetic observation revealed no complications, and the patient was discharged two days after surgery. This case highlights the significant delayed emergence phenomenon linked to remimazolam, even when administered as a bolus. Instances of delayed emergence following remimazolam administration underscore the complexities in anesthesia responses, emphasizing the importance of vigilant clinical monitoring and the need for ongoing research in this area.


Keywords

Remimazolam; Flumazenil; Benzodiazepines; Delayed emergence; General anesthesia; Case report


Cite and Share

Eun-Jin Ahn,Je Jin Lee,Chan Su Park,Min Kyoung Kim. Delayed emergence after general anesthesia using remimazolam for induction agent in laparoscopic cholecystectomy: a case report. SignaVitae. 2024. 20(5);107-111.

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