Remimazolam sedation with regional anesthesia in difficult airway due to huge thyroid goiter: A case report

RATIONALE: Remimazolam, a novel benzodiazepine, is known to have less respiratory depression compared to other anesthetic agents, and it also has a reversal agent that can be used in emergency situations. Remimazolam with these characteristics can be usefully utilized in the anesthetic management of patients with difficult airway. PATIENT CONCERNS: A 78-year-old female patient was scheduled proximal humerus fracture surgery. The patient occasionally complained dyspnea and had multiple comorbidities including thyroid goiter, dementia, and delirium. DIAGNOSES: The patient had a large thyroid goiter compressing and deviating the trachea. A short neck with increased circumference was confirmed. A difficult airway was anticipated in the preanesthetic evaluation. INTERVENTIONS: Sedation with remimazolam followed by regional anesthesia was performed for the surgery. OUTCOMES: The surgery was completed without complications. The patient recovered and was discharged on 15th postoperative days. LESSONS: The use of remimazolam for sedation may be an appropriate option in the anesthetic management of patients with difficult airway.