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Postoperative Heart Failure with Preserved Ejection Fraction Induced by Flumazenil Administered for Remimazolam Antagonism

Remimazolam is an ultrashort-acting benzodiazepine intravenous anesthetic characterized by rapid awakening after anesthesia. However, the method for administering remimazolam in clinical practice remains unclear. Here, we report a case of postoperative heart failure with preserved ejection fraction...

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Autores principales: Koh, Keito, Omae, Takeshi, Sakuraba, Sonoko, Kumemura, Masateru, Yamazaki, Sho, Yunoki, Hiroshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675602/
https://www.ncbi.nlm.nih.gov/pubmed/36411761
http://dx.doi.org/10.1155/2022/8923008
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author Koh, Keito
Omae, Takeshi
Sakuraba, Sonoko
Kumemura, Masateru
Yamazaki, Sho
Yunoki, Hiroshi
author_facet Koh, Keito
Omae, Takeshi
Sakuraba, Sonoko
Kumemura, Masateru
Yamazaki, Sho
Yunoki, Hiroshi
author_sort Koh, Keito
collection PubMed
description Remimazolam is an ultrashort-acting benzodiazepine intravenous anesthetic characterized by rapid awakening after anesthesia. However, the method for administering remimazolam in clinical practice remains unclear. Here, we report a case of postoperative heart failure with preserved ejection fraction (HFpEF) after antagonizing remimazolam with flumazenil. An 82-year-old woman was scheduled to undergo lumbar laminectomy for lumbar spinal canal stenosis. Preoperative echocardiography revealed normal left ventricular systolic function, left atrial enlargement, and impaired left ventricular diastolic function. General anesthesia was induced with 10 mg/kg/h remimazolam and maintained with 0.8 mg/kg/h remimazolam intraoperatively. Before extubation, a total of 1.0 mg of flumazenil was administered. After extubation, the patient developed pulmonary edema due to HFpEF. When remimazolam is administered in elderly patients with cardiac dysfunction, the maintenance dose should be customized according to the patient's general condition to minimize the dosage of flumazenil.
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spelling pubmed-96756022022-11-20 Postoperative Heart Failure with Preserved Ejection Fraction Induced by Flumazenil Administered for Remimazolam Antagonism Koh, Keito Omae, Takeshi Sakuraba, Sonoko Kumemura, Masateru Yamazaki, Sho Yunoki, Hiroshi Case Rep Anesthesiol Case Report Remimazolam is an ultrashort-acting benzodiazepine intravenous anesthetic characterized by rapid awakening after anesthesia. However, the method for administering remimazolam in clinical practice remains unclear. Here, we report a case of postoperative heart failure with preserved ejection fraction (HFpEF) after antagonizing remimazolam with flumazenil. An 82-year-old woman was scheduled to undergo lumbar laminectomy for lumbar spinal canal stenosis. Preoperative echocardiography revealed normal left ventricular systolic function, left atrial enlargement, and impaired left ventricular diastolic function. General anesthesia was induced with 10 mg/kg/h remimazolam and maintained with 0.8 mg/kg/h remimazolam intraoperatively. Before extubation, a total of 1.0 mg of flumazenil was administered. After extubation, the patient developed pulmonary edema due to HFpEF. When remimazolam is administered in elderly patients with cardiac dysfunction, the maintenance dose should be customized according to the patient's general condition to minimize the dosage of flumazenil. Hindawi 2022-11-12 /pmc/articles/PMC9675602/ /pubmed/36411761 http://dx.doi.org/10.1155/2022/8923008 Text en Copyright © 2022 Keito Koh et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Koh, Keito
Omae, Takeshi
Sakuraba, Sonoko
Kumemura, Masateru
Yamazaki, Sho
Yunoki, Hiroshi
Postoperative Heart Failure with Preserved Ejection Fraction Induced by Flumazenil Administered for Remimazolam Antagonism
title Postoperative Heart Failure with Preserved Ejection Fraction Induced by Flumazenil Administered for Remimazolam Antagonism
title_full Postoperative Heart Failure with Preserved Ejection Fraction Induced by Flumazenil Administered for Remimazolam Antagonism
title_fullStr Postoperative Heart Failure with Preserved Ejection Fraction Induced by Flumazenil Administered for Remimazolam Antagonism
title_full_unstemmed Postoperative Heart Failure with Preserved Ejection Fraction Induced by Flumazenil Administered for Remimazolam Antagonism
title_short Postoperative Heart Failure with Preserved Ejection Fraction Induced by Flumazenil Administered for Remimazolam Antagonism
title_sort postoperative heart failure with preserved ejection fraction induced by flumazenil administered for remimazolam antagonism
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675602/
https://www.ncbi.nlm.nih.gov/pubmed/36411761
http://dx.doi.org/10.1155/2022/8923008
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