A New Anesthetic, Remimazolam, Is Useful in the Management of Anesthesia in Patients with Liver Cirrhosis

Abstract

Background: Management of general anesthesia in patients with liver cirrhosis is challenging because it is difficult to maintain the circulation and concentration of anesthetics within a safe range. Unlike many other anesthetics, which are metabolized by cytochrome P450 enzymes, remimazolam is metabolized by carboxylesterase. In a liver cirrhosis model, cytochrome P450 activity is suppressed by approximately 30%; however, carboxylesterase activity is maintained at approximately 60%. Also, remimazolam is less likely to inhibit circulation. A 77-year-old woman was scheduled to undergo laparoscopic cholecystectomy. The patient was diagnosed with Child-Pugh B liver cirrhosis due to type C viral hepatitis. General anesthesia with remimazolam stabilized the intraoperative circulation and resulted in rapid postoperative awakening.

Conclusion: We report a case in which a patient with Child-Pugh B cirrhosis was safely managed under general anesthesia using remimazolam during laparoscopic cholecystectomy.

Figure 1

Anesthetic chart of this case. The anesthetic chart recorded by Prescient ORFujifilm Medical Corporation, Tokyo, Japan. T1: body temperature; HR: heart rate; PR: pulse rate; NIBP: noninvasive blood pressure; ART: arterial pressure (invasive); RR: respiratory ratio; SpO2: oxygen saturation; BIS: Bispectral Index; EtCO2: end-tidal carbon dioxide; ■: in operation room and out operation room; ×: start of anesthesia and end of anesthesia; T: intubation and extubation; ◎: start of operation and end of the operation; R: Sugammadex reverse rocuronium.