Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct 19;8(1):86.
doi: 10.1186/s40981-022-00576-7.

Long-term delayed emergence after remimazolam-based general anesthesia: a case report

Tsubasa Takemori  1 , Yoshimasa Oyama  2 , Takenori Makino  1 , Seigo Hidaka  1 , Takaaki Kitano  1
Affiliations

Long-term delayed emergence after remimazolam-based general anesthesia: a case report

Tsubasa Takemori et al. JA Clin Rep. .

Abstract

Background: Remimazolam is an ultra-short-acting benzodiazepine anesthetic that is antagonized by flumazenil, and it is typically expected to be applied in anesthesia with the purpose of ensuring early postoperative recovery. We report a case of long-term delayed emergence with re-sedation even after three times of flumazenil administration.

Case presentation: A 71-year-old man was scheduled for a robotic-assisted laparoscopic radical prostatectomy for prostate cancer. We used remimazolam for anesthetic induction and maintenance. The intraoperative bispectral index (BIS) was 30-50. Flumazenil was administered as patient emergence was delayed after surgery; however, re-sedation was observed. This finding persisted till 12 h after surgery, and the patient awakened on postoperative day 2.

Conclusions: Remimazolam is a short-acting anesthetic, but long-term delayed emergence with re-sedation may occur even after flumazenil administration. Anesthesia using remimazolam requires anesthesia management that takes into account the individual differences in sensitivity and metabolism, with BIS as the indicator.

Keywords: Benzodiazepines; Flumazenil; Prostatectomy; Prostatic neoplasms; Remimazolam.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Changes in postoperative consciousness level over time. Arrows show flumazenil administration timings. Solid lines show awake periods, while dashed lines show drowsy periods
See this image and copyright information in PMC

References

    1. Doi M, Morita K, Takeda J, Sakamoto A, Yamakage M, Suzuki T. Efficacy and safety of remimazolam versus propofol for general anesthesia: a multicenter, single-blind, randomized, parallel-group, phase uki remima. J Anesth. 2020;34:543–53. doi: 10.1007/s00540-020-02788-6. - DOI - PubMed
    1. Doi M, Hirata N, Suzuki T, Morisaki H, Morimatsu H, Sakamoto A. Safety and efficacy of remimazolam in induction and maintenance of general anesthesia in high-risk surgical patients (ASA Classt): results of a multicenter, randomized, double-blind, parallel-group comparative trial. J Anesth. 2020;34:491–501. doi: 10.1007/s00540-020-02776-w. - DOI - PubMed
    1. Antonik LJ, Goldwater DR, Kilpatrick GJ, Tilbrook GS, Borkett KM. Placebo- and midazolam-controlled Phase I single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamics of remimazolam. Anesth Analg. 2012;115:274–283. doi: 10.1213/ANE.0b013e31823f0c28. - DOI - PubMed
    1. Kilpatrick GJ, McIntyre MS, Cox RF, Stafford JA, Pacofsky GJ, Lovell GG, et al. CNS 7056: a novel ultra-short-acting Benzodiazepine. Anesthesiology. 2007;107:60–66. doi: 10.1097/01.anes.0000267503.85085.c0. - DOI - PubMed
    1. Wiltshire HR, Kilpatrick GJ, Tilbrook GS, Borkett KM. A placebo-and midazolam-controlled phase I single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamic of remimazolam. Anesth Analg. 2012;115:284–296. doi: 10.1213/ANE.0b013e318241f68a. - DOI - PubMed

LinkOut - more resources