General anesthesia with remimazolam for a pediatric patient with MELAS and recurrent epilepsy: a case report

Yusuke Yamadori; Yuki Yamagami; Yukihisa Matsumoto; Mari Koizumi; Akiyo Nakamura; Daiskuke Mizuta; Kyoko Yasuda; Gotaro Shirakami

doi:10.1186/s40981-022-00564-x

General anesthesia with remimazolam for a pediatric patient with MELAS and recurrent epilepsy: a case report

JA Clin Rep. 2022 Sep 16;8(1):75. doi: 10.1186/s40981-022-00564-x.

Authors

Yusuke Yamadori^{1

2}, Yuki Yamagami³, Yukihisa Matsumoto³, Mari Koizumi³, Akiyo Nakamura³, Daiskuke Mizuta³, Kyoko Yasuda³, Gotaro Shirakami⁴

Affiliations

¹ Department of Anesthesiology, Takamatsu Red Cross Hospital, 4-1-3 Bancho, Takamatsu City, Kagawa, 760-0017, Japan. yamadori.yusuke@kagawa-u.ac.jp.
² Department of Anesthesia and Pain Medicine, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kagawa, 761-0793, Japan. yamadori.yusuke@kagawa-u.ac.jp.
³ Department of Anesthesiology, Takamatsu Red Cross Hospital, 4-1-3 Bancho, Takamatsu City, Kagawa, 760-0017, Japan.
⁴ Department of Anesthesia and Pain Medicine, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kagawa, 761-0793, Japan.

Abstract

Background: Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) is a mitochondrial disease. We report here the safe use of remimazolam in a pediatric MELAS patient.

Case presentation: A 10-year-old girl (118 cm, 16 kg) was scheduled for an open gastrostomy to improve nutrition and epileptic seizure control. We induced and maintained general anesthesia with remimazolam, remifentanil, fentanyl, and rocuronium. We also performed a bilateral subcostal transversus abdominis plane block before the surgery. The surgery finished uneventfully. After we discontinued remimazolam administration, the patient woke up immediately but calmly without flumazenil. Epileptic seizures did not occur during intra- and early post-operative periods.

Conclusion: Remimazolam enabled us to provide a pediatric MELAS patient with general anesthesia without causing delayed emergence or epileptic seizures.

Keywords: Epilepsy; Epileptic seizure; General anesthesia; MELAS; Mitochondrial Encephalomyopathy; Open gastrostomy; Remimazolam.