Anesthetic management with remimazolam in very elderly patients undergoing hybrid surgery of transcatheter aortic valve implantation plus off-pump coronary artery bypass grafting: report of two cases

Takafumi Oyoshi; Yuki Mitsuta; Yumiko Uemura; Koichiro Tajima; Naoyuki Hirata

doi:10.1186/s40981-023-00662-4

Anesthetic management with remimazolam in very elderly patients undergoing hybrid surgery of transcatheter aortic valve implantation plus off-pump coronary artery bypass grafting: report of two cases

JA Clin Rep. 2023 Oct 25;9(1):69. doi: 10.1186/s40981-023-00662-4.

Authors

Takafumi Oyoshi¹, Yuki Mitsuta², Yumiko Uemura³, Koichiro Tajima⁴, Naoyuki Hirata⁴

Affiliations

¹ Department of Anesthesiology, Kumamoto University, Graduate School of Medical Sciences, Kumamoto, Japan. turkey8505@yahoo.co.jp.
² Department of Anesthesiology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
³ Department of Anesthesiology, Minamata City General Hospital and Medical Center, Kumamoto, Japan.
⁴ Department of Anesthesiology, Kumamoto University, Graduate School of Medical Sciences, Kumamoto, Japan.

Abstract

Background: Remimazolam is a short-acting benzodiazepine with small circulatory depression. We used remimazolam for general anesthesia management in two very elderly patients undergoing hybrid surgery of transcatheter aortic valve implantation (TAVI) plus off-pump coronary artery bypass grafting (OPCABG).

Case presentation: A 96-year-old man (case 1) and a 92-year-old woman (case 2) had complex coronary artery disease (CAD) and severe aortic stenosis (AS) and were scheduled for TAVI plus OPCAB. Anesthesia in both patients was induced with 6 mg/kg/h remimazolam and fentanyl and maintained with 0.3 mg/kg/h and 0.5 mg/kg/h remimazolam and fentanyl, respectively. Although catecholamines were required, we successfully maintained circulation during the induction of anesthesia and the procedures of OPCAB and TAVI. Both patients were discharged without complications.

Conclusion: Remimazolam can be a useful option for safe general anesthesia in very elderly patients when performing hybrid surgery.

Keywords: Aortic stenosis; Elderly; Hemodynamics; Hybrid surgery; Off-pump coronary artery bypass grafting; Remimazolam; Transcatheter aortic valve implantation.