The intraoperative motor-evoked potential when propofol was changed to remimazolam during general anesthesia: a case series

Remimazolam is a short-acting benzodiazepine that was approved for clinical use in 2020. We report three patients who underwent surgery for cerebral and spinal cord tumors, in whom transcranial electrical stimulation-motor-evoked potential (TES-MEP) was successfully monitored under general anesthesi...

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Bibliographic Details
Published in:Journal of anesthesia 2023-02, Vol.37 (1), p.154-159
Main Authors: Yamada, Shoto, Akiyama, Yukinori, Tachibana, Shunsuke, Hayamizu, Kengo, Kimura, Yusuke, Hashimoto, Shuichi, Yamakage, Michiaki, Mikuni, Nobuhiro
Format: Article
Language:English
Subjects:
Anesthesia
Anesthesia, General
Anesthesiology
Anesthetics, Intravenous
Benzodiazepines - pharmacology
Care and treatment
Clinical Report
Critical Care Medicine
Emergency Medicine
Evoked Potentials, Motor - physiology
Humans
Intensive
Medicine
Medicine & Public Health
Monitoring, Intraoperative
Pain Medicine
Patients
Phenols
Propofol - pharmacology
Remifentanil
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Summary:Remimazolam is a short-acting benzodiazepine that was approved for clinical use in 2020. We report three patients who underwent surgery for cerebral and spinal cord tumors, in whom transcranial electrical stimulation-motor-evoked potential (TES-MEP) was successfully monitored under general anesthesia with remimazolam. During total intravenous anesthesia with propofol at a target concentration of 2.7 − 3.5 µg/mL and 0.1 − 0.35 µg/kg/min of remifentanil, delayed awakening, bradycardia, and hypotension during propofol anesthesia were expected in all three cases. With patient safety as the top priority, we considered changing the anesthetic agent. Propofol was replaced with remimazolam at a loading dose of 12 mg/kg/h for a few seconds (case 3), followed by 1 mg/kg/h for maintenance (cases 1–3). TES-MEP was recorded during propofol and remimazolam administration in all three patients. Amplitudes of TES-MEP during anesthesia with propofol and remimazolam were 461.5 ± 150 µV and 590.5 ± 100.9 µV, 1542 ± 127 µV and 1698 ± 211 µV, and 581.5 ± 91.3 µV and 634 ± 82.7 µV sequentially from Case 1. Our findings suggest that intraoperative TES-MEP could be measured when anesthesia was managed with remimazolam at 1 mg/kg/h.
ISSN:0913-8668
1438-8359
DOI:10.1007/s00540-022-03112-0