Successful reversal of remimazolam anesthesia in a "cannot intubate, can ventilate" situation: a case report.
CICV
Difficult laryngoscopy
Epiglottis
Flumazenil
Remimazolam
Journal
JA clinical reports
ISSN: 2363-9024
Titre abrégé: JA Clin Rep
Pays: Germany
ID NLM: 101682121
Informations de publication
Date de publication:
24 Jul 2023
24 Jul 2023
Historique:
received:
28
06
2023
accepted:
16
07
2023
revised:
14
07
2023
medline:
24
7
2023
pubmed:
24
7
2023
entrez:
23
7
2023
Statut:
epublish
Résumé
Compared to other intravenous anesthetics, availability of a specific antagonist flumazenil is a clear advantage of remimazolam. We report a patient who could be rapidly woken up when laryngoscopy and tracheal intubation were unexpectedly difficult. A 62-year-old man was scheduled to have resection of a small gingival tumor. Preoperative airway examination was unremarkable except for an omega-shaped epiglottis. Anesthesia was induced with remifentanil/remimazolam infusion and rocuronium. A small omega-shaped edematous epiglottis precluded identification of glottis. Consciousness and spontaneous ventilation were rapidly restored after administration of flumazenil and sugammadex. Tracheostomy was done under local anesthesia while the patient breathed spontaneously. Remimazolam can be a reasonable induction agent when there are concerns regarding airway management. Avoiding repeated airway manipulations is extremely important to prevent deterioration into a "cannot intubate, cannot ventilate (CICV)" emergency.
Sections du résumé
BACKGROUND
BACKGROUND
Compared to other intravenous anesthetics, availability of a specific antagonist flumazenil is a clear advantage of remimazolam. We report a patient who could be rapidly woken up when laryngoscopy and tracheal intubation were unexpectedly difficult.
CASE PRESENTATION
METHODS
A 62-year-old man was scheduled to have resection of a small gingival tumor. Preoperative airway examination was unremarkable except for an omega-shaped epiglottis. Anesthesia was induced with remifentanil/remimazolam infusion and rocuronium. A small omega-shaped edematous epiglottis precluded identification of glottis. Consciousness and spontaneous ventilation were rapidly restored after administration of flumazenil and sugammadex. Tracheostomy was done under local anesthesia while the patient breathed spontaneously.
CONCLUSIONS
CONCLUSIONS
Remimazolam can be a reasonable induction agent when there are concerns regarding airway management. Avoiding repeated airway manipulations is extremely important to prevent deterioration into a "cannot intubate, cannot ventilate (CICV)" emergency.
Identifiants
pubmed: 37482584
doi: 10.1186/s40981-023-00638-4
pii: 10.1186/s40981-023-00638-4
pmc: PMC10363519
doi:
Types de publication
Journal Article
Langues
eng
Pagination
46Informations de copyright
© 2023. The Author(s).
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