Remimazolam Induction in a Patient with Super-Super Obesity and Obstructive Sleep Apnea: A Case Report

Abstract

Background: With the rising prevalence of obesity, anesthesiologists are expected to increasingly encounter patients with obesity, which poses challenges for anesthetic management. The use of remimazolam, an intravenous anesthetic agent approved in 2020, may be beneficial in these patients. However, its use in patients with super-super obesity remains underexplored. Case Description: A 55-year-old woman with a body mass index (BMI) of 60.6 kg/m2 and moderate obstructive sleep apnea (OSA) underwent laparoscopic sleeve gastrectomy under general anesthesia. The transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) technique was used along with the administration of remimazolam at a rate of 6 mg/kg/h based on the total body weight. The patient was sedated within 125 s without any signs of hemodynamic instability, and the surgery was completed successfully. Conclusions: This case study demonstrates the potential effectiveness of remimazolam infusion for inducing general anesthesia in patients with super-super obesity. The infusion rate, derived from the total body weight, yielded an outcome comparable with that observed in individuals without obesity. Further studies with larger cohorts are required to confirm these findings.

Remimazolam for general anesthesia in a patient with aortic stenosis and severe obesity undergoing transcatheter aortic valve implantation

“…Continuous infusion of remimazolam 6 mg/kg/h was used for induction of general anesthesia in a morbidly obese patient [ 4 ]. In a previous study involving patients aged 60–80 years, the induction dose ranged from 0.14 to 0.19 mg/kg [ 6 ].…”

“…Remimazolam has a rapid onset, less circulatory suppression, a short and predictable duration of sedation, and the ability to be antagonized using flumazenil [ 1 – 3 ]. These pharmacological features make remimazolam a potentially useful anesthetic for severely obese patients and those with unstable circulation [ 4 ]. Despite its potential benefits, there is currently limited research on the clinical use of remimazolam in severely obese patients.…”