We performed anesthetic management with remimazolam during dental treatment in a 15-year-old male adolescent patient (height, 146.5 cm ; weight, 35.5 kg) with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS), who had elected to undergo tooth extraction for carious teeth that were not preservable. He had been diagnosed as having MELAS at the age of seven years, following a convulsive seizure, and he also had mental retardation. He was unable to remain calm without the company of his parents, had difficulty communicating, and was aggressive toward medical personnel. Consents for the off-label use of remimazolam (which is indicated for adults only) and the publication of this article were obtained from the patient’s parents. Lacoamide, perampanel hydrate, and ubidecarenone were being used as routine oral medications. Remimazolam was started at 12 mg/kg/h through a peripheral venous route that was secured prior to entering the operation theater, and the patient was sedated without any problems. During surgery, remimazolam (0.8-1.0 mg/kg/h) was administered along with a continuous remifentanil infusion (0.15-0.2 μg/kg/min), and a sedation monitor was observed continuously. The patient’s lactate level was 2.2 mmol/L at the start of the first hour of surgery. The surgical and anesthetic times were 107 min and 193 min, respectively. There were no problems with the patient’s progress after leaving the operating theater, and he was discharged safely the next day.
In conclusion, anesthesia using remimazolam seemed to be useful in an adolescent patient with MELAS.
