Usefulness of Remimazolam for Anesthesia Management of Kidney Transplantation in a Patient with Cognitive Decline: A Case Report

Abstract

Remimazolam is an ultrashort-acting benzodiazepine whose action is not prolonged. It is rapidly hydrolyzed, mainly by hepatic carboxylesterase 1, resulting in a short duration of action and little metabolic activity, so its effects are not prolonged in patients with renal impairment. It is useful for anesthesia management in kidney transplantation because it causes little decrease in blood pressure. We report the use of remimazolam in the management of kidney transplantation in a patient with cognitive decline. The patient was a 46-year-old woman on maintenance hemodialysis. She had experienced cognitive decline after a subarachnoid hemorrhage. She was managed with combined epidural general anesthesia, which was induced with remimazolam, remifentanil, and rocuronium, and was maintained with remimazolam, remifentanil, and levobupivacaine. Intraoperatively, there is no decrease in blood pressure, remimazolam was discontinued after surgery, and she awoke immediately and was extubated in the operating room without postoperative delirium. In conclusion, remimazolam causes less hypotension than other agents and was useful for anesthesia management of kidney transplantation in a patient with cognitive decline. Remimazolam has little effect on metabolites, so even patients with renal failure and a history of postoperative delirium do not have prolonged effects and may experience rapid, mild awakening and extubation without postoperative delirium and no need for re-sedation.