scholarly journals Anesthetic management of super-elderly patients with remimazolam: a report of two cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Junko Nakayama ◽  
Tomomi Ogihara ◽  
Rui Yajima ◽  
Yasushi Innami ◽  
Takashi Ouchi
Keyword(s):  
Elderly Patients ◽  
General Anesthesia ◽  
Small Dose ◽  
Elderly Women ◽  
Anesthetic Management ◽  
Vital Signs ◽  
Rapid Onset ◽  
Women Patients ◽  
Hip Fracture Surgery ◽  
Adequate Sedation

Abstract Background Remimazolam is a newly developed benzodiazepine with more rapid onset and offset of sedation effects than midazolam. We report elderly patients in whom a small dose of remimazolam was successfully used for general anesthesia. Case presentation Two elderly women (patients 1 and 2, aged 95 and 103 years, respectively) underwent hip fracture surgery under general anesthesia guided by bispectral index (BIS). Anesthesia was induced with 1.2 and 1.0 mg/kg/h and maintained with 0.2 and 0.1 mg/kg/h remimazolam, combined with fentanyl and remifentanil in patients 1 and 2, respectively. Their hemodynamics were stable with a small dose of vasopressor, and they awoke soon after the discontinuation of remimazolam without flumazenil reversal. Their postoperative courses were uneventful without any complications. Conversely, the remimazolam dose required to achieve adequate sedation were much lower than expected. Conclusion Remimazolam could be useful in general anesthesia, particularly for super-elderly patients. However, the appropriate dose for induction and maintenance of anesthesia should be carefully considered based on BIS or vital signs.

scholarly journals Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Chung-Sik Oh ◽  
Ka Young Rhee ◽  
Tae-Gyoon Yoon ◽  
Nam-Sik Woo ◽  
Seung Wan Hong ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
General Anesthesia ◽  
Cholinesterase Inhibitor ◽  
Postoperative Delirium ◽  
Neuromuscular Block ◽  
Pulmonary Complications ◽  
Laboratory Findings ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Background.Residual neuromuscular block (NMB) after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD). We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery.Methods.Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor.Results.The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.;P=0.750). Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min;P<0.001) and the frequency of postoperative hypoxia were significantly lower (23% versus 43%;P=0.010) in the sugammadex group than in the conventional cholinesterase inhibitor group.Conclusion.Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia.

scholarly journals Comparison of Effects between Combined Lumbar-Sacral Plexus Block plus General Anesthesia and Unilateral Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery: A Pilot Randomized Controlled Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Lili Tang ◽  
Panpan Fang ◽  
Yuxin Fang ◽  
Yao Lu ◽  
Guanghong Xu ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Postoperative Delirium ◽  
Sacral Plexus ◽  
Hip Fracture Surgery ◽  
Unilateral Spinal Anesthesia ◽  
Plexus Block ◽  
Fracture Surgery

Purpose. Hip fracture is a common injury in geriatric populations, which is associated with poor quality of life. However, the ideal anesthesia technique for this disease is yet to be identified. This study aimed to compare the combined lumbar-sacral plexus block (CLSB) plus general anesthesia (bispectral index (BIS) 60–80) with the unilateral spinal anesthesia (SA) on activity of daily living in elderly patients undergoing hip fracture surgery. Methods. A total of 124 elderly patients undergoing hip fracture surgery were randomly assigned to two groups. Patients in the SA group received light-specific gravity spinal anesthesia, and patients in the CLSB group received lumbar and sacral plexus block with general anesthesia (BIS 60–80). The primary outcomes were 30-day activity of daily living (ADL). The secondary outcomes were postoperative pain scores, postoperative delirium, in-hospital cost, and major complications. Results. The ADL scores of postoperative day 30 (POD30) in the CLSB group are higher than those in the SA group (27.34 ± 7.01 versus 24.70 ± 6.40, P = 0.045 ). Compared to preoperative ADL scores, there were higher increased scores in the CLSB group than in POD30 (CLSB group 8.09 ± 3.39 versus SA group 4.87 ± 3.90, P < 0.001 ). Mild-to-moderate pain did not have differences between the two groups (rest pain: 3 versus 2, P = 0.344 ; motion pain: 5 versus 4, P = 0.073 ). There were no significant differences in incidence of postoperative delirium, PONV, and other complications. Conclusion. The unilateral SA can reduce the deterioration of ADL after hip fracture surgery and provide a better postoperative recovery.

scholarly journals General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Matsuyuki Doi ◽  
Yoshiki Nakajima
Keyword(s):  
Lactic Acidosis ◽  
General Anesthesia ◽  
Mitochondrial Disease ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Mitochondrial Encephalomyopathy ◽  
Anesthesia Induction ◽  
General Anesthetic ◽  
Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

scholarly journals Junctional Rhythm Preoperatively and During General Anesthesia for Oral and Maxillofacial Surgery

2017 ◽  
Vol 64 (3) ◽  
pp. 165-167 ◽  
Author(s):  
Naotaka Kishimoto ◽  
Ikue Kinoshita ◽  
Yoshihiro Momota
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Anesthetic Management ◽  
Maxillofacial Surgery ◽  
Oral And Maxillofacial Surgery ◽  
Anesthesia Induction ◽  
Sagittal Split Ramus Osteotomy ◽  
Junctional Rhythm ◽  
Appropriate Treatment ◽  
Slow Heart Rate

We report a case of junctional rhythm that occurred both preoperatively and later during a portion of general anesthesia. A 19-year-old woman was scheduled to undergo bilateral sagittal split ramus osteotomy after being diagnosed with a jaw deformity. Preoperative electrocardiography (ECG) revealed a junctional rhythm with a slow heart rate (HR). At 90 minutes after anesthesia induction, local anesthesia with 10 mL of 1% lidocaine and 1:100,000 adrenaline was administered. A junctional rhythm appeared 15 minutes after the local anesthesia. We believe that the atrioventricular nodal pacemaker cells accelerated because of the increased sympathetic activity due to the adrenaline. On the preoperative ECG, the junctional rhythm with slow HR appeared as an escaped beat caused by slowing of the primary pacemaker. Therefore, we think that the preoperative junctional rhythm and the junctional rhythm that appeared during general anesthesia were due to different causes. Understanding the cause of a junctional rhythm could lead to more appropriate treatment. We therefore believe that identifying the cause of the junctional rhythm is important in anesthetic management.

Anesthesia and post-operative delirium in elderly patients undergoing hip fracture surgery

2013 ◽  
Vol 4 ◽  
pp. S17-S18 ◽  
Author(s):  
G. Bellelli ◽  
P. Mazzola ◽  
M. Corsi ◽  
A. Mazzone ◽  
G. Vitale ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Hip Fracture Surgery ◽  
Fracture Surgery
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