Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2023; 11(14): 3330-3339
Published online May 16, 2023. doi: 10.12998/wjcc.v11.i14.3330
Successful remimazolam sedation-epidural block in an older patient with severe chronic obstructive pulmonary disease: A case report
Jia-Jia Yu, Huan-Shuang Pei, Yu Meng
Jia-Jia Yu, Huan-Shuang Pei, Yu Meng, Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Author contributions: Yu JJ and Meng Y participated in anesthesia management in the present case, and both were major contributors to this manuscript; Pei HS helped revise the manuscript; and all authors have read and approved the final version of the manuscript.
Informed consent statement: The patient profiled in this case report provided written informed consent for the anonymized publication of his case report findings and all accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Huan-Shuang Pei, MD, Associate Professor, Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, No. 12 Jian-Kang Road, Chang’ an District, Shijiazhuang 050000, Hebei Province, China. wxhmz99999@163.com
Received: February 15, 2023
Peer-review started: February 15, 2023
First decision: March 14, 2023
Revised: March 18, 2023
Accepted: April 4, 2023
Article in press: April 4, 2023
Published online: May 16, 2023
Processing time: 89 Days and 18.3 Hours
Abstract
BACKGROUND

Chronic obstructive pulmonary disease (COPD) is associated with high morbidity and mortality rates worldwide. Older patients have a degenerative cardiopulmonary function, weak compensatory capacity, and poor surgical tolerance. Therefore, the mode of anesthesia must be optimized. Remimazolam is a new ultrashort-acting benzodiazepine with a rapid onset of action, rapid metabolism, and mild effects on pulmonary circulation. Remimazolam sedation combined with an epidural block has not been reported in hypertensive older adults with severe COPD and inguinal mass resection.

CASE SUMMARY

We report the case of a 73-year-old man with hypertension and severe COPD, who underwent resection of an enlarged inguinal mass that he had noticed more than 7 mo before presentation. The patient presented with a “right inguinal mass” and was recommended to undergo an enlarged inguinal mass resection. Surgery was relatively challenging, due to the large mass (13 cm × 8 cm × 7 cm), hard texture, and poor mobility. Considering the advanced age of the patient, grade III hypertension, and severe COPD, we administered remimazolam combined with an epidural block for anesthesia to ensure perioperative safety and careful consideration. The anesthetic effect was precise; the procedure was performed smoothly without any complications, and the patient was successfully anesthetized. However, anesthetic management in such cases has not yet been reported by previous studies.

CONCLUSION

Remimazolam sedation combined with an epidural block is safe and effective in older patients with hypertension and severe COPD.

Keywords: Remimazolam; Older adult; Chronic obstructive pulmonary disease; Epidural block; Case report

Core Tip: Chronic obstructive pulmonary disease (COPD) is associated with high morbidity and mortality rates. Older patients have degenerative systems with weak compensatory capacity. Therefore, their status must be carefully evaluated to optimize the anesthesia plan when choosing an anesthetic agent for surgery. Remimazolam sedation combined with an epidural block in older adults with hypertension and severe COPD has rarely been reported. Our management experience shows that remimazolam sedation combined with an epidural block is safe and effective in older adults with hypertension and severe COPD.