Anesthetic Management with Remimazolam in an Arrhythmogenic Right Ventricular Cardiomyopathy Patient with a History of Stable Sustained Ventricular Tachycardia: A Case Report
Hiroki Iwanaga
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo 857-0134, Japan.
Hiroshi Aoki *
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo 857-0134, Japan.
Yoshiaki Terao
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo 857-0134, Japan.
Ekuko Fujimoto
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo 857-0134, Japan.
Makito Oji
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo 857-0134, Japan.
Natsuko Oji
Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo 857-0134, Japan.
Tetsuya Hara
Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan.
*Author to whom correspondence should be addressed.
Abstract
Aims: Arrhythmogenic right ventricular cardiomyopathy (ARVC) may cause sudden and unexpected deaths during the perioperative period. This study reports a case of ARVC, safely managed using total intravenous anesthesia with remimazolam.
Presentation of Case: A 51-year-old male patient (weight: 100.1 kg, height: 171.0 cm) with a history of ARVC underwent open cholecystectomy. The patient underwent total intravenous anesthesia with remimazolam, remifentanil, and a modified thoracoabdominal nerves block perichondrial approach for postoperative analgesia. Hemodynamic stability was maintained throughout the surgery. Catecholamine use was not warranted during the perioperative period. No episodes of stable sustained ventricular tachycardia or other cardiovascular episodes were observed.
Discussion and Conclusion: ARVC is a genetically-determined heart muscle disease characterized by life-threatening ventricular arrhythmias in apparently healthy young people. Anesthesiologists should pay close attention to the anesthetic management of patients with ARVC. Remimazolam can be safely used in such cases.
Keywords: Arrhythmogenic right ventricular cardiomyopathy, ventricular tachycardia, perioperative sudden cardiac death, electrocardiogram, \(\beta\)-blockers