Two Cases of Remimazolam Anesthesia Managed With Pharmacokinetic Simulations in an Awake Craniotomy of Patients With Obesity

Anesthetic management for awake craniotomy (AC) often poses problems in patients with obesity including respiratory management. The Japan Awake Craniotomy Guidelines state that the indication for surgery should be carefully considered, especially in patients with obesity (body mass index (BMI) > 30). Patients with obesity often have comorbidities such as dyslipidemia, hypertension, and type 2 diabetes, and this is a risk factor for perioperative morbidity and mortality. Remimazolam, a new intravenous anesthetic, has been reported to be useful in anesthesia management during AC, but its use in obese patients has not been reported. Herein, we report two cases case series in which remimazolam was used in patients with obesity and safely managed under anesthesia with the pharmacokinetic simulations.