Remimazolam Anesthesia for Modified Electroconvulsive Therapy Mitigates Postoperative Agitation

Postoperative complications, such as immediate postoperative blood pressure elevation, agitation, and delirium, have been associated with modified electroconvulsive therapy (mECT). Remimazolam may reduce postoperative delirium; however, there are no reports of its use in mECT. Herein, we present a case of effective convulsions and calm arousal with remimazolam in a patient with a history of postoperative agitation. The patient was a 45-year-old man who was diagnosed with severe depression and psychotic symptoms and was treated with electroconvulsive therapy (ECT). Owing to previous episodes of agitation upon awakening, remimazolam and suxamethonium were administered, and mECT was performed under general anesthesia to ensure effective convulsions and calm awakening. Intraoperative vital signs were normal, with no signs of agitation post-treatment. Remimazolam administration for general anesthesia induction for mECT effectively induced convulsions and suppressed postoperative excitation. However, its effect on convulsions during mECT remains unclear, warranting further investigation.