Anesthesia Management Involving Remimazolam in a Patient With Pulmonary Hypertension and Right Ventricular Failure: A Case Report

In the anesthetic management of patients with pulmonary hypertension (PH), it is essential to minimize right ventricular (RV) load and prevent abrupt changes in pulmonary vascular resistance (PVR). We report a case in which safe anesthetic management was achieved without circulatory collapse by using remimazolam in a patient with PH. An 84-year-old woman was scheduled to undergo percutaneous left atrial appendage closure for non-valvular atrial fibrillation. She had developed secondary PH and RV failure secondary to atrial fibrillation and systemic sclerosis, necessitating careful general anesthesia with positive pressure ventilation. Total intravenous anesthesia was administered using remifentanil and remimazolam. Hemodynamic stability was maintained throughout induction and intraoperative management. Transesophageal echocardiography performed during the procedure revealed no exacerbation of PH or RV failure, and the percutaneous catheter procedure was completed uneventfully. The patient's postoperative course was also uneventful, and she was discharged without any serious complications. Anesthesia management using remimazolam might be beneficial in patients with PH, as it provides stable hemodynamics and allows for safe perioperative care.