Successful Anesthetic Management Using Remimazolam in a Patient With Spinocerebellar Degeneration Undergoing Pulmonary Resection

Spinocerebellar degeneration (SCD) comprises a broad range of neurodegenerative disorders mainly characterized by cerebellar ataxia, and the prevention of perioperative respiratory complications is of great importance in patients with cerebellar ataxia. Clinical papers addressing anesthetic management using remimazolam in patients with SCD, specifically those undergoing pulmonary resection, are limited. A 79-year-old man with cortical cerebellar atrophy, a sporadic adult-onset SCD, was admitted for pulmonary resection for primary lung adenocarcinoma. He has experienced chronic aspiration caused by dysphagia, placing him at an increased risk for perioperative respiratory complications. Video-assisted right S6 segmentectomy was performed under general-epidural anesthesia using remimazolam, remifentanil, and local anesthetics. During emergence from anesthesia and tracheal extubation, a supraglottic airway was inserted while the double-lumen tube remained in place, after which the tube was removed under deep anesthesia. Subsequently, continuous infusion of remimazolam and remifentanil was terminated, and remimazolam was antagonized using flumazenil. After confirmation of spontaneous breathing and response to verbal commands, the supraglottic airway was removed without triggering the cough reflex or laryngospasm. The patient was fully conscious and did not experience re-sedation or respiratory depression. Furthermore, he had a good postoperative course and was discharged without respiratory complications or exacerbation of neurological symptoms. In conclusion, anesthetic management using remimazolam alongside careful airway management contributed to the successful management of a patient with SCD undergoing pulmonary resection. For a patient exhibiting cerebellar ataxia, remimazolam can be a useful anesthetic agent.