J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

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Case Report

Volume 000, Number 000, October 2025, pages 000-000

Perioperative Care of a Child With Combined Oxidative Phosphorylation Deficiency 6: Total Intravenous Anesthesia With Remimazolam

Table

**Table 1.** Intraoperative Medications and Indications
Perioperative time	Medication, route, and dose	Comments
IM: intramuscular; IV: intravenous; ETT: endotracheal tube; OR: operating room; MAP: mean arterial pressure; BIS: bispectral index; PONV: postoperative nausea and vomiting.
Preoperative sedation	Ketamine (5 mg/kg) IM	Patient had preoperative agitation and would not come to the OR.
Induction of anesthesia	Peripheral IV placed after 50% nitrous oxide in oxygen	Trachea intubated without difficulties with a 6.0-mm cuffed ETT.
	IV lidocaine (1 mg/kg), fentanyl (2 µg/kg), and remimazolam (two doses of 0.25 mg/kg/dose for a total of 0.5 mg/kg)
	Neuromuscular blockade with rocuronium (0.5 mg/kg)
Maintenance anesthesia	Methadone (0.1 mg/kg), remifentanil (0.1 - 0.5 µg/kg/min), remimazolam (5 - 25 µg/kg/min), and lidocaine (1 mg/kg/h)	Titrated to clinical needs to maintain the MAP and BIS.
Other intraoperative medications	Surgical site infection prophylaxis: IV cefazolin (50 mg/kg every 3 h) and a single dose of IV gentamicin (5 mg/kg)	No intraoperative concerns noted.
	Tranexamic acid (50 mg/kg followed by 5 mg/kg/h)	Measures to limit allogenic blood transfusion included intraoperative blood salvage and tranexamic acid.
	Clevidipine (0.3 - 0.6 µg/kg/min) or phenylephrine (0.4 - 0.7 µg/kg/min)	IV clevidipine or phenylephrine used to control MAP.
Postoperative course	IV acetaminophen (15 mg/kg) and ketorolac (0.5 mg/kg)	Acetaminophen and ketorolac to supplement opioid analgesia.
	IV ondansetron (4 mg) and dexamethasone (4 mg) administered for prevention of postoperative nausea and vomiting	Dexamethasone and ondansetron for prevention of PONV.