| Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access |
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Case Report
Volume 16, Number 11, November 2025, pages 434-439
Perioperative Care of a Child With Combined Oxidative Phosphorylation Deficiency 6: Total Intravenous Anesthesia With Remimazolam
Table
| 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. | |