J Med Cases

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

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Case Report

Volume 17, Number 11, November 2026, pages 660-664

Remimazolam-Based Total Intravenous Anesthesia for Cardiac Surgery in an Infant With a Pathogenic RYR1 Variant

↓ **Table 1.** Reports of Remimazolam Administration to Patients With Possible Malignant Hyperthermia Susceptibility
First author and reference	Patient demographics	Surgical procedure	Anesthetic agents administered
BIS: Bispectral Index; CPB: cardiopulmonary bypass; NM: neuromuscular; NMBA: neuromuscular blocking agent.
Uchiyama et al [15]	26-year-old, 64 kg male	Endoscopic sinus surgery and septoplasty	Induction: remimazolam infusion (12 mg/kg/h) with fentanyl, remifentanil, and rocuronium (doses not specified). Maintenance: remimazolam infusion (1.5 mg/kg/h) with rocuronium, fentanyl, and remifentanil (doses not specified).
Kondo et al [16]	72-year-old, 71 kg male	Endoscopic sinus surgery and nasal septoplasty	Induction: remimazolam (0.1 mg/kg), fentanyl (50 µg), and rocuronium (50 mg). Maintenance: remimazolam and remifentanil infusions (doses not specified), intermittent rocuronium (10 mg) guided by NM monitoring; flumazenil 0.2 mg for emergence.
Blansky et al [17]	6-month-old, 5.9 kg female infant	Repair of atrioventricular canal	Premedication: oral midazolam (0.5 mg/kg). Induction: remimazolam (10–15 µg/kg/min) and dexmedetomidine (0.5 µg/kg/min); endotracheal intubation facilitated with fentanyl (25 µg) and rocuronium (5 mg). Maintenance: remifentanil (0.3 µg/kg/min) and dexmedetomidine (0.5 µg/kg/min). Milrinone (0.25 µg/kg/min) during rewarming. Additional agents during CPB: propofol boluses (2–4 mg/kg), fentanyl boluses (total 35 µg), nitroprusside infusion (1 µg/kg/min). Reversal of NM blockade: sugammadex (8 mg/kg × 2 doses).
Petkus et al [18]	6-year-old, 24.3 kg girl	Dental rehabilitation procedure	Induction: propofol (4 mg/kg). No NMBA. Maintenance: remimazolam (5–7 µg/kg/min) with propofol (50 µg/kg/min). Analgesia with morphine (1 mg) and ketorolac (0.5 mg/kg).
Zhu et al [19]	1-year-old, 9 kg boy	Orchidopexy	Induction: remimazolam (0.2 mg/kg) and alfentanil (10 µg/kg). Maintenance: remimazolam (1–2 mg/kg/h) and alfentanil (10–20 µg/kg/h). Caudal block with 0.25% ropivacaine.
Murao et al [20]	80-year-old, 49 kg male	Laparoscopic inguinal hernia repair	Induction: remimazolam (12 mg/kg/h), fentanyl (50 µg), remifentanil (0.5 µg/kg/min), and rocuronium (40 mg). Maintenance: remimazolam infusion adjusted to the BIS, remifentanil infusion, and intermittent rocuronium (10 mg) guided by NM monitoring.

↓ Table 1. Reports of Remimazolam Administration to Patients With Possible Malignant Hyperthermia Susceptibility

First author and reference

Patient demographics

Surgical procedure

Anesthetic agents administered

BIS: Bispectral Index; CPB: cardiopulmonary bypass; NM: neuromuscular; NMBA: neuromuscular blocking agent.

Uchiyama et al [15]

26-year-old, 64 kg male

Endoscopic sinus surgery and septoplasty

Induction: remimazolam infusion (12 mg/kg/h) with fentanyl, remifentanil, and rocuronium (doses not specified).
Maintenance: remimazolam infusion (1.5 mg/kg/h) with rocuronium, fentanyl, and remifentanil (doses not specified).

Kondo et al [16]

72-year-old, 71 kg male

Endoscopic sinus surgery and nasal septoplasty

Induction: remimazolam (0.1 mg/kg), fentanyl (50 µg), and rocuronium (50 mg). Maintenance: remimazolam and remifentanil infusions (doses not specified), intermittent rocuronium (10 mg) guided by NM monitoring; flumazenil 0.2 mg for emergence.

Blansky et al [17]

6-month-old, 5.9 kg female infant

Repair of atrioventricular canal

Premedication: oral midazolam (0.5 mg/kg).
Induction: remimazolam (10–15 µg/kg/min) and dexmedetomidine (0.5 µg/kg/min); endotracheal intubation facilitated with fentanyl (25 µg) and rocuronium (5 mg).
Maintenance: remifentanil (0.3 µg/kg/min) and dexmedetomidine (0.5 µg/kg/min). Milrinone (0.25 µg/kg/min) during rewarming.
Additional agents during CPB: propofol boluses (2–4 mg/kg), fentanyl boluses (total 35 µg), nitroprusside infusion (1 µg/kg/min).
Reversal of NM blockade: sugammadex (8 mg/kg × 2 doses).

Petkus et al [18]

6-year-old, 24.3 kg girl

Dental rehabilitation procedure

Induction: propofol (4 mg/kg). No NMBA.
Maintenance: remimazolam (5–7 µg/kg/min) with propofol (50 µg/kg/min). Analgesia with morphine (1 mg) and ketorolac (0.5 mg/kg).

Zhu et al [19]

1-year-old, 9 kg boy

Orchidopexy

Induction: remimazolam (0.2 mg/kg) and alfentanil (10 µg/kg).
Maintenance: remimazolam (1–2 mg/kg/h) and alfentanil (10–20 µg/kg/h).
Caudal block with 0.25% ropivacaine.

Murao et al [20]

80-year-old, 49 kg male

Laparoscopic inguinal hernia repair

Induction: remimazolam (12 mg/kg/h), fentanyl (50 µg), remifentanil (0.5 µg/kg/min), and rocuronium (40 mg).
Maintenance: remimazolam infusion adjusted to the BIS, remifentanil infusion, and intermittent rocuronium (10 mg) guided by NM monitoring.