重症筋無力症患者に対するレミマゾラムを用いた全静脈麻酔の経験

Total Intravenous Anesthesia Using Remimazolam for a Patient with Myasthenia Gravis：A Case Report

要旨

　全身麻酔中に重度低血圧既往のある重症筋無力症患者に全身麻酔が予定された。レミマゾラムは筋弛緩作用遷延の可能性があるため重症筋無力症に禁忌とされるが，低血圧を生じにくく，超短時間作用性で作用遷延リスクが低い。今回，当該患者に対して，レミマゾラム麻酔を行い，術中重度低血圧も術後筋弛緩遷延もなく管理できた。

　A 64-year-old woman with myasthenia gravis（MG）was scheduled for endoscopic gastric mucosectomy under general anesthesia. She had a history of severe intraoperative hypotension under general anesthesia with propofol and remifentanil. Remimazolam, a ultrashort-acting benzodiazepine, has less potent cardiovascular depression effect than propofol or sevoflurane. Remimazolam is contraindicated for patients with myasthenia gravis in drug information documents because of possible risks of prolonged muscle weakness and respiratory depression. To avoid excessive hypotension, we used it for general anesthesia. She revealed no excessive intraoperative hypotension and no prolongation of postoperative muscle weakness.