出血を伴う前置胎盤により緊急帝王切開となった下肢静脈血栓症を有する妊婦のレミマゾラムを用いた全身麻酔の経験

General Anesthesia using Remimazolam for an Emergency Cesarean Section due to Placenta Previa and Vaginal Bleeding in a Parturient with Lower-limb Venous Thrombosis：A Case Report

要旨

　出血性前置胎盤により緊急帝王切開となった下肢静脈血栓症を有する妊婦にレミマゾラムを用いた全身麻酔を行った。術中止血困難で大量出血し，子宮摘出術となったが，術中循環抑制なく管理できた。児のアプガースコアは7/9で出生時啼泣した。循環動態変動高リスク妊婦の帝王切開の全身麻酔にレミマゾラムは良い選択肢となる可能性がある。

　A 32-year-old parturient with left iliofemoral and femoropopliteal vein thrombosis underwent an emergency cesarean section under general anesthesia by remimazolam, due to placenta previa and vaginal bleeding. Remimazolam is a newly developed, short-acting benzodiazepine that exerts a lesser cardiovascular effect compared to classical general anesthetics. Hypotension did not occur and no vasopressors were required during the surgery, but a cesarean hysterectomy was necessary due to massive bleeding and the difficulty of achieving intraoperative hemostasis. The procedure was completed no significant postoperative complications. The newborn cried at birth, and its Apgar scores were 7 at 1 min and 9 at 5 min. Remimazolam can be a strong candidate as a general anesthetic for cesarean sections with possible intraoperative cardiovascular instability.