フルマゼニルによるレミマゾラム拮抗後に生じた流涎・呼吸困難がフルマゼニル再投与により改善した脊髄小脳変性症6型の1症例

Abatement of Sialorrhea and Dyspnea After Re-administration of Flumazenil for Antagonizing Remimazolam in a Patient with Spinocerebellar Ataxia Type 6

要旨

　脊髄小脳変性症6型の患者にレミマゾラムで全身麻酔を行い，術後にフルマゼニルで拮抗した。拮抗の約1時間後に流涎と呼吸困難を生じた。フルマゼニルの再投与で改善したため，レミマゾラムの効果再発現の影響が疑われた。脊髄小脳変性症の患者では，レミマゾラムおよびフルマゼニルの慎重な使用が求められる。

　A 57-year-old female with spinocerebellar ataxia type 6 underwent a total abdominal hysterectomy with bilateral tubal oophorectomy for uterine cancer under general anesthesia with remimazolam. Postoperative arousal and extubation were achieved after the administration of 0.5 mg flumazenil for antagonizing remimazolam. Approximately 1 hour after the flumazenil administration, the patient exhibited symptoms of sialorrhea and dyspnea. These symptoms rapidly abated with a subsequent administration of 0.5 mg flumazenil. In patients with spinocerebellar ataxia, a careful use of remimazolam and flumazenil is required, as the reappearance of the effects of remimazolam may cause symptoms associated with spinocerebellar ataxia, such as drooling and dyspnea.