• Hyun Joo Heo, Geonbo Kim, Yu Yil Kim, and Junyoung Park.
• Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Jeollabuk-Do, Korea.
• Medicine (Baltimore). 2023 Aug 11; 102 (32): e34822e34822.

RationaleRemimazolam, a benzodiazepine drug, has recently been developed and is currently used for the induction and maintenance of anesthesia. Remimazolam provides hemodynamic stability during anesthesia induction. However, in patients with cardiac tamponade, it is unclear how hemodynamic stability is maintained during the induction and maintenance of general anesthesia with remimazolam.Patient ConcernsAn 88-year-old male patient had developed hemopericardium due to penetration of a pigtail catheter into the left ventricle during pericardiocentesis, which was performed to treat massive pericardial effusion.DiagnosesThe patient was diagnosed with acute cardiac tamponade and a hemothorax. Hemopericardium and hemothorax were confirmed on chest radiography and computed tomography performed immediately after pericardiocentesis.InterventionsDecompressive pericardiostomy was performed through a left anterolateral thoracotomy with 1-lung ventilation under general anesthesia. Remimazolam was administered for total intravenous anesthesia.OutcomesSevere hypotension and bradycardia occurred during the induction of anesthesia with remimazolam (6 mg/kg/hours).LessonsRemimazolam may induce severe hemodynamic instability during induction of general anesthesia in patient with cardiac tamponade.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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