Leigh-Syndrome Anesthesia Case Required Recovery and Airway Management After Remimazolam

A spinal-surgery case described useful anesthetic monitoring alongside postoperative respiratory-management challenges.

What the source reports

Remimazolam was selected for scoliosis surgery in a patient with Leigh syndrome where motor-evoked-potential monitoring mattered. At the end, spontaneous breathing had not resumed despite other recovery steps. Flumazenil was followed by return of breathing and extubation; upper-airway obstruction then required a nasopharyngeal airway and subsequent intensive monitoring.

Limits and uncertainty

This was one medically complex patient with abnormal baseline consciousness and respiratory vulnerability. The case cannot isolate drug effects from mitochondrial disease, co-medication or lengthy surgery. Ability to reverse a benzodiazepine effect does not establish an uncomplicated airway or eliminate later recovery concerns.

Implications for forensic review

For an anesthetic opinion, review monitoring feasibility separately from recovery safety. Document respiratory drive, reversal timing, airway patency and later observation. The report illustrates competing clinical goals, rather than proving that a favorable intraoperative signal guarantees a straightforward postoperative course.

Source and related reading

Source reviewed: Remimazolam based anesthesia with intraoperative motor evoked potential monitoring in a patient with (PMC13004789). Forensic implications are interpretive analysis of the supplied paper.

Related reading: Movement Occurred During Remimazolam Spinal Surgery Despite BIS Below Sixty.