Preserved systolic ejection fraction does not exclude clinically important cardiac vulnerability during emergence.
What the supplied source reports
An older surgical patient with pre-existing diastolic abnormalities received remimazolam anesthesia and flumazenil reversal. Pulmonary edema developed after extubation, and the report attributed the presentation to heart failure with preserved ejection fraction in that clinical sequence.
Limits and uncertainty
This was one complex perioperative case without a controlled comparison. Reversal, emergence stress, fluid status and underlying cardiac disease are intertwined. The title’s causal language does not by itself prove that flumazenil was the sole cause or quantify risk.
Implications for forensic review
For an anesthetic reconstruction, review baseline echocardiography, pressure changes, fluids, respiratory observations and reversal timing. Separate recovery of consciousness from cardiopulmonary stability. The report identifies a possible complication pathway while leaving the relative contribution of drug, patient and procedural factors open to analysis.
Source and related reading
Source reviewed: Postoperative Heart Failure with Preserved Ejection Fraction Induced by Flumazenil Administered for (PMC9675602). Forensic applications above are interpretive analysis of the supplied publication.
Related reading: Takotsubo During Benzodiazepine Withdrawal Requires More Than a Medication Gap.
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