# Anesthesia Management Using Remimazolam for Lower Limb Amputation in a Patient With Septic Shock Due to Necrotizing Fasciitis

## TL;DR

A patient with severe infection and septic shock successfully underwent amputation surgery using remimazolam for anesthesia without significant circulatory issues.

## Contribution

Demonstrates the safe use of remimazolam in septic shock patients requiring surgery.

## Key findings

- Remimazolam provided effective sedation without significant circulatory depression.
- Hemodynamic stability was maintained during surgery with minimal vasopressor adjustments.
- The case highlights remimazolam's suitability for high-risk surgical patients.

## Abstract

We report a case of a patient with necrotizing fasciitis and septic shock caused by streptococcal toxic shock syndrome, who was anesthetized and managed with remimazolam. The patient, a woman in her 40s, was admitted to the ICU with a diagnosis of necrotizing fasciitis of the right lower extremity and septic shock and was scheduled for above-the-knee amputation under general anesthesia. She was anesthetized with remimazolam for sedation and fentanyl and remifentanil for analgesia. Intraoperatively, we were able to maintain hemodynamic stability with similar or only slightly higher doses of circulatory agonists during admission. In the present case, remimazolam, an ultrashort-acting benzodiazepine, was safely used to provide anesthesia to a patient in septic shock due to necrotizing fasciitis, who was receiving high doses of vasopressor agents for cardiovascular support, as it was necessary to select an anesthetic drug that would cause minimal circulatory depression.