# Remimazolam-based precision anesthesia management combined with nasopharyngeal airway in gastroscopic surgery for a patient with obesity and difficult airway: a successful case report

## TL;DR

A patient with obesity and a difficult airway safely underwent gastroscopy using remimazolam and a nasopharyngeal airway, avoiding complications.

## Contribution

Introduces a safe anesthesia strategy using remimazolam and a nasopharyngeal airway for high-risk patients with difficult airways.

## Key findings

- Remimazolam provided stable sedation with preserved spontaneous breathing in a high-risk patient.
- The use of a lubricated nasopharyngeal airway prevented airway complications during the procedure.
- Flumazenil enabled rapid and complete reversal of sedation post-procedure.

## Abstract

Patients with moderate obesity, obstructive sleep apnea hypopnea syndrome (OSAHS), and an anticipated difficult airway are at high risk for hypoxemia and airway complications under deep sedation.

The initial procedural attempt was aborted due to propofol-induced respiratory complications, including pronounced coughing and severe hypoxemia, in a high-risk patient with obesity and a Mallampati Class III airway. The subsequent optimized anesthetic protocol involved proactively establishing a patent upper airway with a lubricated nasopharyngeal conduit. Sedation was then carefully induced using remimazolam, a novel ultra-short-acting benzodiazepine chosen for its superior cardiorespiratory stability. This strategy successfully maintained spontaneous ventilation and stable hemodynamics throughout the entire gastroscopy procedure, enabling immediate reversal with flumazenil and facilitating rapid postoperative recovery.

This case demonstrates that for high-risk patients, the “precise sedation with preserved spontaneous breathing” strategy using remimazolam combined with a nasopharyngeal airway is a safe, effective, and reversible innovative anesthesia option.