Anesthetic Management With Remimazolam for Adolescent Mitochondrial Encephalomyopathy With Lactic Acidosis and Stroke-like Episodes (MELAS): A Case Report

We successfully anesthetized a 15-year-old male dental patient with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome using remimazolam and remifentanil. During the rapid sequence induction, we administered intravenous continuous infusions of remimazolam and remfentanil along with boluses of fentanyl and rocuronium to quickly induce general anesthesia without complications. General anesthesia was maintained during the operation with continuous infusions of remimazolam (0.8–1.0 mg/kg/h) and remifentanil (0.15–0.2 μg/kg/min) while using a SedLine monitor to help assess anesthetic depth. Except for immediately after extubation, the patient was stable postoperatively. He progressed satisfactorily and was discharged safely the following day. This experience suggests that the combination of remimazolam and remifentanil is an effective anesthetic for adolescent patients with MELAS syndrome undergoing dental procedures requiring general anesthesia.