DOI: https://doi.org/10.36347/sjmcr.2026.v14i06.024

Pages: 1419-1424

Background: Remimazolam, an ultra-short-acting benzodiazepine, is increasingly used for general anesthesia. However, systematic data on remimazolam use for the maintenance of total intravenous anesthesia (TIVA) in extremely obese patients (BMI ≥ 40 kg/m2) remain scarce, leaving the clinical feasibility of this comprehensive approach uncertain. The unique pharmacokinetic characteristics of remimazolam, including its rapid onset, swift metabolism, and ability to maintain stable vital signs and respiration, make it a promising choice for anesthesia in obese patients. Case: We present two case reports where remimazolam was employed for total intravenous general anesthesia in such patients. The first patient, with a BMI of 51.44 kg/m2, underwent robot-assisted parathyroidectomy, whereas the second patient, with a BMI of 42.66 kg/m2, underwent wound debridement for cerebrospinal fluid leakage. Both patients progressed without complications and maintained stable vital signs. Conclusions: These cases suggest that remimazolam may be a safe and effective option for anesthesia management in extremely obese patients. Further research is warranted to confirm these findings.