{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T05:16:41Z","timestamp":1764393401006,"version":"3.46.0"},"reference-count":25,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Severe aortic stenosis (AS) poses major anesthetic challenges because cardiac output is highly dependent on preload and heart rate, and abrupt afterload reduction or tachycardia may precipitate ischemia and cardiovascular collapse. Coexisting myelodysplastic syndrome (MDS) with severe thrombocytopenia further increases the perioperative bleeding risk, which we considered particularly important in the anesthetic planning for this patient. We report a case of laparoscopic anterior resection in a patient with severe AS and thrombocytopenia, highlighting a transfusion strategy adjusted according to the patient\u2019s response and remimazolam-based anesthesia. To the best of our knowledge, there have been no previous reports describing remimazolam-based total intravenous anesthesia achieving stable hemodynamics without vasopressor support in a patient with severe AS and MDS\u2013related thrombocytopenia. Method: A 78-year-old man with previously diagnosed MDS and chronic pancytopenia, whose baseline platelet counts (PLTs) ranged from 20,000 to 40,000\/\u03bcL, was found to have severe AS (aortic valve area, 0.73 cm2; mean pressure gradient, 42 mmHg) during preoperative evaluation for laparoscopic anterior resection. After platelet transfusions titrated to his response, the patient\u2019s PLT increased to 93,000\/\u03bcL before surgery. Anesthesia was induced and maintained with remimazolam and remifentanil, which were chosen to prevent afterload reduction associated with propofol. Results: Hemodynamics, including arterial pressure, cardiac index, systemic vascular resistance index, and cerebral oxygen saturation, remained stable without vasopressor support. Transient systolic hypertension during surgical stimulation was controlled using remifentanil titration and esmolol. Recovery and the postoperative course were uneventful, and the patient was discharged in a stable condition. Conclusions: Remimazolam-based total intravenous anesthesia can provide hemodynamic stability without vasopressors in high-risk patients with severe AS, and a transfusion strategy adjusted step by step according to the patient\u2019s response can be effective for optimizing PLTs while minimizing the transfusion-related risks of MDS-associated thrombocytopenia.<\/jats:p>","DOI":"10.3390\/jcm14238371","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T17:31:34Z","timestamp":1764091894000},"page":"8371","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Remimazolam-Based Anesthetic Management in a Patient with Severe Aortic Stenosis and Myelodysplastic Syndrome-Related Thrombocytopenia: A Case Report"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6785-7688","authenticated-orcid":false,"given":"Sou-Hyun","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4564-0007","authenticated-orcid":false,"given":"Seung Bae","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8030-9668","authenticated-orcid":false,"given":"Hyojun","family":"Choo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3163-5025","authenticated-orcid":false,"given":"Jongone","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9287-5087","authenticated-orcid":false,"given":"Sung-Hye","family":"Byun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"110871","DOI":"10.1016\/j.ijscr.2025.110871","article-title":"Perioperative management of a patient with severe aortic stenosis and chronic obstructive pulmonary disease undergoing abdominal aortic aneurysm repair: A case report","volume":"127","author":"Hassan","year":"2025","journal-title":"Int. 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