Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. X:X | DOI: 10.5507/bp.2026.016

Successful transcranial motor evoked potentials monitoring under remimazolam-based anaesthesia: Case reports of two patients

Jan Hudec^{1, 2}, Tereza Prokopova^{1, 2}, Michal Galko³, Roman Gal¹

¹ Department of Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic

² Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czech Republic

³ Department of Orthopaedic and Spine Surgery, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic

Introduction: Intraoperative neurophysiological monitoring is a standard in surgeries with an increased risk of iatrogenic neurological injury development. The gold standard for this monitoring modality is propofol-based total intravenous anaesthesia (TIVA). Although there seems to be no clinically significant complication for propofol administration in patients with soy, egg, or peanut allergies, a whole range of recommendations still prohibit propofol administration in patients with these allergies. Remimazolam is a new, ultra-short-acting benzodiazepine that can potentially be an alternative in cases of propofol contraindications in need of TIVA.

Case reports: We report two cases of a 19-year-old girl and a 17-year-old boy undergoing scoliosis surgery with transcranial motor evoked potentials monitoring (TcMEP). We chose remimazolam-based total intravenous anaesthesia due to the severe peanut and soy allergy, respectively. Total intravenous anaesthesia was maintained with remimazolam at a dose of 1.5-2 mg/kg/h and remifentanil at a dose of 0.5-0.8 µg/kg/min. Depth of anaesthesia was controlled using frontal EEG monitoring. TcMEP remained stable and showed no significant alterations throughout the surgeries. No new neurological deficits were detected after the surgeries.

Conclusion: Our results show that remimazolam-based anaesthesia may be a safe alternative to propofol-based anaesthesia for surgeries with an intraoperative neurophysiological monitoring, or patients with propofol contraindications but more data are needed.

Keywords: total intravenous anaesthesia, remimazolam, scoliosis, motor evoked potentials, case report

Received: January 26, 2026; Revised: May 22, 2026; Accepted: June 15, 2026; Prepublished online: July 7, 2026