Anesthesia and pain medicine最新文献

{"title":"Prophylactic infusion of norepinephrine enhances hemodynamic stability during propofol induction and early intubation period in elderly patients: a double-blind randomized placebo-controlled trial.","authors":"Wenping Peng, Xiaolu Sun, Shuang Zhao, Jingxian Xu, Siwen Zhao","doi":"10.17085/apm.25329","DOIUrl":"10.17085/apm.25329","url":null,"abstract":"<p><strong>Background: </strong>The induction of general anesthesia with propofol often results in hypotension, which is primarily attributed to a decrease in the cardiac index (CI) among elderly patients. Norepinephrine (NE) is typically used to manage anesthesia-induced hypotension. We hypothesized that NE attenuates the reduction in CI while preserving blood pressure.</p><p><strong>Methods: </strong>In a randomized, double-blinded trial, 60 elderly patients undergoing elective major abdominal surgery under general anesthesia were randomly allocated to receive infusion of NE (6 µg/ml) (NE group) or saline (control [CT] group) during induction. CI was monitored using the FloTrac/Vigileo system, and the primary outcome was the change in CI (△CI) (△Value = value measured at the study time point-baseline value) at 10 min post-intubation (T10). Additionally, changes in systemic vascular resistance index (△SVRI) and mean arterial pressure (△MAP) were also evaluated for comparison.</p><p><strong>Results: </strong>In the NE group, the CI decreased from 3.9 to 2.9 L·min-1/m-2 at 10 min post-intubation (T10), whereas in the CT group, it declined from 3.7 to 2.6 L·min-1/m-2. After adjusting for propofol dosage per weight, the decreases in △CI (β = 0.63, 95% confidence interval [CI] 0.18 to 1.07; P = 0.006) and △MAP (β = 11.99, 95% CI 2.05 to 21.94; P = 0.018) at T10 were significantly less in the NE group compared to the CT group, whereas △SVRI did not show a significant difference between the two groups. From induction until 10 min post-intubation, the reductions in △CI, △MAP and stroke volume (△SV) were attenuated, and stroke volume variation was lower, while △SVRI and pulse rate (△PR) remained comparable between the NE and CT groups.</p><p><strong>Conclusions: </strong>Prophylactic infusion of NE effectively attenuated the decrease in △CI during propofol-induced anesthesia in elderly patients while maintaining MAP.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13444187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intercostal nerve cryoanalgesia in lung transplantation: a retrospective single-center study.","authors":"Sébastien Tanaka, Charles Baulier, Enora Atchade, Aurelie Gouel, Brice Lortat-Jacob, Laura Soldan, Sandrine Boudinet, Vincent Bunel, Kinan El Husseini, Yves Castier, Arnaud Roussel, Antoine Girault, Philippe Montravers, Pierre Mordant","doi":"10.17085/apm.26530","DOIUrl":"https://doi.org/10.17085/apm.26530","url":null,"abstract":"<p><strong>Background: </strong>Pain management after lung transplantation (LT) is challenging, with most cen-ters using a multimodal analgesia approach that includes opioids and thoracic epidural analge-sia (TEA). Intercostal nerve cryoanalgesia (INCA), which blocks peripheral nerves to provide pain control for about two months, is gaining popularity worldwide but has rarely been stud-ied in the context of LT.</p><p><strong>Methods: </strong>Retrospective, before-and-after single-center study conducted between October 2024 and July 2025. A group without INCA (PRE-INCA) was compared to a group with INCA (POST-INCA). All patients received TEA and multimodal analgesia. The primary out-come was the total consumption of oral morphine milligram equivalents (MMEs) between Day 1 and Day 28.</p><p><strong>Results: </strong>We included 28 consecutive LT recipients, among whom 14 received INCA. Pa-tients' baseline characteristics were similar across groups. Patients in the POST-INCA group received significantly fewer opioids during the first 28 days (PRE-INCA 1,499 [972, 1,909] MME vs. POST-INCA 543 [153, 1,050] MME; P = 0.004). Moreover, at month 1, basal pain was significantly reduced in the POST-INCA group (Numeric Rating Scale [NRS] PRE-INCA 2.25 [0.00, 4.50] vs. NRS POST-INCA 0.00 [0.00, 0.00]; P = 0.010). Other clinical outcomes, including duration of mechanical ventilation, length of stay, forced expiratory value at 1 s, and mortality, were similar between the groups.</p><p><strong>Conclusions: </strong>Adding INCA to TEA is associated with a significant reduction in opioid con-sumption and postoperative pain during the first 28 days following LT. These results should be interpreted with caution due to the retrospective, single-center design and the small sample size of the study.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacologic adjuvants in peribulbar anesthesia: a narrative review with a comparative and decision-oriented framework.","authors":"Putu Herdita Sudiantara, I Made Prema Putra, Anak Agung Ngurah Aryawangsa, Christopher Ryalino, I Made Gede Widnyana, Tjokorda Gde Agung Senapathi","doi":"10.17085/apm.26501","DOIUrl":"https://doi.org/10.17085/apm.26501","url":null,"abstract":"<p><p>Peribulbar anesthesia is widely used in ophthalmic surgery because it offers a favorable balance between efficacy and safety. However, clinically meaningful variability in block onset, duration, and akinesia quality persists despite technical advances. Pharmacologic adjuvants are commonly added to improve block performance; however, much of the available evidence is extrapolated from peripheral nerve block literature and does not fully account for the unique anatomic and physiologic characteristics of the peribulbar space. This narrative review critically synthesizes current evidence on commonly used pharmacologic adjuvants in peribulbar anesthesia, including dexmedetomidine, magnesium sulfate, fentanyl, and rocuronium, using a peribulbar-specific framework. Evidence is interpreted across key clinical domains relevant to ophthalmic anesthesia practice, including block onset, reliability of akinesia, duration of analgesia, ocular physiology, sedation, hemodynamic stability, and injectate volume considerations. Available data indicate that these adjuvants exert distinct and non-interchangeable effects. Dexmedetomidine provides the most consistent prolongation of block duration and improves reliability with cooperative sedation. Magnesium sulfate offers a hemodynamically stable option with favorable effects on intraocular pressure without sedation. Fentanyl and rocuronium primarily enhance onset and early surgical readiness, with limited impact on block duration. Injectate volume emerges as a critical determinant of ocular safety within the confined orbital space, and pharmacologic adjuvants may improve block quality without necessitating potentially risky increases in volume. Rather than identifying a universally optimal agent, this review supports a goal-directed, peribulbar-specific approach to adjuvant selection that integrates procedural priorities, patient characteristics, ocular safety, and volume constraints to guide individualized, evidence-informed clinical practice.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of anesthetic methods on the incidence of postpartum depression after cesarean section using national health insurance claims data.","authors":"Kuen Su Lee, Sang Hun Kim, Bum Sik Tae, Sunwoo Kim, Yoon Ji Choi","doi":"10.17085/apm.25405","DOIUrl":"https://doi.org/10.17085/apm.25405","url":null,"abstract":"<p><strong>Background: </strong>Cesarean sections (CS) are commonly performed worldwide, with spinal and general anesthesia being the primary anesthetic techniques. Postpartum depression (PPD) is a common condition that occurs after childbirth. PPD adversely affects both mothers and infants. However, the relationship between the type of anesthesia used and PPD remains unclear.</p><p><strong>Methods: </strong>We analyzed CS data in South Korea from January 1, 2013, to December 31, 2022, using the National Health Insurance Service database. A total of 115,952 women were included in the analysis (spinal anesthesia, 94,611; general anesthesia, 21,341). Propensity score matching (1:1) was conducted to balance the baseline characteristics, including maternal age, household income, alcohol consumption, smoking, and physical activity. After propensity score matching, 21,316 women remained in each group. Logistic regression analysis was performed to estimate the odds ratios (ORs) for PPD.</p><p><strong>Results: </strong>PPD occurred in 2.7% of patients receiving spinal anesthesia and 3.2% of those receiving general anesthesia. After propensity score matching, the anesthesia type was not significantly associated with PPD in univariate (OR 1.106; 95% CI 0.991-1.236) or multivariate analyses (OR 1.079; 95% CI 0.959-1.214). Independent risk factors for PPD included young maternal age, low household income, smoking, prenatal depression, preexisting hypertension, and thyroid disease.</p><p><strong>Conclusions: </strong>General anesthesia for CS was not associated with an increased risk of PPD in South Korea. Greater attention to maternal comorbidities and other modifiable risk factors may be more effective for preventing PPD and reassuring patients who require general anesthesia.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical study evaluating the perioperative combination of duloxetine and pregabalin to improve postoperative pain after mega-liposuction surgery under general anesthesia: a double-blind randomized clinical trial.","authors":"Amr Samir Wahdan, Ahmed Abd Elaziz Seleem, Wessam Samir Wahdan, Mennatallah Magdi Mohamed","doi":"10.17085/apm.26544","DOIUrl":"https://doi.org/10.17085/apm.26544","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing liposuction often experience moderate-to-severe postoperative pain, delaying recovery and reducing patient satisfaction. This study evaluated the effectiveness and safety of combined duloxetine and pregabalin in reducing postoperative pain and opioid consumption after mega-liposuction surgery.</p><p><strong>Methods: </strong>This randomized controlled trial included 90 patients aged 18-50 years with American Society of Anesthesiologists physical status I-II, scheduled for elective mega-liposuction under general anesthesia. Patients were randomized into three groups (30 in each). Group I received pregabalin 300 mg plus duloxetine 60 mg orally 90 min preoperatively, followed by pregabalin 75 mg 12 hourly and duloxetine 60 mg once daily for three postoperative days. Group II received pregabalin plus placebo on the same schedule, whereas Group III received placebo capsules only.</p><p><strong>Results: </strong>Postoperative morphine consumption over 72 h was lower in Group I (19.40 ± 2.51 mg) than in Groups II and III (24.07 ± 3.14 mg vs. 33.90 ± 4.74 mg). Time to the first analgesic request was longer in Group I (2.39 ± 0.72 h) than in Groups II and III (1.89 ± 0.61 h vs. 0.95 ± 0.52 h; P < 0.001). Group I demonstrated higher postoperative global Quality of Recovery Questionnaire-40 (183.10 ± 4.85) and satisfaction scores (3.47 ± 0.68) than Group II (181.10 ± 4.50, 2.90 ± 0.76) and Group III (178.57 ± 5.51, 2.23 ± 0.97) (P = 0.003 and P < 0.001, respectively).</p><p><strong>Conclusions: </strong>Perioperative duloxetine combined with pregabalin improved postoperative pain, reduced morphine consumption, and enhanced recovery quality after mega-liposuction without substantial adverse effects.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scheduled versus on-demand nonopioid analgesia after cesarean delivery under regional anesthesia: a meta-analysis of randomized controlled trials.","authors":"Manupriya Madhavan, K Pushpalatha, Kumar Madhavan, Amrut Phonde","doi":"10.17085/apm.26511","DOIUrl":"https://doi.org/10.17085/apm.26511","url":null,"abstract":"<p><p>Effective pain relief after cesarean delivery is crucial for maternal comfort, recovery, and breastfeeding. Although scheduled nonopioid analgesics are standard, on-demand regimens have been suggested to reduce drug exposure. PubMed/MEDLINE, Embase, Scopus, and Cochrane CENTRAL were systematically searched from inception to August 20, 2025, for randomized controlled trials (RCTs) comparing scheduled vs. on-demand nonopioid analgesia following cesarean delivery under regional anesthesia. The primary outcomes were postoperative pain intensity and analgesic consumption, and the secondary outcomes were maternal satisfaction, adverse effects, breastfeeding outcomes, and neonatal safety. Three RCTs that included 666 women were identified. At 24 h, scheduled dosing significantly reduced pain scores compared with on-demand regimens (mean difference [MD] 0.98, 95% confidence interval [CI] 0.55 to 1.41; P < 0.001, I2 = 78%), but no difference was observed at 48 h (MD 0.76, 95% CI -0.30 to 1.82; P = 0.16, I2 = 96%). Overall analgesic consumption did not differ significantly between groups (standardized MD -0.23, 95% CI -0.62 to 0.16, P = 0.24; I2 = 80%). Maternal adverse effects were rare and similar across groups (risk difference -0.01, 95% CI -0.04 to 0.02; I2 = 0%). Breastfeeding outcomes were inconsistently defined, with two trials indicating benefits from scheduled dosing. Neonatal safety outcomes were reported in one trial, showing no differences between groups. Scheduled nonopioid analgesia after cesarean delivery under regional anesthesia was linked to better pain control during the first postoperative day. After this period, the comparative effectiveness of scheduled vs. on-demand regimens remained uncertain, with considerable variability across studies. No significant differences were found in analgesic consumption or maternal adverse effects, and evidence regarding breastfeeding and neonatal outcomes was limited.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prospective randomized study to evaluate the effect of epidural volume extension with normal saline in combined spinal epidural anesthesia for lower limb surgeries using intrathecal hyperbaric levobupivacaine.","authors":"Kavana S, Ashwini Turai, Archana Shivashankar, Subham Tripathy, Soundarya D U, Sudhir S Sherikar","doi":"10.17085/apm.25473","DOIUrl":"10.17085/apm.25473","url":null,"abstract":"<p><strong>Background: </strong>Combined spinal epidural anesthesia (CSEA) offers rapid onset and effective postoperative analgesia for lower limb surgeries. Epidural volume extension (EVE), achieved by epidural saline injection following intrathecal administration, influences the cephalad spread of local anesthetic. This study examined the effect of EVE with normal saline on sensory and motor block characteristics following intrathecal hyperbaric levobupivacaine.</p><p><strong>Methods: </strong>A total of 100 American Society of Anesthesiologists I-II patients aged 18-60 years were assigned to two groups. Group A received 2.5 ml of 0.5% hyperbaric levobupivacaine intrathecally, while Group B received the same dose followed by EVE with 10 ml of normal saline. Sensory and motor block onset, peak block height, regression characteristics, and epidural supplementation requirement were compared.</p><p><strong>Results: </strong>A peak sensory block height of T10 was achieved in Group A (42%), whereas T8 (46%) was achieved in Group B (P = 0.003). Sensory and motor block onset was significantly faster in Group B (P < 0.001). However, the motor block was longer in Group A (219.30 ± 22.20 min) than in Group B (206.20 ± 22.87 min; P = 0.005). Epidural top-up was numerically more frequent in Group B (18%) compared with Group A (6%), though this difference did not achieve statistical significance (P = 0.08). Adequate intraoperative anesthesia was achieved in all patients with timely epidural supplementation when required.</p><p><strong>Conclusions: </strong>EVE with normal saline in CSEA using intrathecal hyperbaric levobupivacaine results in faster onset and greater cephalad sensory blockade with comparable hemodynamic effects; however, it may be associated with earlier block regression in longer surgical procedures.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13444189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustained-release local anesthetics: advances in drug delivery systems for prolonged postoperative analgesia.","authors":"Seok Kyeong Oh, Sang Hyun Hong, Jung-Woo Shim","doi":"10.17085/apm.26668","DOIUrl":"10.17085/apm.26668","url":null,"abstract":"<p><p>Effective perioperative pain control is essential for patient comfort and for optimizing surgical outcomes and the quality of recovery. Multimodal analgesic strategies have become a cornerstone of modern perioperative pain management. Although regional analgesia is widely used within this framework, the clinical utility of conventional local anesthetics remains limited by their relatively short duration of action. Continuous infusion techniques can sustain local anesthetic delivery; however, catheter-based systems have several device- and technique-related limitations. In response, sustained-release local anesthetic formulations have been developed to extend analgesia after a single administration. These formulations include liposomal preparations, polymer-based delivery systems, and hydrogel-based carriers. Liposomal bupivacaine uses a multivesicular delivery system that acts as a local drug depot and gradually releases the anesthetic at the injection site. Polymer-based systems that combine local anesthetics with anti-inflammatory agents enhance analgesia by modulating the local tissue environment. Hydrogel-based carriers, including thermoresponsive and hyaluronic acid-based platforms, provide sustained drug release through three-dimensional polymer networks while minimizing systemic exposure. Recent advances in these delivery platforms have expanded the clinical potential of sustained-release local anesthetic technologies. Nevertheless, widespread clinical adoption remains constrained by several challenges, including burst release, variability in release kinetics, high costs, and limited clinical evidence. Sustained-release local anesthetic systems may provide catheter-free, prolonged postoperative analgesia in accordance with the principles of enhanced recovery after surgery. As drug delivery technologies continue to evolve, sustained-release local anesthetic formulations are likely to play an increasingly important role in perioperative pain management.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"21 3","pages":"323-335"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13444181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric anesthesia and postpartum mental health: implications from delivery to long-term recovery.","authors":"Sou-Hyun Lee, Kyung-Hwa Kwak","doi":"10.17085/apm.26688","DOIUrl":"10.17085/apm.26688","url":null,"abstract":"<p><p>Obstetric anesthesiologists have traditionally focused on providing effective labor analgesia and ensuring safe cesarean delivery. However, growing evidence suggests that anesthetic choices and childbirth experiences influence maternal mental health beyond the immediate intrapartum period. Postpartum depression (PPD) and postpartum post-traumatic stress disorder (PP-PTSD) are linked to impaired mother-infant bonding, reduced quality of life, and adverse long-term outcomes in mothers and children. Therefore, this review aimed to synthesize the current evidence on antenatal risk factors, delivery mode, anesthetic management, labor epidural analgesia (LEA), perioperative pharmacological prevention, and long-term outcomes, emphasizing the expanding role of obstetric anesthesiologists in postpartum mental health care. General anesthesia for cesarean delivery is linked to an increased risk of severe PPD and suicidality, although its relationship with PP-PTSD remains unclear. LEA does not appear to protect against PPD or PP-PTSD when assessed by binary exposure. Instead, the quality of pain relief, intraoperative pain, failed neuraxial anesthesia, and conversion to general anesthesia may be clinically relevant determinants of postpartum mental health. Perioperative ketamine and esketamine may help prevent the risk of early PPD following cesarean delivery, although evidence of sustained long-term benefits remains limited. These findings support an expanded role for obstetric anesthesiologists beyond intrapartum safety, including trauma-informed communication, optimized pain management, early identification of high-risk women, and prompt referral to multidisciplinary perinatal mental health care.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":"285-295"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13444182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suspected remimazolam formulation-associated peri-induction anaphylaxis: two cases highlighting diagnostic complexity - Two case reports.","authors":"Hyun-Seong Lee, Min Woo Lee, Daeseok Oh","doi":"10.17085/apm.26622","DOIUrl":"10.17085/apm.26622","url":null,"abstract":"<p><strong>Background: </strong>Reports of remimazolam formulation-associated anaphylaxis are increasing as its use expands. Between 2023 and 2025, we identified two severe reactions among 1,592 patients who received remimazolam at our institution.</p><p><strong>Case: </strong>A 65-year-old man with end-stage renal disease developed profound hypotension without cutaneous signs after induction with 10 mg of remimazolam and peri-induction cefazedone administration. Surgery was cancelled due to persistent hypotension. Serum tryptase at 6 h was 38.0 μg/L; however, delayed skin testing was negative. Subsequent propofol-based anesthesia without cefazedone re-administration was uneventful. A 50-year-old woman developed hypotension and facial flushing within 2 min of receiving 10 mg of remimazolam. Although serum tryptase levels remained within the normal range, delayed skin testing for remimazolam was positive.</p><p><strong>Conclusions: </strong>Diagnosis of remimazolam formulation-associated hypersensitivity may remain inconclusive when based on a single diagnostic test. Accurate evaluation requires integrating timed tryptase, delayed skin testing, and exposure history.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":"368-374"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13444177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}