Background: Remimazolam is a novel ultrashort-acting benzodiazepine that has recently become available for general anesthesia. However, the incidence of postoperative nausea and vomiting (PONV) associated with remimazolam remains unknown. In this propensity score-matched, retrospective, observational study, we compared the rates of PONV between remimazolam and propofol.Methods: In this retrospective observational study, propensity score-matching was performed to minimize selection bias. Patients who received total intravenous anesthesia with remimazolam or propofol at the Hamamatsu University Hospital between August 2020 and July 2021 were enrolled in the study. Data on patient demographics, anesthetic agents, and PONV within the first 24 h were collected and analyzed.Results: Of the 1,239 patients who met the study selection criteria, 585 received remimazolam and 684 received propofol. After propensity score matching, 333 matched pairs were further analyzed. Patient demographics and the anesthetic agents used were comparable between the matched cohorts. The incidence of PONV was significantly higher in the remimazolam group than in the propofol group (35% vs. 21%, P < 0.001).Conclusions: The incidence of PONV is higher with remimazolam anesthesia than with propofol anesthesia. The findings of this study require confirmation in larger prospective randomized controlled trials.

Albumin, the most abundant protein, contributes significantly to various physiological processes, indicating its multifunctional properties. It has drawn the attention of scientists and physicians because of its primary role in maintaining osmotic pressure and involvement in transporting numerous small molecules, including hormones, fatty acids, and drugs. A growing body of evidence has recently illustrated an additional aspect of albumin’s antioxidant properties. Therefore, based on recent research findings, this review article delves into the molecular and biochemical aspects of albumin’s antioxidative capabilities. We highlight the multifaceted significance of proteins in oxidative stress and their relation to pathologies in obstetrics and gynecology. In particular, we focused on preeclampsia, in which oxidative stress is closely involved in the pathogenesis, and renal dysfunction leads to increased albumin excretion into the urine, resulting in hypoalbuminemia. In addition, we discussed the role of albumin in preeclampsia pathogenesis, diagnosis, and patient prognosis. Understanding the antioxidant properties of albumin opens new avenues for therapeutic intervention and sheds light on novel strategies for combating preeclampsia associated with oxidative damage. In this study, we employed the PubMed database to search for articles that assessed the antioxidant properties of albumin, with a specific focus on obstetric diseases, particularly preeclampsia. The last update of the search was conducted in November 2024.

Among reactive oxygen species, superoxide mediates the critical vascular redox signaling, resulting in the regulation of the human cardiovascular system. The reduced form of nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase, NOX) is the source of superoxide and relates to the crucial intracellular pathology and physiology of vascular smooth muscle cells, including contraction, proliferation, apoptosis, and inflammatory response. Human vascular smooth muscle cells express NOX1, 2, 4, and 5 in physiological and pathological conditions, and those enzymes play roles in most cardiovascular disorders caused by hypertension, diabetes, inflammation, and arteriosclerosis. Various physiologically active substances, including angiotensin II, stimulate NOX via the cytosolic subunits’ translocation toward the vascular smooth muscle cell membrane. As we have shown, some pathological stimuli such as high glucose augment the enzymatic activity mediated by the phosphatidylinositol 3-kinase-Akt pathway, resulting in the membrane translocation of cytosolic subunits of NOXs. This review highlights and details the roles of human vascular smooth muscle NOXs in the pathophysiology and clinical aspects. The regulation of the enzyme expressed in the vascular smooth muscle cells may lead to the prevention and treatment of human cardiovascular diseases.

Article: Electroencephalogram inability to detect intraoperative awakening in a patient with remimazolam tolerance - Minerva Anestesiologica 2022 Nov 16 - Minerva Medica - Journals

Purpose: Sedation has advantages for patients receiving transcatheter aortic valve replacement (TAVR) compared with general anesthesia. However, the beneficial effect of an antiemetic agent on intra-procedural nausea and vomiting (IPNV) remains unclear. Therefore, we aimed to evaluate whether ondansetron reduces IPNV in patients undergoing transfemoral TAVR with conscious sedation. Methods: We conducted a single-center retrospective study, analyzing outcomes of 100 patients undergoing TAVR before (Before group, n=48) and after (After group, n=52) ondansetron administration. Conscious sedation was initiated with a bolus of 0.7 μg/kg and subsequent 0.1-0.4 μg/kg/h IV dexmedetomidine, supplemented with IV remifentanil and IV propofol to achieve a bispectral index <90 with a Richmond Agitation-Sedation Scale of -2 to -1. Only the After group received ondansetron 4 mg IV at the beginning of sedation. All patients underwent an ultrasound-guided right or left fascia iliaca block using 30 mL of 0.185% ropivacaine, depending on the sheath insertion side. The primary endpoint was IPNV incidence during TAVR procedures, with statistical significance set at P<0.05. Results: Groups were well balanced, with no significant differences in aortic stenosis severity, cardiac function, or comorbidities affecting heart function. The After group showed a significantly lower incidence of IPNV (0% vs. 22.9%, P<0.001 using the χ2 test). No differences were observed in intra-operative vasopressor use, and no cases of suspected aspiration occurred. Conclusions: Ondansetron prevented IPNV in transfemoral TAVR patients with conscious sedation. These results suggest that pretreatment with ondansetron may be a useful strategy for reducing aspiration risk in procedures requiring conscious sedation, including transfemoral TAVR.