{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:32:05Z","timestamp":1784547125544,"version":"3.55.0"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100012319","name":"National Center for Global Health and Medicine","doi-asserted-by":"publisher","award":["21A1016"],"award-info":[{"award-number":["21A1016"]}],"id":[{"id":"10.13039\/100012319","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["24hk0102081"],"award-info":[{"award-number":["24hk0102081"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Anesth"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>In this study, we aimed to develop and evaluate an automated phenylephrine delivery system by lower limit control for the management of intraoperative hypotension, assessing its efficacy in maintaining adequate blood pressure levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty patients undergoing surgery with anticipated blood pressure fluctuations were enrolled in this study. Patients were randomly assigned to two groups. Noninvasive blood pressure (NIBP) was measured at 2.5-min intervals using an upper arm cuff. In the automated group, phenylephrine administration was governed by an automated system that delivered bolus doses and adjusted the continuous infusion rate when mean blood pressure (MBP) dropped below 65\u00a0mmHg. In the manual group, phenylephrine administration was initiated by the attending anesthesiologist under the same MBP threshold. Propofol, remifentanil, and rocuronium were administered via the automated delivery system for total intravenous anesthesia, to minimize hemodynamic variability between groups. The primary end point was the percentage of time during which MBP remained above 65\u00a0mmHg and systolic blood pressure below 140\u00a0mmHg, measured from the initiation to the cessation of intravenous anesthesia and assessed using a non-inferiority test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The automated group adequately maintained blood pressure within the target range for 84.53% of the time, compared to 72.45% in the manual group, confirming statistical non-inferiority (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This system effectively managed intraoperative hypotension using intermittent NIBP measurements, which are more feasible in clinical practice. Despite relying on less frequent and lower-resolution blood pressure data, it demonstrated efficacy comparable to anesthesiologist-led management, indicating its potential for broader clinical application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00540-025-03476-z","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T11:54:33Z","timestamp":1741780473000},"page":"372-388","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Development and evaluation of an automated phenylephrine delivery system by lower limit control for managing intraoperative hypotension"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2988-8977","authenticated-orcid":false,"given":"Osamu","family":"Nagata","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emi","family":"Morinushi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9782-6870","authenticated-orcid":false,"given":"Aya","family":"Kuroyanagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8529-2974","authenticated-orcid":false,"given":"Fumiyo","family":"Yasuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,12]]},"reference":[{"key":"3476_CR1","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1213\/ANE.0000000000006789","volume":"138","author":"MJ Scott","year":"2024","unstructured":"Scott MJ, APSF Hemodynamic Instability Writing Group. Perioperative patients with hemodynamic instability: consensus recommendations of the Anesthesia Patient Safety Foundation. Anesth Analg. 2024;138:713\u201324.","journal-title":"Anesth Analg."},{"key":"3476_CR2","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1002\/jhm.2394","volume":"10","author":"J Cardenas-Garcia","year":"2015","unstructured":"Cardenas-Garcia J, Schaub KF, Belchikov YG, Narasimhan M, Koenig SJ, Mayo PH. Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med. 2015;10:581\u20135.","journal-title":"J Hosp Med"},{"key":"3476_CR3","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1111\/j.1365-2044.2007.05257.x","volume":"62","author":"WD Ngan Kee","year":"2007","unstructured":"Ngan Kee WD, Tam YH, Khaw KS, Ng FF, Critchley LA, Karmakar MK. Closed-loop feedback computer-controlled infusion of phenylephrine for maintaining blood pressure during spinal anaesthesia for caesarean section: a preliminary descriptive study. Anaesthesia. 2007;62:1251\u20136.","journal-title":"Anaesthesia"},{"key":"3476_CR4","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1097\/ALN.0000000000003807","volume":"135","author":"A Joosten","year":"2021","unstructured":"Joosten A, Rinehart J, Van der Linden P, Alexander B, Penna C, De Montblanc J, Cannesson M, Vincent JL, Vicaut E, Duranteau J. Computer-assisted individualized hemodynamic management reduces intraoperative hypotension in intermediate- and high-risk surgery: a randomized controlled trial. Anesthesiology. 2021;135:258\u201372.","journal-title":"Anesthesiology"},{"key":"3476_CR5","doi-asserted-by":"publisher","first-page":"6611","DOI":"10.3390\/jcm12206611","volume":"12","author":"O Nagata","year":"2023","unstructured":"Nagata O, Matsuki Y, Matsuda S, Hazama K, Fukunaga S, Nakatsuka H, Yasuma F, Maehara Y, Fujioka S, Tajima K, Kondo I, Ginoza I, Hayashi M, Kakinohana M, Shigemi K. Anesthesia management via an automated control system for propofol, remifentanil, and rocuronium compared to management by anesthesiologists: an investigator-initiated study. J Clin Med. 2023;12:6611.","journal-title":"J Clin Med"},{"key":"3476_CR6","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s10877-005-2452-5","volume":"18","author":"H Ishihara","year":"2004","unstructured":"Ishihara H, Okawa H, Tanabe K, Tsubo T, Sugo Y, Akiyama T, Takeda S. A new noninvasive continuous cardiac output trend solely utilizing routine cardiovascular monitors. J Clin Monit Comput. 2004;18:313\u201320.","journal-title":"J Clin Monit Comput"},{"key":"3476_CR7","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1007\/s00540-021-03015-6","volume":"36","author":"O Nagata","year":"2022","unstructured":"Nagata O, Matsuki Y, Ogino Y, Shigemi K. Safety and efficacy of an automated anesthesia delivery system for total intravenous anesthesia with propofol, remifentanil, and rocuronium: a non-inferiority randomized controlled trial versus manually controlled anesthesia. J Anesth. 2022;36:96\u2013106.","journal-title":"J Anesth"},{"key":"3476_CR8","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1007\/s10877-018-0126-3","volume":"32","author":"AF Kalmar","year":"2018","unstructured":"Kalmar AF, Allaert S, Pletinckx P, Maes JW, Heerman J, Vos JJ, Struys MMRF, Scheeren TWL. Phenylephrine increases cardiac output by raising cardiac preload in patients with anesthesia induced hypotension. J Clin Monit Comput. 2018;32:969\u201376.","journal-title":"J Clin Monit Comput"},{"key":"3476_CR9","first-page":"2853","volume":"2010","author":"Y Sugo","year":"2010","unstructured":"Sugo Y, Ukawa T, Takeda S, Ishihara H, Kazama T, Takeda J. A novel continuous cardiac output monitor based on pulse wave transit time. 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J Pharmacokinet Biopharm. 1992;20:63\u201394.","journal-title":"J Pharmacokinet Biopharm"}],"container-title":["Journal of Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00540-025-03476-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00540-025-03476-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00540-025-03476-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T21:07:53Z","timestamp":1777842473000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00540-025-03476-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,12]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["3476"],"URL":"https:\/\/doi.org\/10.1007\/s00540-025-03476-z","relation":{},"ISSN":["0913-8668","1438-8359"],"issn-type":[{"value":"0913-8668","type":"print"},{"value":"1438-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,12]]},"assertion":[{"value":"4 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 February 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Osamu Nagata holds a patent on the automated delivery system for intravenous anesthetics; Emi Morinushi, Aya Kuroyanagi, and Fumiyo Yasuma have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}