{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T15:46:36Z","timestamp":1789832796690,"version":"4.0.1"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,6]],"date-time":"2021-12-06T00:00:00Z","timestamp":1638748800000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Remimazolam, a novel benzodiazepine, has been reported to cause less hypotension than propofol during induction of anesthesia. Therefore, remimazolam might be a valuable option in elderly patients with severe aortic stenosis who are considered to be the most vulnerable to hemodynamic instability. We aimed to evaluate the feasibility and hemodynamic effects of remimazolam as an induction agent in elderly patients with severe aortic stenosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective, open-label, single-arm, observational pilot study was conducted in a university hospital between November 2020 and April 2021. We included 20 patients aged 65\u2009years or older scheduled for transcatheter or surgical aortic valve replacement for severe aortic stenosis under general anesthesia. Patients were administered intravenous remimazolam infusion at 6\u2009mg\/kg\/h combined with 0.25\u2009\u03bcg\/kg\/min of remifentanil infusion. The primary outcome was the vasopressor dosage between the induction of anesthesia and the completion of tracheal intubation. The secondary outcomes included hemodynamic changes, bispectral index changes, and the time from the start of remimazolam infusion to loss of consciousness. We also recorded awareness during anesthesia induction and serious adverse events related to death, life-threatening events, prolonged hospitalizations, and disability due to permanent damage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty patients aged 84 [79\u201386] (median [interquartile range]) with American Society of Anesthesiologists physical status 4 were analyzed. Ephedrine 0 [0\u20134] mg and phenylephrine 0.1 [0\u20130.1] mg were administered to 14\/20 patients (3 doses in 1 patient, 2 doses in 4 patients, and one dose in 9 patients). Loss of consciousness was achieved at 80 [69\u201386] s after the remimazolam infusion was started. The mean arterial pressure decreased gradually after loss of consciousness but recovered immediately after tracheal intubation. The bispectral index values gradually decreased and reached &lt;\u200960 at 120\u2009s after loss of consciousness. Neither awareness during induction of anesthesia nor serious adverse events, such as severe bradycardia (&lt;\u200940\u2009bpm), life-threatening arrhythmia, myocardial ischemia, or anaphylactic reactions were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Remimazolam could be used as an induction agent with timely bolus vasopressors in elderly patients with severe aortic stenosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration<\/jats:title><jats:p>UMIN Clinical Trials Registry, identifier<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/upload.umin.ac.jp\/cgi-open-bin\/ctr_e\/ctr_view.cgi?recptno=R000048304\">UMIN000042318<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12871-021-01530-3","type":"journal-article","created":{"date-parts":[[2021,12,6]],"date-time":"2021-12-06T07:02:28Z","timestamp":1638774148000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":70,"title":["Remimazolam for induction of anesthesia in elderly patients with severe aortic stenosis: a prospective, observational pilot study"],"prefix":"10.1186","volume":"21","author":[{"given":"Toshiyuki","family":"Nakanishi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiki","family":"Sento","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Kamimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuya","family":"Tsuji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eisuke","family":"Kako","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuya","family":"Sobue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,6]]},"reference":[{"key":"1530_CR1","doi-asserted-by":"publisher","first-page":"16006","DOI":"10.1038\/nrdp.2016.6","volume":"2","author":"BR Lindman","year":"2016","unstructured":"Lindman BR, Clavel MA, Mathieu P, Iung B, Lancellotti P, Otto CM, et al. Calcific aortic stenosis. Nat Rev Dis Primers. 2016;2:16006.","journal-title":"Nat Rev Dis Primers"},{"key":"1530_CR2","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.jacc.2014.10.051","volume":"65","author":"P Samarendra","year":"2015","unstructured":"Samarendra P, Mangione MP. Aortic stenosis and perioperative risk with noncardiac surgery. J Am Coll Cardiol. 2015;65:295\u2013302.","journal-title":"J Am Coll Cardiol"},{"key":"1530_CR3","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1213\/01.ANE.0000175214.38450.91","volume":"101","author":"DL Reich","year":"2005","unstructured":"Reich DL, Hossain S, Krol M, Baez B, Patel P, Bernstein A, et al. Predictors of hypotension after induction of general anesthesia. Anesth Analg. 2005;101:622\u20138.","journal-title":"Anesth Analg"},{"key":"1530_CR4","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1093\/bja\/aex127","volume":"119","author":"S S\u00fcdfeld","year":"2017","unstructured":"S\u00fcdfeld S, Brechnitz S, Wagner JY, Reese PC, Pinnschmidt HO, Reuter DA, et al. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth. 2017;119:57\u201364.","journal-title":"Br J Anaesth"},{"key":"1530_CR5","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1053\/j.jvca.2020.03.054","volume":"35","author":"A Pisano","year":"2021","unstructured":"Pisano A, Torella M, Yavorovskiy A, Landoni G. The impact of anesthetic regimen on outcomes in adult cardiac surgery: a narrative review. J Cardiothorac Vasc Anesth. 2021;35:711\u201329.","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"1530_CR6","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1093\/bja\/54.10.1053","volume":"54","author":"U Schulte-Sasse","year":"1982","unstructured":"Schulte-Sasse U, Hess W, Tarnow J. Haemodynamic responses to induction of anaesthesia using midazolam in cardiac surgical patients. Br J Anaesth. 1982;54:1053\u20138.","journal-title":"Br J Anaesth"},{"key":"1530_CR7","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.chest.2018.09.015","volume":"155","author":"NJ Pastis","year":"2019","unstructured":"Pastis NJ, Yarmus LB, Schippers F, Ostroff R, Chen A, Akulian J, et al. Safety and Efficacy of Remimazolam Compared With Placebo and Midazolam for Moderate Sedation During Bronchoscopy. Chest. 2019;155:137\u201346.","journal-title":"Chest"},{"key":"1530_CR8","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1097\/ALN.0000000000003103","volume":"132","author":"J Sch\u00fcttler","year":"2020","unstructured":"Sch\u00fcttler J, Eisenried A, Lerch M, Fechner J, Jeleazcov C, Ihmsen H. Pharmacokinetics and pharmacodynamics of Remimazolam (CNS 7056) after continuous infusion in healthy male volunteers: part I. Pharmacokinetics and Clinical Pharmacodynamics. Anesthesiology. 2020;132:636\u201351.","journal-title":"Anesthesiology"},{"key":"1530_CR9","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1007\/s00540-020-02788-6","volume":"34","author":"M Doi","year":"2020","unstructured":"Doi M, Morita K, Takeda J, Sakamoto A, Yamakage M, Suzuki T. Efficacy and safety of remimazolam versus propofol for general anesthesia: a multicenter, single-blind, randomized, parallel-group, phase IIb\/III trial. J Anesth. 2020;34:543\u201353.","journal-title":"J Anesth"},{"key":"1530_CR10","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1007\/s00540-020-02776-w","volume":"34","author":"M Doi","year":"2020","unstructured":"Doi M, Hirata N, Suzuki T, Morisaki H, Morimatsu H, Sakamoto A. Safety and efficacy of remimazolam in induction and maintenance of general anesthesia in high-risk surgical patients (ASA class III): results of a multicenter, randomized, double-blind, parallel-group comparative trial. J Anesth. 2020;34:491\u2013501.","journal-title":"J Anesth"},{"key":"1530_CR11","doi-asserted-by":"crossref","first-page":"e00851","DOI":"10.1002\/prp2.851","volume":"9","author":"T Liu","year":"2021","unstructured":"Liu T, Lai T, Chen J, Lu Y, He F, Chen Y, et al. Effect of remimazolam induction on hemodynamics in patients undergoing valve replacement surgery: a randomized, double-blind, controlled trial. Pharmacol Res Perspect. 2021;9:e00851.","journal-title":"Pharmacol Res Perspect"},{"key":"1530_CR12","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1186\/s12871-021-01422-6","volume":"21","author":"M Furuta","year":"2021","unstructured":"Furuta M, Ito H, Yamazaki M. Anaesthetic management using remimazolam in a patient with severe aortic stenosis: a case report. BMC Anesthesiol. 2021;21:202.","journal-title":"BMC Anesthesiol"},{"key":"1530_CR13","first-page":"e521","volume":"129","author":"RA Nishimura","year":"2014","unstructured":"Nishimura RA, Otto CM, Bonow RO, Carabello BA. Erwin JP 3rd, Guyton RA, et al; ACC\/AHA task force members. 2014 AHA\/ACC guideline for the Management of Patients with Valvular Heart Disease: a report of the American College of Cardiology\/American Heart Association task force on practice guidelines. Circulation. 2014;129:e521\u2013643.","journal-title":"Circulation"},{"key":"1530_CR14","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1111\/j.1399-6576.2006.01206.x","volume":"51","author":"S Bendel","year":"2007","unstructured":"Bendel S, Ruokonen E, P\u00f6l\u00f6nen P, Uusaro A. Propofol causes more hypotension than etomidate in patients with severe aortic stenosis: a double-blind, randomized study comparing propofol and etomidate. Acta Anaesthesiol Scand. 2007;51:284\u20139.","journal-title":"Acta Anaesthesiol Scand"},{"key":"1530_CR15","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1097\/00000542-200310000-00018","volume":"99","author":"JB Lesser","year":"2003","unstructured":"Lesser JB, Sanborn KV, Valskys R, Kuroda M. Severe bradycardia during spinal and epidural anesthesia recorded by an anesthesia information management system. Anesthesiology. 2003;99:859\u201366.","journal-title":"Anesthesiology"},{"key":"1530_CR16","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1002\/jcph.1552","volume":"60","author":"LL Lohmer","year":"2020","unstructured":"Lohmer LL, Schippers F, Petersen KU, Stoehr T, Schmith VD. Time-to-event modeling for Remimazolam for the indication of induction and maintenance of general anesthesia. J Clin Pharmacol. 2020;60:505\u201314.","journal-title":"J Clin Pharmacol"},{"key":"1530_CR17","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1007\/s40265-020-01299-8","volume":"80","author":"SJ Keam","year":"2020","unstructured":"Keam SJ. Remimazolam: First Approval. Drugs. 2020;80:625\u201333.","journal-title":"Drugs"},{"key":"1530_CR18","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1007\/s00228-019-02800-3","volume":"76","author":"XY Sheng","year":"2020","unstructured":"Sheng XY, Liang Y, Yang XY, Li LE, Ye X, Zhao X, et al. Safety, pharmacokinetic and pharmacodynamic properties of single ascending dose and continuous infusion of remimazolam besylate in healthy Chinese volunteers. Eur J Clin Pharmacol. 2020;76:383\u201391.","journal-title":"Eur J Clin Pharmacol"}],"container-title":["BMC Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-021-01530-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12871-021-01530-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-021-01530-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T17:01:16Z","timestamp":1699894876000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcanesthesiol.biomedcentral.com\/articles\/10.1186\/s12871-021-01530-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1530"],"URL":"https:\/\/doi.org\/10.1186\/s12871-021-01530-3","relation":{},"ISSN":["1471-2253"],"issn-type":[{"value":"1471-2253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"5 September 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was approved by the Nagoya City University Graduate School of Medical Sciences and Nagoya City University Hospital Institutional Review Board (60-20-0108, October 14, 2020). After explaining the study protocol to the participants, we obtained written informed consent for study participation from all the participants. All methods were carried out in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"306"}}