{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:12:57Z","timestamp":1772165577878,"version":"3.50.1"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T00:00:00Z","timestamp":1723161600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T00:00:00Z","timestamp":1723161600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Remifentanil, an ultra-short-acting \u00b5-opioid receptor agonist, is commonly used for anesthetic management due to excellent adjustability. Remifentanil is known to cause sinus bradycardia, however, because it has a direct negative chronotropic effect on the cardiac conduction system and there is an indirect negative chronotropic effect via the parasympathetic nervous system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>An 8-year-old Japanese boy was diagnosed with acute hydrocephalus due to a brain tumor in the fourth ventricle and underwent emergency surgery. Imaging examination showed brainstem compression. Endoscopic third ventriculostomy and ventriculoperitoneal shunt surgery were scheduled. Remifentanil was started during induction of general anesthesia, but electrocardiogram showed sinus bradycardia, then Wenckebach-type atrioventricular block, and then complete atrioventricular block. Remifentanil was immediately discontinued, and we administered atropine sulfate. Complete atrioventricular block was restored to sinus rhythm. When remifentanil was restarted, however, the electrocardiogram again showed sinus bradycardia, Wenckebach-type atrioventricular block, and then complete atrioventricular block. Remifentanil was again immediately discontinued, we administered adrenaline, and then complete atrioventricular block was restored to sinus rhythm. Fentanyl was used instead of remifentanil with continuous infusion of dopamine. There has since been no further occurrence of complete atrioventricular block.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This is the first known case of complete atrioventricular block in a pediatric patient with increased intracranial pressure seemingly caused by administration of remifentanil.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12871-024-02593-8","type":"journal-article","created":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T04:30:23Z","timestamp":1723177823000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Repeated complete atrioventricular block during remifentanil administration in a pediatric patient with brain tumor and acute hydrocephalus: a case report"],"prefix":"10.1186","volume":"24","author":[{"given":"Akihiro","family":"Ura","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keisuke","family":"Fujii","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tadashi","family":"Tanioku","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoyuki","family":"Kawamata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,8,9]]},"reference":[{"key":"2593_CR1","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1213\/00000539-199311000-00028","volume":"77","author":"PS Glass","year":"1993","unstructured":"Glass PS, Hardman D, Kamiyama Y, et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (GI87084B). Anesth Analg. 1993;77:1031\u201340.","journal-title":"Anesth Analg"},{"issue":"10","key":"2593_CR2","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1111\/j.1365-2044.2005.04298.x","volume":"60","author":"O Tirel","year":"2005","unstructured":"Tirel O, Chanavaz C, Bansard JY, et al. Effect of remifentanil with and without atropine on heart rate variability and RR interval in children. Anaesthesia. 2005;60(10):982\u20139.","journal-title":"Anaesthesia"},{"key":"2593_CR3","first-page":"58","volume":"91","author":"P Elliott","year":"2000","unstructured":"Elliott P, O\u2019Hare R, Bill KM, Phillips AS, Gibson FM, Mirakhur RK. Severe cardiovascular depression with remifentanil. Anesth Analg. 2000;91:58\u201361.","journal-title":"Anesth Analg"},{"key":"2593_CR4","first-page":"301","volume":"24","author":"NJ Kertesz","year":"1997","unstructured":"Kertesz NJ, Fenrich AL, Friedman RA. Congenital complete atrioventricular block. Tex Heart Inst J. 1997;24:301\u20137.","journal-title":"Tex Heart Inst J"},{"key":"2593_CR5","doi-asserted-by":"publisher","first-page":"65","DOI":"10.7180\/kmj.2019.34.1.65","volume":"34","author":"GJ Byeon","year":"2019","unstructured":"Byeon GJ, Kim HJ, Ri HS, Lee SS, Kim HY. Persistent complete atrioventricular block after induction of General Anesthesia in a healthy patient. Kosin Med J. 2019;34:65\u201371.","journal-title":"Kosin Med J"},{"key":"2593_CR6","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1111\/j.1540-8159.2012.03489.x","volume":"35","author":"SN Barra","year":"2012","unstructured":"Barra SN, Provid\u00eancia R, Paiva L, Nascimento J, Marques AL. A review on advanced atrioventricular block in young or middle-aged adults. Pacing Clin Electrophysiol. 2012;35:1395\u2013405.","journal-title":"Pacing Clin Electrophysiol"},{"key":"2593_CR7","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1093\/bja\/aep131","volume":"103","author":"M Zaballos","year":"2009","unstructured":"Zaballos M, Jimeno C, Almendral J, et al. Cardiac electrophysiological effects of remifentanil: study in a closed-chest porcine model. Br J Anaesth. 2009;103:191\u20138.","journal-title":"Br J Anaesth"},{"key":"2593_CR8","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1046\/j.1365-2044.2000.01607.x","volume":"55","author":"C Prys-Roberts","year":"2000","unstructured":"Prys-Roberts C, Lerman J, Murat I, et al. Comparison of remifentanil versus regional anaesthesia in children anaesthetised with isoflurane\/nitrous oxide. International Remifentanil Paediatric Anaesthesia Study group. Anaesthesia. 2000;55:870\u20136.","journal-title":"Anaesthesia"},{"key":"2593_CR9","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1111\/j.1399-6576.2008.01745.x","volume":"52","author":"CJ Chung","year":"2008","unstructured":"Chung CJ, Lee JM, Choi SR, Lee SC, Lee JH. Effect of remifentanil on caulocardiac reflex in paediatric strabismus surgery. Acta Anaesthesiol Scand. 2008;52:1273\u20137.","journal-title":"Acta Anaesthesiol Scand"},{"key":"2593_CR10","first-page":"673","volume":"69","author":"F Fattorini","year":"2003","unstructured":"Fattorini F, Romano R, Ciccaglioni A, et al. Effects of remifentanil on human heart electrical system. A transesophageal pacing electrophysiological study. Minerva Anestesiol. 2003;69:673\u20137.","journal-title":"Minerva Anestesiol"},{"key":"2593_CR11","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1213\/ANE.0b013e318210f4ef","volume":"112","author":"K Fujii","year":"2011","unstructured":"Fujii K, Iranami H, Nakamura Y, Hatano Y. High-dose remifentanil suppresses sinoatrial conduction and sinus node automaticity in pediatric patients under propofol-based anesthesia. Anesth Analg. 2011;112:1169\u201373.","journal-title":"Anesth Analg"},{"key":"2593_CR12","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1016\/j.joa.2017.03.008","volume":"33","author":"M Aste","year":"2017","unstructured":"Aste M, Brignole M. Syncope and paroxysmal atrioventricular block. J Arrhythm. 2017;33:562\u20137.","journal-title":"J Arrhythm"},{"key":"2593_CR13","first-page":"3","volume":"81","author":"S Guzzetti","year":"2015","unstructured":"Guzzetti S, Bassani T, Latini R, et al. Autonomic cardiovascular modulation with three different anesthetic strategies during neurosurgical procedures. Minerva Anestesiol. 2015;81:3\u201311.","journal-title":"Minerva Anestesiol"},{"key":"2593_CR14","doi-asserted-by":"crossref","unstructured":"Topjian AA, Raymond TT, Atkins D et al. Pediatric Basic and Advanced Life Support collaborators. Part 4: Pediatric Basic and Advanced Life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020: 20;142(16_suppl_2): S469-S523.","DOI":"10.1161\/CIR.0000000000000918"}],"container-title":["BMC Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-024-02593-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12871-024-02593-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-024-02593-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T04:30:31Z","timestamp":1723177831000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcanesthesiol.biomedcentral.com\/articles\/10.1186\/s12871-024-02593-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,9]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["2593"],"URL":"https:\/\/doi.org\/10.1186\/s12871-024-02593-8","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-3803737\/v1","asserted-by":"object"}]},"ISSN":["1471-2253"],"issn-type":[{"value":"1471-2253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,9]]},"assertion":[{"value":"25 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 June 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 August 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All methods were carried out in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics and consent to participate"}},{"value":"Written informed consent was obtained from the patient\u2019s guardian for publication of the case report and the images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"279"}}