{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T14:01:34Z","timestamp":1784642494709,"version":"3.55.0"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":57,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["JA Clin Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anaphylaxis in patients with a left ventricular assist device (LVAD) may critically reduce LVAD flow, particularly when the right ventricular function is impaired.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 51-year-old man with a HeartMate III LVAD developed bronchospasm, profound hypotension, and decreased LVAD flow during anesthetic induction for endoscopic sinus surgery. The shock remained refractory despite epinephrine boluses and continuous infusions of epinephrine, norepinephrine, and vasopressin. Transesophageal echocardiography revealed severe right ventricular dilatation, leftward septal shift, and reduced left ventricular size, findings consistent with acute right heart failure (RHF). Treatment was escalated to include dobutamine, olprinone, and inhaled nitric oxide, achieving recovery of blood pressure and LVAD flow. Elevated serum tryptase supported the diagnosis of anaphylaxis, and a positive intradermal test identified remimazolam as the cause.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Successful anaphylaxis management in LVAD recipients may require rapid recognition and treatment of acute RHF in addition to standard treatment including epinephrine.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40981-026-00864-6","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T14:14:02Z","timestamp":1779718442000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Refractory anaphylactic shock complicated by acute right heart failure during anesthetic induction in a patient with a left ventricular assist device: a case report"],"prefix":"10.1186","volume":"12","author":[{"given":"Shohei","family":"Kaneko","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sojiro","family":"Matsumoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taiga","family":"Ichinomiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ushio","family":"Higashijima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motohiro","family":"Sekino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Hara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"864_CR1","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1016\/j.bjae.2023.06.003","volume":"23","author":"R Falland","year":"2023","unstructured":"Falland R, Allen SJ. Perioperative management of patients with a ventricular assist device undergoing non-cardiac surgery. BJA Educ. 2023;23:406\u201313.","journal-title":"BJA Educ"},{"key":"864_CR2","doi-asserted-by":"publisher","first-page":"351","DOI":"10.4103\/aca.ACA_239_17","volume":"21","author":"KW Hwang","year":"2018","unstructured":"Hwang KW, Hwang NC. Facilitating noncardiac surgery for the patient with left ventricular assist device: a guide for the anesthesiologist. Ann Card Anaesth. 2018;21:351\u201362.","journal-title":"Ann Card Anaesth"},{"key":"864_CR3","doi-asserted-by":"publisher","first-page":"175","DOI":"10.4097\/kja.23169","volume":"77","author":"JJ Min","year":"2024","unstructured":"Min JJ, Cho YH, Lee SM, Lee JH. Anesthetic management for non-cardiac surgery in patients with left ventricular assist devices. Korean J Anesthesiol. 2024;77:175\u201384.","journal-title":"Korean J Anesthesiol"},{"key":"864_CR4","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1007\/s12630-025-02915-5","volume":"72","author":"M Ma","year":"2025","unstructured":"Ma M, Duncan D, Bartoszko J. Perioperative anaphylaxis: an update on pathophysiology, diagnosis, and management. Can J Anaesth. 2025;72:649\u201374.","journal-title":"Can J Anaesth"},{"key":"864_CR5","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1097\/EJA.0000000000001536","volume":"38","author":"A Gouel-Cheron","year":"2021","unstructured":"Gouel-Cheron A, Neukirch C, Kantor E, et al. Clinical reasoning in anaphylactic shock: addressing the challenges faced by anaesthesiologists in real time: a clinical review and management algorithms. Eur J Anaesthesiol. 2021;38:1158\u201367.","journal-title":"Eur J Anaesthesiol"},{"key":"864_CR6","unstructured":"Japanese Society of Allergology. Hifu tesuto no tebiki 2025 [Skin Test Guide 2025]. https:\/\/www.jsaweb.jp\/modules\/journal\/index.php?content_id=4. Accessed 7 May 2026. In Japanese."},{"key":"864_CR7","doi-asserted-by":"publisher","first-page":"2683","DOI":"10.1056\/NEJMra051884","volume":"353","author":"MJ Griffiths","year":"2005","unstructured":"Griffiths MJ, Evans TW. Inhaled nitric oxide therapy in adults. N Engl J Med. 2005;353:2683\u201395.","journal-title":"N Engl J Med"},{"key":"864_CR8","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1053\/j.jvca.2018.04.038","volume":"33","author":"E Zhou","year":"2019","unstructured":"Zhou E, Parikh PS, Kanchuger MS, Balsam LB. Intraoperative anaphylaxis to chlorhexidine during LVAD and transplant surgery. J Cardiothorac Vasc Anesth. 2019;33:169\u201372.","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"864_CR9","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1016\/S1053-2498(02)00395-9","volume":"21","author":"CA Milano","year":"2002","unstructured":"Milano CA, Patel VS, Smith PK, Smith MS. Risk of anaphylaxis from aprotinin re-exposure during LVAD removal and heart transplantation. J Heart Lung Transpl. 2002;21:1127\u201330.","journal-title":"J Heart Lung Transpl"}],"container-title":["JA Clinical Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40981-026-00864-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40981-026-00864-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40981-026-00864-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T13:06:18Z","timestamp":1784639178000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40981-026-00864-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["864"],"URL":"https:\/\/doi.org\/10.1186\/s40981-026-00864-6","relation":{},"ISSN":["2363-9024"],"issn-type":[{"value":"2363-9024","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]},"assertion":[{"value":"30 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 May 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 May 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This report was approved by the Institutional Review Board of Nagasaki University Hospital (Approval number: 25120212).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and accompanying images.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"28"}}