{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T13:07:07Z","timestamp":1765976827527,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T00:00:00Z","timestamp":1744848000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Hana Pharm Co., Ltd. (Seoul, Republic of Korea)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The Analgesia Nociception Index (ANI), a surrogate marker derived from heart rate variability (HRV) analysis, has been validated for assessing the balance between antinociception and nociception during propofol anesthesia. The ANI continuously monitors this balance, with values above 50 indicating optimal analgesia. By adjusting analgesic administration based on ANI values, anesthesiologists can provide more personalized intraoperative pain control. Remimazolam, a novel benzodiazepine anesthetic lacking intrinsic analgesic properties, exhibits distinct HRV patterns compared to propofol. Considering these differences, the validity of the ANI during remimazolam anesthesia remains uncertain. We evaluated the validity of the ANI by assessing its ability to detect nociceptive stimuli during remimazolam anesthesia. Materials and Methods: In total, 28 patients were administered general anesthesia using remimazolam and remifentanil. We evaluated changes in the ANI before and after tetanic stimulation. In addition, we investigated the association between hemodynamic responses during surgical incisions and changes in the ANI. Results: Tetanic stimulation resulted in a significant (p &lt; 0.001) reduction in the ANI, from 62.0 (interquartile range [IQR] 50.5\u201376.0) to 44.0 (IQR 37.0\u201355.5). Of the 13 patients who experienced hemodynamic responses during surgical incision, the ANI significantly decreased from 63.2 \u00b1 13.6 to 36.9 \u00b1 13.8 following noxious surgical stimulation (p &lt; 0.001). Conclusions: The ANI reflects the dynamic equilibrium between antinociception and nociception during remimazolam-based general anesthesia.<\/jats:p>","DOI":"10.3390\/medicina61040742","type":"journal-article","created":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T20:50:46Z","timestamp":1744923046000},"page":"742","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Analgesia Nociception Index\u2019s Performance During Remimazolam-Based General Anesthesia: A Prospective Observational Study"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6224-1788","authenticated-orcid":false,"given":"Joohyun","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, CHA Ilsan Medical Center, CHA University, Ilsan 13496, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4481-8923","authenticated-orcid":false,"given":"Jung-Min","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5104-9486","authenticated-orcid":false,"given":"Young","family":"Joo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, CHA Ilsan Medical Center, CHA University, Ilsan 13496, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/01.anes.0000267503.85085.c0","article-title":"CNS 7056: A novel ultra-short-acting Benzodiazepine","volume":"107","author":"Kilpatrick","year":"2007","journal-title":"Anesthesiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.17085\/apm.21115","article-title":"Remimazolam: Pharmacological characteristics and clinical applications in anesthesiology","volume":"17","author":"Kim","year":"2022","journal-title":"Anesth. 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Anaesth."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/742\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:16:29Z","timestamp":1760030189000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/742"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,17]]},"references-count":20,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["medicina61040742"],"URL":"https:\/\/doi.org\/10.3390\/medicina61040742","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2025,4,17]]}}}