Kosin Medical Journal

Case reports

Remimazolam in pediatric surgery under general anesthesia: a case series: Hong-Sik Shon, Seyeon Park, Jung-Pil Yoon, Yeong Min Yoo, Jimin Lee, Da Eun Lee, Hee Young Kim; Kosin Med J. 2024;39(3):201-206. Published online May 9, 2024; DOI: https://doi.org/10.7180/kmj.24.105

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Remimazolam is a promising drug for general anesthesia due to its rapid onset, short duration, and short context-sensitive half-life. However, its use in pediatric patients remains off-label, and limited prospective data have been published. Herein, we report successful anesthesia using remimazolam in pediatric patients who had a history of epilepsy or required shared airway surgery. In all cases, remimazolam provided general anesthesia, and flumazenil was used for reversal with rapid recovery. Remimazolam offers advantages for pediatric anesthesia in scenarios with a risk of seizure or shared airway surgery. However, the potential for higher bispectral index values and the risk of anaphylaxis in dextran-allergic patients necessitate caution and further research.

Citations

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Remimazolam: Is the new “wonder drug” in anesthesia any good in children?
Tom G. Hansen, Thomas Engelhardt
Acta Anaesthesiologica Scandinavica.2025;[Epub] CrossRef

A Case of an Infant Diagnosed with Cow's Milk Allergy and Concurrent Meat Allergy via ImmunoCAP ISAC®: So Yoon Jo, Chan Ho Lee, Sung Won Kim, Yoon Ha Hwang; Kosin Med J. 2019;34(1):72-77. Published online June 30, 2019; DOI: https://doi.org/10.7180/kmj.2019.34.1.72

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Approximately 13–20% of infants with milk allergies concurrently exhibit beef allergies. Here, we report a 24-month-old infant who exhibited both pork and beef allergies, concurrently with a milk allergy. The infant's laboratory test results were: 3.73 ISU-E (ISAC standardized unit for IgE) for cow milk β-lactoglobulin, 23.8 ISU-E for casein, 12.8 ISU-E for cow milk Bos d 6 of serum albumin, and 4.85 ISU-E for cat Fel d 2. This case report summarizes an infant patient diagnosed with a meat allergy that was associated with cow's milk allergy, using ImmunoCAP ISAC®. Not only ImmunoCAP ISAC® but also immunocap can be used to diagnose milk allergy and meat allergy at the same time, immunocap testing for component antigen is rare. ImmunoCAP ISAC® is used to diagnose these allergies in our case study, as it has advantage that only 1ml of blood is needed to run various component antigen tests.

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Preparation, Identification and Application of β-Lactoglobulin Hydrolysates with Oral Immune Tolerance
Linghan Tian, Qianqian Zhang, Yanjun Cong, Wenjie Yan
Foods.2023; 12(2): 307. CrossRef
Benefits, perceived and actual risks and barriers to egg consumption in low- and middle-income countries
Chhavi Tiwari, Mulubrhan Balehegn, Adegbola T. Adesogan, Sarah L. McKune
Frontiers in Animal Science.2023;[Epub] CrossRef

Persistent Complete Atrioventricular Block after Induction of General Anesthesia in a Healthy Patient: Gyeong-Jo Byeon, Hye-Jin Kim, Hyun-Su Ri, Su Sung Lee, Hee Young Kim; Kosin Med J. 2019;34(1):65-71. Published online June 30, 2019; DOI: https://doi.org/10.7180/kmj.2019.34.1.65

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A 38-year-old female patient had bradycardia in the preoperative electrocardiogram (ECG), and she showed severe bradycardia, with the heart rate (HR) under 40 beats per minute (bpm) even after arrival in the operating room. Immediately after endotracheal intubation, ventricular tachycardia with HR over 200 bpm occurred, but it disappeared voluntarily. The surgery was postponed for additional cardiac evaluation because of the persistent severe bradycardia. On postanesthesia day 2, complete atrioventricular (AV) block appeared. We expected spontaneous recovery over 2 weeks, but the complete AV block persisted. A permanent pacemaker was eventually inserted, and the patient was discharged without other complications on day 4 after insertion of the pacemaker. We report this case because complete AV block has commonly occurred in patients with risk factors such as first AV block, secondary AV block, or bundle branch block, but complete AV block has occurred despite the absence of arrhythmia in this patient.

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Repeated complete atrioventricular block during remifentanil administration in a pediatric patient with brain tumor and acute hydrocephalus: a case report
Akihiro Ura, Keisuke Fujii, Tadashi Tanioku, Tomoyuki Kawamata
BMC Anesthesiology.2024;[Epub] CrossRef

Original article

Relation of Various Parameters Used to Estimate Cardiac Vagal Activity and Validity of pNN50 in Anesthetized Humans: Jae Ho Lee, In Young Huh, Jae Min Lee, Hyung Kwan Lee, Il Sang Han, Ho Jun Kang; Kosin Med J. 2018;33(3):369-379. Published online January 19, 2018; DOI: https://doi.org/10.7180/kmj.2018.33.3.369

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Objectives

Analysis of heart rate variability (HRV) has been used as a measure of cardiac autonomic function. According to the pNN50 statistic, the percentage of differences between successive normal RR intervals (RRI) that exceed 50 ms, has been known to reflect cardiac vagal modulation. Relatively little is known about the validity of pNN50 during general anesthesia (GA). Therefore, we evaluated the correlation of pNN50 with other variables such as HF, RMSSD, SD1 of HRV reflecting the vagal tone, and examined the validity of pNN50 in anesthetized patients. Methods: We assessed changes in RRI, pNN50, root mean square of successive differences of RRI (RMSSD), high frequency (HF) and standard deviation 1 (SD1) of Poincaré plots after GA using sevoflurane anesthesia. We also calculated the probability distributions for the family of pNNx statistics (x: 2-50 ms).

Results

All HRV variables were significantly decreased during GA. HF power was not correlated with pNN50 during GA (r = 0.096, P = 0.392). Less than pNN47 was shown to have a correlation with other variables.

Conclusions

These data suggest that pNN50 can not reflect the level of vagal tone during GA.

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Comprehensive evaluation of machine learning algorithms for predicting sleep–wake conditions and differentiating between the wake conditions before and after sleep during pregnancy based on heart rate variability
Xue Li, Chiaki Ono, Noriko Warita, Tomoka Shoji, Takashi Nakagawa, Hitomi Usukura, Zhiqian Yu, Yuta Takahashi, Kei Ichiji, Norihiro Sugita, Natsuko Kobayashi, Saya Kikuchi, Ryoko Kimura, Yumiko Hamaie, Mizuki Hino, Yasuto Kunii, Keiko Murakami, Mami Ishik
Frontiers in Psychiatry.2023;[Epub] CrossRef

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