Journal of Anesthesia最新文献

Purpose: A stable supply of pharmaceuticals is essential for safe perioperative management. In 2019, Japan experienced a nationwide shortage of cefazolin (CEZ), a first-line prophylactic antibiotic, following the suspension of shipments by a major manufacturer (Company A). This study aimed to examine how this shortage influenced perioperative antibiotic selection in operating rooms across Japan.

Methods: We analyzed antibiotic usage data at 37 of 42 facilities that participated in the Japanese Epidemiologic Study for Perioperative Anaphylaxis (JESPA, UMIN000035350) from July 2019 to July 2020. The usage frequency of each antibiotic administered under general anesthesia was evaluated. Statistical analyses included the Mann-Whitney U test and multivariable linear regression, with CEZ usage proportion as the dependent variable.

Results: During the CEZ shortage period (July to December 2019), CEZ usage decreased, whereas the use of alternatives such as cefmetazole, flomoxef, sulbactam/ampicillin, and clindamycin increased. Facilities supplied exclusively by Company A (Group A) showed a significantly greater decline in CEZ usage than those with other/multiple suppliers (Group B) (p < 0.001). Multivariable analysis identified manufacturer group as the only significant factor associated with CEZ usage (Group B vs. Group A: β = 2.11, 95% CI 1.52 to 2.71, p < 0.001; adjusted R² = 0.64).

Conclusion: The drop in CEZ supply reduced its perioperative use and increased reliance on alternative antimicrobials. The impact was less severe at facilities with multiple suppliers, suggesting supplier diversification may help mitigate future shortages. These findings, based on actual administration data from operating rooms across Japan, provide insights for ensuring a stable antibiotic supply.

Purpose: Remimazolam is a novel benzodiazepine intravenous sedative that is reversible by flumazenil. The related drug midazolam inhibits platelet aggregation through multiple pathways, but the effect of remimazolam on platelet function remains unclear. The aim of this study is to investigate the effect of remimazolam (Anerem^®) on platelet function in vitro.

Methods: Venous blood from healthy volunteers was incubated with remimazolam (3-300 μg/mL) in platelet-rich plasma and whole blood. Dextran, an excipient in Anerem^®, was also investigated at corresponding concentrations (12-1200 μg/mL). Platelet aggregation was assessed by light transmission aggregometry using adenosine diphosphate (ADP) stimulation, and P-selectin expression was measured by flow cytometry. Platelet counts and mean platelet volume (MPV) were determined using an automated hematology analyzer. The same effects were also investigated in the presence of flumazenil (0.6-30 ng/mL).

Results: At 3 μg/mL, corresponding to clinical plasma levels, remimazolam showed no effect on platelet function. However, at 300 μg/mL, both ADP-induced platelet aggregation and P-selectin expression were significantly inhibited. The inhibition of aggregation was antagonized by flumazenil, but the reduced P-selectin expression was not reversed. Neither dextran nor flumazenil alone showed significant effects, and platelet count and MPV remained unchanged.

Conclusion: Remimazolam (Anerem^®) did not affect human platelet function at clinically relevant concentrations. However, it inhibited platelet aggregation at supra-clinical concentrations and this effect was partially mediated by a flumazenil-sensitive pathway. These findings provide pharmacological insight into the effects of remimazolam on platelets; however, the clinical relevance of these observations requires further evaluation in future in vivo and clinical studies.

Purpose: Prolonged labor is associated with adverse maternal and neonatal outcomes. Combined spinal-epidural analgesia and dural puncture epidural analgesia are neuraxial analgesic techniques commonly used for labor pain relief. We aimed to compare labor duration between these two techniques.

Methods: This single-center, retrospective, observational study analyzed obstetric data of women who delivered using combined spinal-epidural or dural puncture epidural analgesia between January 2022 and November 2024. We used the inverse probability of treatment weighting method with combined spinal-epidural analgesia as the treatment group. The primary outcome was first-stage labor duration; secondary outcomes included second-stage labor duration, proportion of cesarean and instrumental deliveries, and neonatal outcomes. Time-to-event analysis was performed using the Kaplan-Meier method and Cox proportional hazards models.

Results: Of 1087 participants, 1011 were included (combined spinal-epidural analgesia, n = 845; dural puncture epidural analgesia, n = 166). After the inverse probability of treatment weighting adjustment, participant characteristics were well-balanced. First-stage labor duration did not significantly differ between groups (weighted hazard ratio, 1.14; 95% confidence interval [CI], 0.94-1.40; p = 0.187). However, combined spinal-epidural analgesia was associated with prolonged second-stage labor duration (weighted hazard ratio, 0.79; 95% CI, 0.65-0.96; p = 0.018) and lower cesarean delivery during the first stage (weighted odds ratio, 0.36; 95% CI, 0.22-0.61; p < 0.001). Other secondary outcomes were not significantly different between the groups.

Conclusion: First-stage labor duration was not significantly different between the two techniques. These results may inform clinical discussions about neuraxial analgesia selection in obstetric practice.