Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients : a single-center, randomized, controlled trial

Background Remimazolam confers a lower risk of hypotension than propofol. However, no studies have compared the efficacy of remimazolam and propofol administered using target-controlled infusion (TCI). This study aimed to investigate hemodynamic effects of remimazolam and target-controlled propofol in middle-aged and elderly patients during the induction of anesthesia. Methods Forty adults aged 45–80 years with the American Society of Anesthesiologists Physical Status 1–2 were randomly assigned to remimazolam or propofol group (n = 20 each). Patients received either remimazolam (12 mg/kg/h) or propofol (3 μg/mL, TCI), along with remifentanil for inducing anesthesia. We recorded the blood pressure, heart rate (HR), and estimated continuous cardiac output (esCCO) using the pulse wave transit time. The primary outcome was the maximum change in mean arterial pressure (MAP) after induction. Secondary outcomes included changes in HR, cardiac output (CO), and stroke volume (SV). Results MAP decreased after induction of anesthesia in both groups, without significant differences between the groups (− 41.1 [16.4] mmHg and − 42.8 [10.8] mmHg in remimazolam and propofol groups, respectively; mean difference: 1.7 [95% confidence interval: − 8.2 to 4.9]; p = 0.613). Furthermore, HR, CO, and SV decreased after induction in both groups, without significant differences between the groups. Remimazolam group had significantly shorter time until loss of consciousness than propofol group (1.7 [0.7] min and 3.5 [1.7] min, respectively; p < 0.001). However, MAP, HR, CO, and SV were not significantly different between the groups despite adjusting time until loss of consciousness as a covariate. Seven (35%) and 11 (55%) patients in the remimazolam and propofol groups, respectively, experienced hypotension (MAP < 65 mmHg over 2.5 min), without significant differences between the groups (p = 0.341). Conclusions Hemodynamics were not significantly different between remimazolam and target-controlled propofol groups during induction of anesthesia. Thus, not only the choice but also the dose and usage of anesthetics are important for hemodynamic stability while inducing anesthesia. Clinicians should monitor hypotension while inducing anesthesia with remimazolam as well as propofol

ALS vs. BLS for Trauma

Background: Advanced Life Support (ALS) is regarded to be associated with improved survival in pre-hospital trauma care when compared to Basic Life Support (BLS) irrespective of lack of evidence. The aim of this study is to ascertain ALS improves survival for trauma in prehospital settings when compared to BLS. Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for published controlled trials (CTs), and observational studies that were published until Aug 2017. The population of interest were adults (>18 years old) trauma patients who were transported by ground transportation and required resuscitation in prehospital settings. We compared outcomes between the ALS and BLS groups. The primary outcome was in-hospital mortality and secondary outcomes were neurological outcome and time spent on scene. Results: We identified 2,502 studies from various databases and 10 studies were included in the analysis (two CTs, and eight observational studies). The outcomes were not statistically significant between the ALS and BLS groups (pooled OR 1.14; 95% CI 0.95 to 1.36 for mortality, pooled OR 1.12; 95% CI 0.88 to 1.42 for good neurological outcomes, pooled mean difference −0.96; 95% CI−6.64 to 4.72 for on-scene time) in CTs. In observational studies, ALS prolonged on-scene time and increased mortality (pooled OR 1.56; 95% CI: 1.31 to 1.86 for mortality, and pooled mean difference, 1.26; 95% CI: 0.07 to 2.45 for on-scene time). Conclusions: In prehospital settings, the present study showed no advantages of ALS on the outcomes in patients with trauma compared to BLS

Dusty ERO Search behind Two Massive Clusters

We performed deep K'-band imaging observations of 2 massive clusters, MS 0451.6-0305 at z = 0.55 and MS 0440.5+0204 at z = 0.19, for searching counterparts of the faint sub-mm sources behind these clusters, which would provide one of the deepest extremely red object(ERO) samples. Comparing our near-infrared images with optical images taken by the Hubble Space Telescope and by the Subaru Telescope, we identified 13 EROs in these fields. The sky distributions of EROs are consistent with the previous results, that there is a sign of strong clustering among detected EROs. Also, the surface density with corrected lensing amplification factors in both clusters are in good agreement with that derived from previous surveys. We found 7 EROs and 3 additional very red objects in a small area (\sim 0.6 arcmin^2) of the MS 0451.6-0305 field around an extended SCUBA source. Many of their optical and near-infrared colors are consistent with dusty star-forming galaxies at high redshifts(z \sim 1.0-4.0), and they may be constituting a cluster of dusty starburst galaxies and/or lensed star-forming galaxies at high redshift. Their red J-K' colors and faint optical magnitudes suggest they are relatively old massive stellar systems with ages(>300 Mega years) suffering from dust obscuration. We also found a surface-density enhancement of EROs around the SCUBA source in the MS 0440.5+0204 field.Comment: 19 pages, 11 figures, Latex(using pasj00.cls). To be published in PASJ vol 55, No. 4(Aug 2003

Photometry and Polarimetry of 2010 XC15_{15}: Observational Confirmation of E-type Near-Earth Asteroid Pair

Asteroid systems such as binaries and pairs are indicative of physical properties and dynamical histories of the Small Solar System Bodies. Although numerous observational and theoretical studies have been carried out, the formation mechanism of asteroid pairs is still unclear, especially for near-Earth asteroid (NEA) pairs. We conducted a series of optical photometric and polarimetric observations of a small NEA 2010 XC$_{15}$ in 2022 December to investigate its surface properties. The rotation period of 2010 XC$_{15}$ is possibly a few to several dozen hours and color indices of 2010 XC$_{15}$ are derived as $g-r=0.435\pm0.008$, $r-i=0.158\pm0.017$, and $r-z=0.186\pm0.009$ in the Pan-STARRS system. The linear polarization degrees of 2010 XC$_{15}$ are a few percent at the phase angle range of 58$^{\circ}$ to 114$^{\circ}$. We found that 2010 XC$_{15}$ is a rare E-type NEA on the basis of its photometric and polarimetric properties. Taking the similarity of not only physical properties but also dynamical integrals and the rarity of E-type NEAs into account, we suppose that 2010 XC$_{15}$ and 1998 WT$_{24}$ are of common origin (i.e., asteroid pair). These two NEAs are the sixth NEA pair and first E-type NEA pair ever confirmed, possibly formed by rotational fission. We conjecture that the parent body of 2010 XC$_{15}$ and 1998 WT$_{24}$ was transported from the main-belt through the $\nu_6$ resonance or Hungaria region.Comment: Resubmitted to AAS Journals. Any comments are welcom