Background: Prompt awakening and sufficient recovery of psychomotor and equilibrium functions are important for day surgery. Flumazenil accelerates recovery of consciousness after remimazolam anesthesia, but its effects on psychomotor and equilibrium functions are not well known. The purpose of this study was to determine whether flumazenil improves time to recovery, psychomotor, and equilibrium functions in subjects undergoing remimazolam anesthesia. Methods: The design was a single-center, double-blind, randomized, controlled trial. Inclusion criteria were patients aged 18–64 years scheduled for oral surgery under remimazolam anesthesia, with American Society of Anesthesiologists physical status I or II. The predictor variable was the use of a reversal agent (flumazenil group) versus placebo (non-flumazenil group). The primary outcome variable was recovery from sedation measured using the Modified Observer’s Alertness/Sedation (MOAA/S) scale for wakefulness. Secondary outcome variables were psychomotor function measured using the Trieger Dot Test (number of dots missed [NDM], maximum distance of dots missed [MDDM]), and the digit symbol substitution test (DSST), as well as equilibrium function measured using the timed up and go test (TUG), and gravimetric area and speed. Statistical analyses were performed using the Mann-Whitney U test, χ² test, Student’s t-test, two-way ANOVA, and Bonferroni correction. P-values < 0.05 were considered significant. Results: Sixty-eight subjects were included (male: 33, female: 35). The mean time from extubation to an MOAA/S score of 5 (minutes) was 6.5 (1.5–10.5) in the flumazenil group and 13.5 (6.8–19.3) in the non-flumazenil group (P = 0.01). There was no significant difference in the recovery of psychomotor and balance functions between the two groups. However, the following measurements were significantly increased compared to baseline: NDM (P < 0.001) and DSST (P < 0.001) at 30 minutes, MDDM (P < 0.001), TUG (P < 0.001), and gravimetric speed (P < 0.001) at 60 minutes, and gravimetric area (P = 0.03) at 90 minutes. Conclusion Administration of flumazenil after remimazolam anesthesia resulted in faster recovery of consciousness, but it did not affect the recovery of psychomotor and equilibrium functions. The time until patients were safe to return home was 120 minutes. Flumazenil did not improve the time until it was safe for patients to return home.

Background: Prompt awakening and sufficient recovery of psychomotor and equilibrium functions are important for day surgery. Flumazenil accelerates recovery of consciousness after remimazolam anesthesia, but its effects on psychomotor and equilibrium functions are not well known. The purpose of this study was to determine whether flumazenil improves time to recovery, psychomotor, and equilibrium functions in subjects undergoing remimazolam anesthesia. Methods: The design was a single-center, double-blind, randomized, controlled trial. Inclusion criteria were patients aged 18–64 years scheduled for oral surgery under remimazolam anesthesia, with American Society of Anesthesiologists physical status I or II. The predictor variable was the use of a reversal agent (flumazenil group) versus placebo (non-flumazenil group). The primary outcome variable was recovery from sedation measured using the Modified Observer’s Alertness/Sedation (MOAA/S) scale for wakefulness. Secondary outcome variables were psychomotor function measured using the Trieger Dot Test (number of dots missed [NDM], maximum distance of dots missed [MDDM]), and the digit symbol substitution test (DSST), as well as equilibrium function measured using the timed up and go test (TUG), and gravimetric area and speed. Statistical analyses were performed using the Mann-Whitney U test, χ² test, Student’s t-test, two-way ANOVA, and Bonferroni correction. P-values < 0.05 were considered significant. Results: Sixty-eight subjects were included (male: 33, female: 35). The mean time from extubation to an MOAA/S score of 5 (minutes) was 6.5 (1.5–10.5) in the flumazenil group and 13.5 (6.8–19.3) in the non-flumazenil group (P = 0.01). There was no significant difference in the recovery of psychomotor and balance functions between the two groups. However, the following measurements were significantly increased compared to baseline: NDM (P < 0.001) and DSST (P < 0.001) at 30 minutes, MDDM (P < 0.001), TUG (P < 0.001), and gravimetric speed (P < 0.001) at 60 minutes, and gravimetric area (P = 0.03) at 90 minutes. Conclusion Administration of flumazenil after remimazolam anesthesia resulted in faster recovery of consciousness, but it did not affect the recovery of psychomotor and equilibrium functions. The time until patients were safe to return home was 120 minutes. Flumazenil did not improve the time until it was safe for patients to return home.

Background: Prompt awakening and sufficient recovery of psychomotor and equilibrium functions are important for day surgery. Flumazenil accelerates recovery of consciousness after remimazolam anesthesia, but its effects on psychomotor and equilibrium functions are not well known. The purpose of this study was to determine whether flumazenil improves time to recovery, psychomotor, and equilibrium functions in subjects undergoing remimazolam anesthesia. Methods: The design was a single-center, double-blind, randomized, controlled trial. Inclusion criteria were patients aged 18–64 years scheduled for oral surgery under remimazolam anesthesia, with American Society of Anesthesiologists physical status I or II. The predictor variable was the use of a reversal agent (flumazenil group) versus placebo (non-flumazenil group). The primary outcome variable was recovery from sedation measured using the Modified Observer’s Alertness/Sedation (MOAA/S) scale for wakefulness. Secondary outcome variables were psychomotor function measured using the Trieger Dot Test (number of dots missed [NDM], maximum distance of dots missed [MDDM]), and the digit symbol substitution test (DSST), as well as equilibrium function measured using the timed up and go test (TUG), and gravimetric area and speed. Statistical analyses were performed using the Mann-Whitney U test, χ² test, Student’s t-test, two-way ANOVA, and Bonferroni correction. P-values < 0.05 were considered significant. Results: Sixty-eight subjects were included (male: 33, female: 35). The mean time from extubation to an MOAA/S score of 5 (minutes) was 6.5 (1.5–10.5) in the flumazenil group and 13.5 (6.8–19.3) in the non-flumazenil group (P = 0.01). There was no significant difference in the recovery of psychomotor and balance functions between the two groups. However, the following measurements were significantly increased compared to baseline: NDM (P < 0.001) and DSST (P < 0.001) at 30 minutes, MDDM (P < 0.001), TUG (P < 0.001), and gravimetric speed (P < 0.001) at 60 minutes, and gravimetric area (P = 0.03) at 90 minutes. Conclusion Administration of flumazenil after remimazolam anesthesia resulted in faster recovery of consciousness, but it did not affect the recovery of psychomotor and equilibrium functions. The time until patients were safe to return home was 120 minutes. Flumazenil did not improve the time until it was safe for patients to return home.

Background: This study evaluated the effect of remimazolam and propofol on changes in autonomic nerve activity caused by surgical stimulation during orthognathic surgery, using power spectrum analysis of blood pressure variability (BPV) and heart rate variability (HRV), and their respective associations with cardiovascular fluctuations. Methods: A total of 34 patients undergoing Le Fort I osteotomy were randomized to the remimazolam (Group R, 17 cases) or propofol (Group P, 17 cases) groups. Observables included the low-frequency component of BPV (BPV LF; index of vasomotor sympathetic nerve activity), high-frequency component of HRV (HRV HF; index of parasympathetic nerve activity), balance index of the low- and high-frequency components of HRV (HRV LF/HF; index of sympathetic nerve activity), heart rate (HR), and systolic blood pressure (SBP). Four observations were made: (1) baseline, (2) immediately before down-fracture, (3) down-fracture, and (4) 5 min after down-fracture. Data from each observation period were compared using a two-way analysis of variance with a mixed model. A Bonferroni multiple comparison test was performed in the absence of any interaction.One-way analysis of variance followed by Tukey's multiple comparisons test was performed when a significant interaction was observed between time and group, with P < 0.05 indicating statistical significance. Results: Evaluation of autonomic nerve activity in comparison with baseline during down-fracture showed a significant increase in BPV LF (P < 0.001), an increasing trend in HRV LF/HF in Group P, and an increasing trend in HRV HF in Group R. There were no significant differences in HR or SBP between the two groups. Conclusion During down-fracture of Le Fort I osteotomy, sympathetic nerve activity was predominant with propofol anesthesia, and parasympathetic nerve activity was predominant with remimazolam anesthesia.

Background: This study aimed to investigate the relationship between pharyngeal morphology and the success or failure of blind nasotracheal intubation using standard lateral cephalometric radiography and to analyze the measurement items affecting the difficulty of blind nasotracheal intubation. Methods: Assuming a line perpendicular to the Frankfort horizontal (FH) plane, the reference point (O) was selected 1 cm above the posterior-most end of the hard palate. A line passing through the reference point and parallel to the FH plane is defined as the X-axis, and a line passing through the reference point and perpendicular to the X-axis is defined as the Y-axis. The shortest length between the tip of the uvula and posterior pharyngeal wall (AW), shortest length between the base of the tongue and posterior pharyngeal wall (BW), and width of the glottis (CW) were measured. The midpoints of the lines representing each width are defined as points A, B, and C, and the X and Y coordinates of each point are obtained (AX, BX, CX, AY, BY, and CY). For each measurement, a t-test was performed to compare the tracheal intubation success and failure groups. A binomial logistic regression analysis was performed using clinically relevant items. Results: The items significantly affecting the success rate of blind nasotracheal intubation included the difference in X coordinates at points A and C (Odds ratio, 0.714; P-value, 0.024) and the ∠ABC (Odds ratio, 1.178;P-value, 0.016). Conclusion Using binomial logistic regression analysis, we observed statistically significant differences in AX-CX and ∠ABC between the success group and the failure group.

Background: Video laryngoscopy is beneficial in difficult airway intubation; however, various factors complicate the process. These devices come in different designs, and their usefulness may vary by type. In this study, we compared the effectiveness of several video laryngoscopic .instruments across three simulated difficult intubation scenarios using manikin models. Methods: Training simulators for tracheal intubation were set to four conditions: (i) Normal (mouth opening:50 mm, normal neck); (ii) Head tilt disorder (mouth opening: 50 mm, rigid neck); (iii) Trismus (mouth opening:20 mm, normal neck); and (iv) Head tilt disorder + trismus (mouth opening: 20 mm, rigid neck). Seventeen dental anesthesiologists attempted oral tracheal intubation using the following video laryngoscopes: Airway Scope;McGRATH (Normal blade [size 3]); McGRATH (X-blade); and i-view. Evaluated parameters included total intubation time, glottic visualization time, tube induction time, success rate, and difficulty grading of tracheal intubation (Cormack-Lehane classification and the Numerical Rating Scale [NRS]). Statistical analysis was conducted using mixed models, incorporating two-way ANOVA, Tukey’s test, two-way ANOVA without repeated measures, and Kruskal-Wallis test, with P < 0.05 deemed statistically significant. Results: Intubation time using i-view was significantly longer for head tilt disorder and trismus compared to other video laryngoscopes (head tilt disorder: P < 0.001 for all, trismus: P = 0.021 vs. Airway Scope, P = 0.028 vs. X-blade). The Cormack-Lehane grade was notably high (P = 0.001) for tracheal intubation with i-view in the head tilt disorder scenario, with intubation failing in three cases. In the combined situation of head tilt disorder and trismus, intubation time with Airway Scope was shorter (P < 0.001 vs. X-blade), achieving a success rate of 100%. However, all attempts with i-view were unsuccessful. The NRS score was significantly higher for i-view compared to the other video laryngoscopes (P < 0.001). Conclusion Video laryngoscopy effectiveness varies by type in difficult tracheal intubation cases. The Airway Scope or McGRATH instrument appears more suitable for such cases, as indicated by the metrics of intubation time, success rate, and difficulty level.

Background: Video laryngoscopy is beneficial in difficult airway intubation; however, various factors complicate the process. These devices come in different designs, and their usefulness may vary by type. In this study, we compared the effectiveness of several video laryngoscopic .instruments across three simulated difficult intubation scenarios using manikin models. Methods: Training simulators for tracheal intubation were set to four conditions: (i) Normal (mouth opening:50 mm, normal neck); (ii) Head tilt disorder (mouth opening: 50 mm, rigid neck); (iii) Trismus (mouth opening:20 mm, normal neck); and (iv) Head tilt disorder + trismus (mouth opening: 20 mm, rigid neck). Seventeen dental anesthesiologists attempted oral tracheal intubation using the following video laryngoscopes: Airway Scope;McGRATH (Normal blade [size 3]); McGRATH (X-blade); and i-view. Evaluated parameters included total intubation time, glottic visualization time, tube induction time, success rate, and difficulty grading of tracheal intubation (Cormack-Lehane classification and the Numerical Rating Scale [NRS]). Statistical analysis was conducted using mixed models, incorporating two-way ANOVA, Tukey’s test, two-way ANOVA without repeated measures, and Kruskal-Wallis test, with P < 0.05 deemed statistically significant. Results: Intubation time using i-view was significantly longer for head tilt disorder and trismus compared to other video laryngoscopes (head tilt disorder: P < 0.001 for all, trismus: P = 0.021 vs. Airway Scope, P = 0.028 vs. X-blade). The Cormack-Lehane grade was notably high (P = 0.001) for tracheal intubation with i-view in the head tilt disorder scenario, with intubation failing in three cases. In the combined situation of head tilt disorder and trismus, intubation time with Airway Scope was shorter (P < 0.001 vs. X-blade), achieving a success rate of 100%. However, all attempts with i-view were unsuccessful. The NRS score was significantly higher for i-view compared to the other video laryngoscopes (P < 0.001). Conclusion Video laryngoscopy effectiveness varies by type in difficult tracheal intubation cases. The Airway Scope or McGRATH instrument appears more suitable for such cases, as indicated by the metrics of intubation time, success rate, and difficulty level.

Background: Video laryngoscopy is beneficial in difficult airway intubation; however, various factors complicate the process. These devices come in different designs, and their usefulness may vary by type. In this study, we compared the effectiveness of several video laryngoscopic .instruments across three simulated difficult intubation scenarios using manikin models. Methods: Training simulators for tracheal intubation were set to four conditions: (i) Normal (mouth opening:50 mm, normal neck); (ii) Head tilt disorder (mouth opening: 50 mm, rigid neck); (iii) Trismus (mouth opening:20 mm, normal neck); and (iv) Head tilt disorder + trismus (mouth opening: 20 mm, rigid neck). Seventeen dental anesthesiologists attempted oral tracheal intubation using the following video laryngoscopes: Airway Scope;McGRATH (Normal blade [size 3]); McGRATH (X-blade); and i-view. Evaluated parameters included total intubation time, glottic visualization time, tube induction time, success rate, and difficulty grading of tracheal intubation (Cormack-Lehane classification and the Numerical Rating Scale [NRS]). Statistical analysis was conducted using mixed models, incorporating two-way ANOVA, Tukey’s test, two-way ANOVA without repeated measures, and Kruskal-Wallis test, with P < 0.05 deemed statistically significant. Results: Intubation time using i-view was significantly longer for head tilt disorder and trismus compared to other video laryngoscopes (head tilt disorder: P < 0.001 for all, trismus: P = 0.021 vs. Airway Scope, P = 0.028 vs. X-blade). The Cormack-Lehane grade was notably high (P = 0.001) for tracheal intubation with i-view in the head tilt disorder scenario, with intubation failing in three cases. In the combined situation of head tilt disorder and trismus, intubation time with Airway Scope was shorter (P < 0.001 vs. X-blade), achieving a success rate of 100%. However, all attempts with i-view were unsuccessful. The NRS score was significantly higher for i-view compared to the other video laryngoscopes (P < 0.001). Conclusion Video laryngoscopy effectiveness varies by type in difficult tracheal intubation cases. The Airway Scope or McGRATH instrument appears more suitable for such cases, as indicated by the metrics of intubation time, success rate, and difficulty level.