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Updated: Jun 18, 2026
Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
Changes in remimazolam plasma concentration associated with the Pringle maneuver during hepatectomy: a pilot study
Shunya Ogawa1, Hirotsugu Kanda2, Takahiro Ito3
1Department of Anesthesiology, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama, 640-8509, Japan.
Background:
Remimazolam (RMZ) is an ultrashort-acting benzodiazepine used in general anesthesia, metabolized rapidly by carboxylesterase 1, an enzyme primarily located in the liver. The Pringle maneuver (PM), an established technique commonly employed during hepatectomies to reduce bleeding, involves clamping major vessels, potentially affecting drug metabolism and clearance. Therefore, we conducted a study to investigate the changes in plasma concentration (Cp) of RMZ associated with the PM during hepatectomy and the impact on bispectral index (BIS) values.
Methods:
This single-center prospective observational pilot study included ten patients undergoing hepatectomy using the PM.
Results:
Our findings showed that the changes in RMZ Cp immediately following each PM tended to be higher than those before PM in six cases, though this was not observed in others. However, there was no statistically significant difference between the median RMZ Cp after the final PM (1099 [723-1386] ng/mL) and before the initial PM (707 [641-856] ng/mL). Similarly, the median BIS value after the final PM (45 [40-46]) was comparable to the BIS prior to initiation of PM (46 [44-50]).
Conclusions:
This study suggested that RMZ may be safely administered during hepatectomies with PM in patients with Child-Pugh classification A.
Trial Registration:
Clinical trial number: not applicable.
Insights
Remimazolam (RMZ) administration during hepatectomy with the Pringle maneuver (PM) showed comparable plasma concentrations and BIS values, suggesting safety in Child-Pugh A patients.
Area of Science:
- Anesthesiology
- Pharmacology
- Hepatobiliary Surgery
Background:
- Remimazolam (RMZ) is an ultrashort-acting benzodiazepine metabolized by liver carboxylesterase 1.
- The Pringle maneuver (PM) is used during hepatectomy to reduce bleeding.
- PM may impact drug metabolism and clearance.
Purpose of the Study:
- To investigate changes in remimazolam plasma concentration (Cp) during hepatectomy with PM.
- To assess the impact of PM on remimazolam's effect on bispectral index (BIS) values.
Main Methods:
- Single-center prospective observational pilot study.
- Ten patients undergoing hepatectomy with PM.
- Monitoring of RMZ Cp and BIS values before and after PM.
Main Results:
- RMZ Cp tended to be higher after PM in some patients, but no significant difference was found between pre- and post-PM median concentrations.
- Median RMZ Cp after final PM: 1099 ng/mL vs. before initial PM: 707 ng/mL.
- Median BIS values were comparable before and after PM.
Conclusions:
- Remimazolam appears safe for use during hepatectomy with PM in Child-Pugh A patients.
- The Pringle maneuver did not significantly alter remimazolam plasma concentrations or anesthetic depth (BIS).
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