Reply to Su et al. Comment on "Matsumoto et al. Remimazolam's Effects on Postoperative Nausea and Vomiting Are Similar to Those of Propofol after Laparoscopic Gynecological Surgery: A Randomized Controlled Trial. J. Clin. Med. 2023, 12, 5402".

We thank the authors for their insightful and thoughtful commentary on our recent publication [...].

Remimazolam's Effects on Postoperative Nausea and Vomiting Are Similar to Those of Propofol after Laparoscopic Gynecological Surgery: A Randomized Controlled Trial.

(1) Background: Remimazolam is a novel benzodiazepine that prevents postoperative nausea and vomiting (PONV), is more effective than volatile anesthetics, and was recently approved for use in Japan. (2) Methods: This prospective, double-blind, randomized controlled trial study aimed to compare the efficacy of remimazolam and propofol as general anesthetics in terms of the incidence of PONV after laparoscopic gynecological surgery (UMIN000046237). High-risk female patients who underwent general anesthesia with either remimazolam or propofol for the maintenance of anesthesia were enrolled. The primary outcome was the incidence of PONV in the two groups (i.e., REM versus PROP) 2 h and 24 h after surgery. The incidence of vomiting without nausea, rescue antiemetic use, and the severity of nausea were also evaluated. (3) Results: No significant differences in PONV were identified between the REM and PROP groups at 2 h or 24 h. Furthermore, no differences were observed in any of the measured parameters, and no adverse events were reported. (4) Conclusions: The results of the present study suggest that remimazolam may be as effective as propofol in preventing PONV; however, further investigation is necessary to identify possible differences between these two agents.

Factors affecting prolonged time to extubation in patients given remimazolam.

PURPOSE: To analyze the cause of prolonged recovery from general anesthesia with remimazolam. METHODS: We studied 65 patients under general anesthesia with remimazolam. According to time to extubation, patients were divided into short period (SP) (n = 34, < 15 min) and long period (LP) (n = 31, ≥ 15 min) groups. Variables affecting time to extubation such as age, sex, height, body weight, body mass index (BMI), plasma albumin concentration, ASA class, duration of surgery, and total duration of general anesthesia, and total dose of remimazolam were compared between SP and LP groups. At the end of remimazolam infusion and upon extubation, predictive remimazolam concentrations were calculated using pharmacokinetic/pharmacodynamic three compartment modeling. RESULTS: LP group showed significantly higher BMI, older age, and lower plasma albumin concentration compared with those of SP group. Logistic regression analysis showed that the probability of time to extubation of ≥ 15 min was higher in patients with BMI greater than 22.0 kg/m2 (AUC 0.668, 95% CI 0.533‒0.803), ages older than 79.0 years (AUC 0.662, 95% CI 0.526‒0.798), and plasma albumin concentrations lower than 3.60 g/dl (AUC 0.720, 95% CI 0.593‒0.847). LP group showed significantly lower predicted remimazolam concentration than SP group upon extubation despite no difference in concentration between both groups at the end of infusion. Pharmacological analysis estimates that LP group is more sensitive to remimazolam than SP group through amplified responses. CONCLUSIONS: Lower remimazolam doses should be considered for the overweight patients, elderly, and those with lower plasma albumin concentration.

Sensitive Quantitative Analysis of Strontium in Microdroplet by Surface-enhanced Laser-induced Breakdown Spectroscopy Using Porous Silicon.

Surface-enhanced laser-induced breakdown spectroscopy (SELIBS) is a promising method for microanalysis of liquid samples. We previously demonstrated that the SELIBS signal was significantly enhanced by using porous silicon (Si) instead of flat Si. In this work, we dried aqueous droplets containing 1 - 200 ppb strontium (Sr) on porous Si substrates and evaluated the quantitative performance by analyzing the dry residues. A linear calibration curve for the Sr quantification (R2 = 0.998) was obtained and an LOD was 0.67 ppb.

A Review of Underwater Laser-induced Breakdown Spectroscopy of Submerged Solids.

Fundamentals to applications of underwater laser-induced breakdown spectroscopy (LIBS) of submerged solid targets are reviewed. Since the deformation of spectral lines caused by plasma confinement has been the most serious problem in underwater LIBS, the methods developed to overcome this effect are overviewed. Deep-sea LIBS, which is the most successful application of underwater LIBS, is described in some detail as well as the hydrostatic pressure effects. Since the downsizing of underwater LIBS instrument is an important task for the applications to on-site measurements, studies on non-gated LIBS are covered. In the subsequent section, the methods for the quantitative analysis of the underwater LIBS signal are reviewed. The basics of the plasma parameters used in quantitative analysis are explained, and various methods of quantitative analysis applicable to underwater LIBS are described.

General corrosion during metal-assisted etching of n-type silicon using different metal catalysts of silver, gold, and platinum.

Metal-assisted etching is a promising technique for microfabrication of semiconductors. In this method, porous silicon (Si) can be produced with a very simple procedure, and various nanostructures can be designed by changing the catalyst patterns. The kind of metal catalysts is one of the key factors to control the porous structure. In this work, we performed the etching of n-type Si (100) in a hydrofluoric acid solution containing hydrogen peroxide in the dark using silver, gold, and platinum particles electrolessly deposited at a constant coverage, and demonstrated the difference in the porous structures obtained for the different kind of metal catalysts. By comparing the mass loss of substrates with the depth of pores formed under the metal particles, we found that general corrosion occurred on the top-surface of the Si substrate around the metal particles even under the dark condition. The general corrosion depended on the metal species and it was explained by the formation and dissolution of a mesoporous layer. The kind of metal catalysts influences the dissolution of the Si surface not only under the metal catalysts but also between them.

On-site quantitative elemental analysis of metal ions in aqueous solutions by underwater laser-induced breakdown spectroscopy combined with electrodeposition under controlled potential.

We propose a technique of on-site quantitative analysis of Zn(2+) in aqueous solution based on the combination of electrodeposition for preconcentration of Zn onto a Cu electrode and successive underwater laser-induced breakdown spectroscopy (underwater LIBS) of the electrode surface under electrochemically controlled potential. Zinc emission lines are observed with the present technique for a Zn(2+) concentration of 5 ppm. It is roughly estimated that the overall sensitivity over 10 000 times higher is achieved by the preconcentration. Although underwater LIBS suffers from the spectral deformation due to the dense plasma confined in water and also from serious shot-to-shot fluctuations, a linear calibration curve with a coefficient of determination R(2) of 0.974 is obtained in the range of 5-50 ppm.

Single-pulse underwater laser-induced breakdown spectroscopy with nongated detection scheme.

We investigated spatially resolved emission spectra of Al atoms in a very small (∼0.1 mm) laser ablation plasma produced by a single long-pulse (∼100 ns) irradiation of an Al target in water. The spectral feature varied considerably, depending on the position to be measured. The density of the plasma periphery was low enough to neglect the self-absorption effect, even when resonance lines were observed. By properly selecting the position, we successfully obtained well-resolved spectral lines even without time-gated detection. This suggests that time-gating is not necessary anymore in the practical applications of underwater laser-induced breakdown spectroscopy when employing spatially resolved detection system.