Won Uk Koh, Shamin Ara Sultana, Jong Ho Kim, So Young Lim, Sang Woo Kim, Sung Mi Hwang, Youngsuk Kwon, Jae Jun Lee, Hong Seuk Yang
{"title":"A survey of anesthesiologists aged 60 years and older in Korea: current status, challenges, and future strategies.","authors":"Won Uk Koh, Shamin Ara Sultana, Jong Ho Kim, So Young Lim, Sang Woo Kim, Sung Mi Hwang, Youngsuk Kwon, Jae Jun Lee, Hong Seuk Yang","doi":"10.17085/apm.24053","DOIUrl":"10.17085/apm.24053","url":null,"abstract":"<p><strong>Background: </strong>As the global population ages, medical professionals are also aging. This study investigates the status of Korean anesthesiologists over the age of 60.</p><p><strong>Methods: </strong>Anesthesiologists aged 60 and older, residing and working in Korea, were invited to participate in this study via e-mail from February to March 2021 and by mail from June to August 2021. The survey consisted of 40 questions covering 10 topics, including health status, residence, work style, and economic status. Depending on the type of question, answers were ranked on a scale of 1, 2, and 3, with the most preferred response being selected.</p><p><strong>Results: </strong>A total of 63 responses were received, resulting in a response rate of 26.5%. Among the respondents, 56 were currently practicing as anesthesiologists and reported satisfaction with their clinical practice and life status. On average, they treated 24 patients per day without experiencing significant discomfort or inconvenience in their roles as senior physicians. Twenty-four respondents acknowledged physical discomfort related to aging, and nine expressed cautions regarding age-related changes. Fifty-two respondents indicated that reeducation for advanced medical practice as anesthesiologists was necessary.</p><p><strong>Conclusions: </strong>Senior anesthesiologists in Korea are primarily working in secondary and tertiary hospitals and are satisfied with their current life status. A comprehensive evaluation of reeducation programs for advanced clinical practice and retirement strategies for senior anesthesiologists is needed to address the growing number of aging physicians in the workforce.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"20 1","pages":"86-97"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A message from the Editor-in-Chief and Editorial Board, 2024: journal metrics and statistics, and appreciation to reviewers.","authors":"Jun Hyun Kim, Hyun Kang","doi":"10.17085/apm.25202","DOIUrl":"https://doi.org/10.17085/apm.25202","url":null,"abstract":"","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"20 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Practical guidance for monitored anesthesia care during awake craniotomy.","authors":"Kyeong Tae Min","doi":"10.17085/apm.24183","DOIUrl":"10.17085/apm.24183","url":null,"abstract":"<p><p>Monitored anesthesia care is a feasible option for anesthetic management during awake craniotomy. Patients selected for surgery are thoroughly evaluated by anesthesiologists, primarily focusing on their risk for airway emergencies, such as respiratory depression and obstruction, throughout the procedure. For patients with relative contraindications, a tailored approach is used to assess their suitability. Neuropsychiatric counseling is also helpful for enhancing the patient's ability to participate in and perform the necessary tasks during brain mapping. Building good rapport with the patient is essential for the success of awake craniotomy, as it helps foster trust and cooperation. Analgesia during awake craniotomy is primarily achieved through scalp nerve blocks or infiltration. Among the six scalp nerve blocks, I have described the zygotemporal nerve block in detail. Proper positioning is crucial for both the surgical approach and the safety and comfort of the patient. Even when local anesthetics are effectively administered, many patients may still experience mild to moderate pain during the procedure. This pain is common and transient, typically occurring around the temporal region. In some cases, sedatives or additional analgesics may be necessary. Serious adverse events can arise, including those that require urgent life-saving interventions or those that interfere with brain mapping and the patient's ability to perform tasks. However, MAC in neurosurgery offers the potential for an improved quality of life for individuals with brain tumors or epileptic seizures, as well as for those with disabilities, such as the deaf or visually impaired, in the future.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"20 1","pages":"23-33"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Selection of intraoperative fluid for kidney transplantation.","authors":"Jeong Eun Lee, Hoon Jung","doi":"10.17085/apm.24180","DOIUrl":"10.17085/apm.24180","url":null,"abstract":"<p><p>The kidney, the most frequently transplanted organ, represents the optimal treatment for end-stage renal disease. Transplanted kidneys are highly vulnerable to perioperative injuries such as hypotension and hypovolemia, which can be influenced by perioperative fluid management. Postoperatively, delayed graft function increases the risk of graft failure. Although adequate volume administration can reduce delayed graft function, the type of intraoperative fluid most likely to benefit and support graft function remains unclear. Traditionally, crystalloids have been the primary choice for fluid management during kidney transplantation. Among these, 0.9% sodium chloride is the most commonly used, as its potassium-free composition minimizes the risk of hyperkalemia in patients with end-stage renal disease. Albumin is not routinely used, whereas synthetic colloids are discouraged owing to their nephrotoxicity. To date, 0.9% sodium chloride has demonstrated fewer advantages compared with balanced crystalloids, particularly regarding acid-base homeostasis, electrolyte balance, and delayed graft function. This review aims to examine the existing evidence on the effect of crystalloids and colloids on postoperative graft function and to recommend an appropriate fluid regimen, including balanced crystalloids, for kidney transplantation.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"20 1","pages":"14-22"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anesthetic management of a 9-year-old girl with Congenital Contractures of the Limbs and Face, Hypotonia, and Developmental Delay syndrome: airway difficulties and postoperative apnea during tendon surgery.","authors":"Jessica G Santos, Alexandre C Buffon","doi":"10.17085/apm.24107","DOIUrl":"10.17085/apm.24107","url":null,"abstract":"<p><strong>Background: </strong>This case report described the anesthetic management and postoperative challenges of a patient diagnosed with Congenital Contractures of the Limbs and Face, Hypotonia, and Developmental Delay (CLIFAHDD) syndrome who underwent tenomyotomy of the right hand tendons. This syndrome, characterized by facial dysmorphisms, musculoskeletal abnormalities, and respiratory disturbances, including central apnea, is caused by a mutation in the NALCN gene.</p><p><strong>Purpose: </strong>A 9-year-old girl diagnosed with CLIFAHDD syndrome underwent tenomyotomy of the right hand tendon. General anesthesia was administered. Despite stable intraoperative conditions, the patient experienced inadequate ventilation with multiple episodes of apnea after extubation, necessitating assisted ventilation using a face mask.</p><p><strong>Conclusions: </strong>This case highlights the challenges and considerations in the anesthetic management of patients with CLIFAHDD syndrome, emphasizing the need for tailored approaches and vigilant postoperative monitoring to mitigate the potential respiratory complications associated with this rare genetic disorder.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"20 1","pages":"46-49"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Noticeable changes in diaphoresis severity following pain management medication adjustments in a complex regional pain syndrome patient.","authors":"Joon Hee Lee, Eun Joo Choi, Pyung-Bok Lee","doi":"10.17085/apm.24174","DOIUrl":"10.17085/apm.24174","url":null,"abstract":"<p><strong>Background: </strong>Serotonin syndrome results from the use of serotonergic agents that elevate intrasynaptic serotonin level or excessively activate serotonin postsynaptic receptors. Common serotonergic agents used for pain management include opioids, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants.</p><p><strong>Purpose: </strong>A 24-year old woman diagnosed with complex regional pain syndrome underwent multidrug therapy for pain management over approximately five years. During this period, changes in diaphoresis severity were noted following adjustments to pain medications. The concurrent use of multiple serotonergic agents, exacerbation of diaphoresis after the addition or dose escalation of opioids, and resolution of symptoms upon discontinuation of duloxetine (Cymbalta®, Lily S.A.) strongly suggest the development of serotonin syndrome.</p><p><strong>Conclusions: </strong>Diagnosing serotonin syndrome without neuromuscular symptoms can be challenging. Careful monitoring of changes in symptoms and signs following medication use is essential in such cases.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"20 1","pages":"72-77"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Soo Jee Lee, Insik Jung, Seongmin Park, Seunghee Ki
{"title":"Case report of atypical re-sedation after general anesthesia using remimazolam.","authors":"Soo Jee Lee, Insik Jung, Seongmin Park, Seunghee Ki","doi":"10.17085/apm.24009","DOIUrl":"10.17085/apm.24009","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam, an ultra-short-acting anesthetic with flumazenil as a reversal agent, typically facilitates patient awakening postoperatively. However, our case reveals an unusual occurrence: despite flumazenil initially restoring consciousness, re-sedation due to remimazolam ensued six hours later.</p><p><strong>Case: </strong>A 65-year-old woman underwent total intravenous general anesthesia with remimazolam and remifentanil during the 140-min surgery. Despite an initially smooth recovery, she progressively became drowsy upon transfer to the general ward, eventually reaching a stuporous state. Multiple interventions, including opioid reversal (intravenous patient-controlled analgesia discontinuation, and naloxone administration) were attempted. Neurological consultation revealed no issues; however, immediate improvement after flumazenil administration suggested remimazolam's involvement. The patient was discharged without complications.</p><p><strong>Conclusions: </strong>This case challenges our understanding of remimazolam's dynamics, emphasizing the necessity for vigilant post-anesthesia monitoring, even in seemingly low-risk cases. It advocates for standardized response protocols to promptly manage unforeseen events and ensure patient safety.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 4","pages":"320-325"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Submental/submandibular intubation: a journey from past to future.","authors":"Kyung Nam Park, Myong-Hwan Karm","doi":"10.17085/apm.24120","DOIUrl":"10.17085/apm.24120","url":null,"abstract":"<p><p>In 1986, Altemir published the first article on submental intubation as an alternative to tracheostomy for managing difficult airways. This review provides an overview of submental/submandibular intubation, covering its development, techniques, and clinical outcomes. Initially devised to address difficult airways in oral and maxillofacial surgery, the technique has since evolved. Recent advancements include focused surgical incisions, ultrasound-guided imaging, and the use of improved procedural tools like the Seldinger technique. Clinical trials have demonstrated that submental/submandibular intubation is generally more efficient and quicker than tracheostomy in trauma patients. One of its key advantages is the absence of visible scarring, along with a less invasive recovery process. However, the technique has some limitations, including risks of infection, bleeding, and scarring, which require further investigation to optimize its application. While submental/submandibular intubation remains a valuable method for managing difficult airways, ongoing refinement and evaluation are necessary to maximize its clinical utility. This technique presents an excellent alternative in specific surgical scenarios and offers a simplified solution where other intubation methods may be unfeasible.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 4","pages":"280-293"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ultrasound-guided pulsed radiofrequency ablation of stellate ganglion in upper-extremity phantom limb pain: a case series.","authors":"Ajit Kumar, Manasa Kantha, Sonal Goyal, Pradeep Atter","doi":"10.17085/apm.24035","DOIUrl":"10.17085/apm.24035","url":null,"abstract":"<p><strong>Background: </strong>Phantom limb pain (PLP) is the most common type of pain experienced by amputees and is chronic and complex, with manifestations including pain in a limb that no longer exists. To date, treatments that are pharmaceutical or surgical in nature are relatively ineffective at bringing much relief as the pathophysiology of PLP is somewhat obscure. Chronic pain syndromes such as PLP may benefit from sympathetic nervous system modulation through the stellate ganglion.</p><p><strong>Case: </strong>Ten refractory PLP patients treated with ultrasound-guided stellate ganglion pulsed radiofrequency ablation (SG PRF) after a diagnostic stellate ganglion block took effect: A case series Patients were assessed before and after the treatment at 1 week, 1 month, and 3 months. Significant reductions in pain as measured using a numerical rating scale; Pain Disability Indexwas improved, and Medication Quantification Scale also was improved. Minimal side effects.</p><p><strong>Conclusions: </strong>Ultrasound-guided SG PRF has provided promising results for PLP by giving the patient with sustained pain relief and functional improvement without much side effects. Further studies need to be done to validate this finding.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 4","pages":"349-352"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intraoperative transfontanelle ultrasonography for pediatric patients.","authors":"Eun-Hee Kim, Jung-Bin Park, Jin-Tae Kim","doi":"10.17085/apm.24106","DOIUrl":"10.17085/apm.24106","url":null,"abstract":"<p><p>Cerebral blood flow (CBF) plays a vital role in delivering cerebral oxygen, and the accurate assessment of CBF is crucial for the intraoperative management of critically ill infants. Although the direct measurement of CBF is challenging, CBF velocity (CBFV) can be assessed using transcranial Doppler. Recent advances in point-of-care ultrasound have introduced brain ultrasound as a feasible intraoperative option, in which transfontanelle ultrasonography (TFU) has been applied to measure the CBFV through the anterior fontanelle. However, the intraoperative application of TFU in pediatric patients remains limited. The present review highlights the procedural aspects and clinical applications of TFU for anesthetic and intensive care management in pediatric patients. TFU facilitates the visualization of cerebral vessels and allows a noninvasive assessment of cerebral hemodynamics. The clinical significance of TFU involves its usefulness in various clinical scenarios, including monitoring CBF during cardiac surgery, assessing fluid responsiveness, and estimating intracranial pressure. TFU also enables the detection of cerebral emboli and the evaluation of anatomical abnormalities such as hydrocephalus or intracranial hemorrhage. TFU has demonstrated potential as an invaluable tool in pediatric care, despite limited familiarity among anesthesiologists. Additional research is needed to explore the associations between CBF and clinical outcomes, focusing on autoregulation, the impact of physiological changes, the associations of TFU findings with other brain monitoring tools such as electroencephalography, cerebral oximetry, and the implications of microemboli. TFU is a significant advancement and valuable tool for noninvasively assessing cerebral hemodynamics and CBF in pediatric patients with open fontanelles.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 Suppl 1","pages":"S25-S35"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}