Korean Journal of Anesthesiology最新文献

{"title":"Comparison of remimazolam and sevoflurane on arterial oxygenation during one-lung ventilation in thoracoscopic surgery: a randomized controlled trial.","authors":"Hong-Sik Shon, Hee Young Kim, Ji-Uk Yoon, Hye-Jin Kim, Seyeon Park, Yeong Min Yoo, Hyeonsoo Park, Jung-Pil Yoon","doi":"10.4097/kja.25376","DOIUrl":"https://doi.org/10.4097/kja.25376","url":null,"abstract":"<p><strong>Background: </strong>One-lung ventilation (OLV) during thoracoscopic surgery can impair oxygenation due to increased intrapulmonary shunts. Remimazolam has gained attention for its hemodynamic stability and rapid recovery profile; however, its effects on arterial oxygenation during OLV remain unclear. This study aimed to compare the effects of remimazolam and sevoflurane on arterial oxygenation during OLV.</p><p><strong>Methods: </strong>In this prospective, randomized controlled trial, 58 adult patients undergoing thoracoscopic surgery were assigned to receive either sevoflurane or remimazolam for anesthesia maintenance. Arterial blood gas analysis and hemodynamic parameters were measured at four time points: 10 min after lateral positioning during two-lung ventilation (TLV10) and 15, 30, and 60 min after initiating OLV (OLV15, OLV30, and OLV60). The primary outcome was arterial partial pressure of oxygen (PaO₂) at OLV30. Secondary outcomes included time-dependent changes in PaO₂, hemodynamic variables, and serum lactate levels.</p><p><strong>Results: </strong>No significant difference in PaO₂ at OLV30 was observed between groups (108.9 ± 37.9 vs. 107.0 ± 37.8 mmHg; 95% CI: -21.8-18.0; P = 0.815). In within-group analysis, PaO₂ at OLV60 increased significantly from TLV10 in the remimazolam group (95% CI: 0.3-36.8; P = 0.044), while no such improvement was observed in the sevoflurane group. Serum lactate levels exhibited a significant time-by-group interaction with a greater reduction in the remimazolam group (P = 0.021).</p><p><strong>Conclusions: </strong>Remimazolam provided arterial oxygenation and hemodynamic stability comparable to sevoflurane during OLV. The greater reduction in serum lactate levels with remimazolam suggests its potential metabolic or immunomodulatory advantages that warrant further investigation.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the analgesic efficacy between the ultrasound-guided continuous costoclavicular brachial plexus block and ultrasound-guided continuous interscalene brachial plexus block: a randomized controlled non-inferiority trial.","authors":"Taotao Xing, Lan Ge, Da Zhong, Shuo Chen, Yongjie Li, Hongjin Ni, Yiqi Fang, Yantian Lv, HuaJie Mao, Lina Yu","doi":"10.4097/kja.25511","DOIUrl":"https://doi.org/10.4097/kja.25511","url":null,"abstract":"<p><strong>Background: </strong>The continuous interscalene brachial plexus block (ISB) is widely used for regional anesthesia in shoulder surgeries. Although the continuous costoclavicular brachial plexus block (CCB) has been proposed, its comparative efficacy and safety remain unclear. This randomized, single-blind trial aimed to determine whether the CCB offers non-inferior postoperative analgesia compared to the ISB while mitigating hemidiaphragmatic paresis (HDP).</p><p><strong>Methods: </strong>patients underwent rotator cuff repair received continuous ISB or CCB followed by 0.2% ropivacaine infusion postoperatively. The primary outcome was the resting numerical rating scale (NRS) pain score 24 h postoperatively. Secondary outcomes included block-related parameters, dynamic and resting pain scores, HDP incidence, opioid consumption, rescue analgesia requirements, and satisfaction scores.</p><p><strong>Results: </strong>Resting NRS scores at 24 h demonstrated the non-inferiority of the CCB compared to the ISB (2.41 ± 0.59 vs. 2.00 ± 0.81; mean difference: 0.41; 95% CI: 0.1-0.73). The CCB significantly reduced the incidence of early complete HDP (30 min post-block: 7.3% vs. 41.5%; P < 0.001), with no incidence of complete HDP at 24 h. The CCB had longer block times (19.2 ± 3.7 vs. 17.2 ± 3.6 min; P = 0.013) and sensory onet (24.0 [21.0-24.0] vs. 18.0 [18.0-21.0] min; P < 0.001). Total ropivacaine consumption, rescue analgesia, or satisfaction scores were comparable.</p><p><strong>Conclusions: </strong>The continuous CCB is non-inferior to the ISB in terms of postoperative analgesia after rotator cuff repair and substantially decreases the risk of HDP. These findings support the CCB as a clinically advantageous alternative for shoulder surgery analgesia.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145301580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipid emulsion as a vehicle for propofol.","authors":"Ju-Tae Sohn","doi":"10.4097/kja.25442","DOIUrl":"10.4097/kja.25442","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"507-508"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of sugammadex and rocuronium on electro-mechanical activity of cardiac myocytes.","authors":"Oguzhan Arun, Nihal Ozturk, Orhan Erkan, Semir Ozdemir, Funda Arun, Sırma Basak Yanardag, Murat Ayaz","doi":"10.4097/kja.24901","DOIUrl":"10.4097/kja.24901","url":null,"abstract":"<p><strong>Background: </strong>Sugammadex reverses the effects of steroidal neuromuscular-blocking agents, such as rocuronium, by encapsulating these agents. Its cardiovascular adverse effects include QTc prolongation, hypotension, bradycardia, atrioventricular block, atrial fibrillation, and asystole. Additionally, rocuronium has cardiac side effects, such as bradycardia, hypotension, cardiac arrest, circulatory collapse, and ventricular fibrillation. Herein, we investigated the effects of sugammadex, rocuronium, and combined rocuronium + sugammadex on cardiac electrophysiological parameters.</p><p><strong>Methods: </strong>In vitro experiments were performed using ventricular myocytes obtained from male Wistar rats. Myocyte contraction and relaxation responses were recorded along with action potential (AP), and L-type calcium (ICaL) and potassium channel currents (Ito, Iss, and IK1).</p><p><strong>Results: </strong>Sugammadex caused dose-dependent decreases in myocyte contraction and relaxation responses. Rocuronium had no effect in this respect, whereas its co-administration with sugammadex led to decreased contraction responses. Sugammadex prolonged the AP repolarization phase, whereas rocuronium prolonged all AP phases. Co-administration of sugammadex and rocuronium did not significantly affect AP parameters. Sugammadex suppressed the peak ICaL value, while rocuronium caused an even greater decrease. Co-administration of these drugs further decreased the current-voltage characteristics of the ICaL. However, no significant effects were observed on the potassium currents.</p><p><strong>Conclusions: </strong>Separate or combined administration of sugammadex and rocuronium had various effects on myocyte contractility, AP, and ICaL, which could cause significant changes leading to adverse cardiac events. Further experimental and clinical studies are required to understand the clinical consequences of the modulatory effects of these drugs on cardiac electrophysiological parameters.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"488-503"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis and development of risk prediction models for chronic opioid use after surgery: a cohort study using the nationwide database.","authors":"Jonghae Kim, Hyun-Lim Yang, Eugene Kim, Hyung-Chul Lee, Hyun-Kyu Yoon, Yun Jin Kim, Kyu-Nam Kim, Ji-Yoon Kim, Jeong Min Sung, Tagkeun Lee","doi":"10.4097/kja.24831","DOIUrl":"10.4097/kja.24831","url":null,"abstract":"<p><strong>Background: </strong>Chronic opioid use has become a socioeconomic as well as a medical problem. This study aimed to identify risk factors and develop prediction models for postoperative chronic opioid use (PCOU).</p><p><strong>Methods: </strong>This retrospective cohort study used data from the Korean National Health Insurance Service (NHIS) between January 2008 and December 2018. Of 2 077 825 patients aged seven years or older who underwent surgery, survived at least one year, and had no additional surgeries, 1 108 119 were randomly selected. Logistic regression (LR) and machine learning models were developed to identify risk factors for PCOU. PCOU was defined as having filled 10 or more prescriptions or receiving more than 120 days' supply between postoperative days 91 and 365. Age, sex, medical comorbidities (systemic diseases, psychological disorders, and substance use disorders), preoperative medications (antidepressants, antipsychotics, anticonvulsants, benzodiazepines, opioids, and nonopioid analgesics), and type of surgery were assessed as potential risk factors.</p><p><strong>Results: </strong>PCOU occurred in 9308 patients (0.84%). Older age, preoperative history of opioid use, and high in-hospital opioid doses were the three most important predictors. Among the 28 most commonly performed surgical procedures in Korea, lung surgery, general spinal surgery, and total knee arthroplasty were most strongly associated with chronic opioid use.</p><p><strong>Conclusions: </strong>According to the best-performing gradient boosting model, older age, longer hospital stay, high in-hospital opioid consumption, and preoperative opioid use were the most important risk factors for PCOU.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"429-442"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"Comment on Hypotension after induction of anesthesia with remimazolam or etomidate: a non-inferiority randomized controlled trial in patients undergoing coronary artery bypass grafting\".","authors":"Jeong-Jin Min, Eun Jung Oh, Hyunsung Cho, Chungsu Kim, Jong-Hwan Lee","doi":"10.4097/kja.25484","DOIUrl":"10.4097/kja.25484","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"509-510"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recto-intercostal fascial plane block for upper abdominal analgesia: the ultimate solution?","authors":"Serkan Tulgar, Ali Ahiskalioglu, Muhammed Enes Aydin, Alessandro De Cassai","doi":"10.4097/kja.25355","DOIUrl":"10.4097/kja.25355","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"504-505"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between preoperative anemia and postoperative delirium in elderly patients undergoing non-cardiac surgery: a retrospective observational study.","authors":"Ah Ran Oh, Jungchan Park, Chung Soo Kim, Sangmin Maria Lee, Seung Yeon Yoo","doi":"10.4097/kja.24701","DOIUrl":"10.4097/kja.24701","url":null,"abstract":"<p><strong>Background: </strong>The association between preoperative anemia and postoperative delirium (POD) is unclear. We sought to evaluate the effect of preoperative anemia on the risk of POD in elderly patients after non-cardiac surgery.</p><p><strong>Methods: </strong>We retrospectively analyzed 62 600 patients aged over 60 years undergoing non-cardiac surgery between January 2011 and June 2019. The patients were divided into two groups according to the presence of preoperative anemia defined as hemoglobin < 13 g/dl for men and < 12 g/dl for women. Anemia was further categorized into mild or moderate-to-severe anemia based on a cutoff of 11 g/dl. The primary outcome was POD within 7 days after surgery. The secondary outcomes included one- and three-year mortality after surgery. The inverse probability of treatment weighting (IPTW) method was used to adjust for confounders between the two groups.</p><p><strong>Results: </strong>The overall incidence of POD was 3.9% (2447/62 600) within 7 days after surgery. After IPTW, preoperative anemia was significantly associated with increased risk of POD (odds ratio [OR]: 1.42, 95% CI [1.30-1.55], P < 0.001). Also, the risk of POD increased with the severity of anemia (OR: 1.32, 95% CI [1.18-1.47], P < 0.001 for mild anemia; and OR: 1.70, 95% CI [1.50-1.93], P < 0.001 for moderate-to-severe anemia). This association was similar for one- and three-year mortality.</p><p><strong>Conclusions: </strong>Preoperative anemia was associated with an increased risk of POD in elderly patients after non-cardiac surgery. Further investigations are required to verify whether preoperative anemia is a modifiable risk factor for POD.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"462-470"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality and factors associated with acute exacerbation after non-cardiac surgery in patients with interstitial pneumonia: a retrospective study.","authors":"Kaoru Umehara, Kazuhiro Shirozu, Taichi Ando, Kentaro Tokuda, Kei Makishima, Kazuya Imura, Shota Tsumura, Shinnosuke Takamori, Ken Yamaura","doi":"10.4097/kja.24656","DOIUrl":"10.4097/kja.24656","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbation of interstitial pneumonia (AE-IP) is associated with high mortality rates. Although the risk factors for AE-IP have been extensively studied, given the small sample sizes, only a few risk factors have been established. This study aimed to investigate the postoperative mortality and factors associated with AE-IP.</p><p><strong>Methods: </strong>This retrospective study included 482 patients with a preoperative diagnosis of IP who underwent noncardiac surgery between December 2012 and April 2020. AE-IP was diagnosed by a radiologist using computed tomography when worsening respiratory symptoms were observed within 1 month postoperatively. The Cox proportional hazards model was used to compare mortality rates. Candidate factors associated with AE-IP were identified through logistic regression analysis using the variable selection method, followed by case-control analysis using propensity score matching to determine possible factors associated with AE-IP.</p><p><strong>Results: </strong>The multivariable-adjusted hazard ratios for all-cause and IP-related deaths were significantly higher in patients with AE-IP than in those without AE-IP. Multivariable analysis with variable selection suggested that male sex, higher C-reactive protein (CRP) levels, fraction of inspired oxygen (FiO2) ≥ 60%, and non-lung surgery were candidate factors associated with AE-IP. Case-control analysis using propensity score matching demonstrated that patients with AE-IP had higher CRP levels (P = 0.044) and frequency of FiO2 ≥ 60% (P = 0.035) than those without AE-IP. Furthermore, a positive, nearly linear relationship was observed between FiO2 ≥ 60% duration and AE-IP incidence.</p><p><strong>Conclusions: </strong>Intraoperative management with FiO2 ≥ 60% and high preoperative CRP levels were significantly associated with postoperative AE-IP.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"453-461"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting neurological complications post clipping surgery in unruptured intracranial aneurysms using the NEURO score: a multi-center retrospective cohort study.","authors":"Yeon Ju Kim, Ah Ran Oh, Soo Jeong, Jungchan Park, Min-Ju Kim, Seong-Yoon Kim, Wonhyoung Park, Jae Sung Ahn, Chan-Sik Kim, Ji-Hoon Sim, Yong-Seok Park, Seungil Ha, Joung Uk Kim","doi":"10.4097/kja.24934","DOIUrl":"10.4097/kja.24934","url":null,"abstract":"<p><strong>Background: </strong>Predicting fatal neurological complications after clipping surgery for unruptured intracranial aneurysms (UIAs) is crucial; however, existing scoring systems are limited by narrow consideration of factors. We aimed to develop and validate a comprehensive risk stratification scoring system that incorporates patient-, aneurysm-, and operation-specific variables for predicting postoperative neurological complications in UIA surgeries.</p><p><strong>Methods: </strong>This multi-center retrospective cohort study was conducted from September 2018 to October 2023. Patients undergoing clipping surgery for UIAs were divided into development and validation sets based on the treating institution. A predictive score for postoperative neurological complications was developed from a multivariate logistic regression analysis. The score, named NEURO, that incorporates variables like previous neurological disease, categorized aneurysm location and size, categorized operation time, and transfusion was validated externally.</p><p><strong>Results: </strong>The study included 2847 patients, with 1547 and 1300 in the development and validation sets, based on the institution of surgery, respectively. The incidence of neurological complications was 5.7% (88/1547) and 5.6% (73/1300) in the development and validation sets, respectively. The NEURO score showed good predictive ability with C-statistics of 0.720 (95% CI [0.667-0.776]) in the development set and 0.693 (95% CI [0.631-0.754]) in the validation set, demonstrating good calibration across the predicted probability range.</p><p><strong>Conclusions: </strong>The NEURO score, integrating multiple perioperative variables, may effectively predict the risk of neurological complications post UIA clipping surgery, aiding in identifying high-risk patients. This tool could enhance clinical decision-making and patient management in neurosurgical practice.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"443-452"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}