Zijian Zhao, Hang Wang, Xinxu Min, Zheng Li, Feng Feng
{"title":"Controlled hypotension under rapid ventricular pacing technique in patients with cerebral arteriovenous malformation: a case report.","authors":"Zijian Zhao, Hang Wang, Xinxu Min, Zheng Li, Feng Feng","doi":"10.4097/kja.24508","DOIUrl":"https://doi.org/10.4097/kja.24508","url":null,"abstract":"<p><strong>Background: </strong>The transvenous approach to the treatment of cerebral arteriovenous malformation (AVM) is difficult and requires strict blood pressure and blood flow control; however, the cure rate is very high. Appropriate blood pressure control techniques can greatly benefit these patients.</p><p><strong>Case: </strong>A 55-year-old male patient was found to have an aneurysm complicated with a cerebral AVM (length: 2.0 cm, width: 1.6 cm, height: 1.2 cm). Aneurysm embolization was considered for the first-stage surgery and transvenous arteriovenous malformation embolization for the second-stage surgery. Rapid ventricular pacing (RVP) provided a stable blood flow environment for the surgery, which was completed successfully.</p><p><strong>Conclusion: </strong>RVP can thus provide an ideal condition for the embolization of cerebral AVM through the transvenous approach and can be a viable surgical option.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522258","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 postoperative outcomes after cranial neurosurgery using propofol-based total intravenous anesthesia versus inhalation anesthesia: a nationwide cohort study in South Korea.","authors":"Tak Kyu Oh, In-Ae Song, Young-Tae Jeon","doi":"10.4097/kja.24443","DOIUrl":"https://doi.org/10.4097/kja.24443","url":null,"abstract":"<p><strong>Background: </strong>We aimed to determine whether propofol-based total intravenous anesthesia (TIVA) is associated with mortality and morbidity following cranial neurosurgery compared with inhalation anesthesia.</p><p><strong>Methods: </strong>This nationwide, retrospective, population-based cohort study included patients who underwent cranial neurosurgery under general anesthesia between January 1, 2016, and December 31, 2021. The two study endpoints were 90-day mortality and postoperative complications.</p><p><strong>Results: </strong>In total, 144,506 adult patients were included: 65,442 patients (45.3%) who received TIVA (TIVA group) and 79,064 (54.7%) who received inhalation anesthesia (inhalation anesthesia group). After propensity score (PS) matching, 97,156 patients (48,578 in each group) were included. The 90-day mortality rates after cranial neurosurgery were 14.0% (6,660 / 48,578) in the TIVA group and 14.2% (6,779 / 48,578) in the inhalation anesthesia group. Moreover, the postoperative complication rates following cranial neurosurgery were 47.1% (22,411 / 48,578) and 50.3% (23,912 / 48,578) in the TIVA and inhalation anesthesia groups, respectively. Based on the logistic regression analysis, TIVA was not associated with 90-day mortality compared with inhalation anesthesia (odds ratio [OR]: 0.97, 95% CI: 0.94, 1.01; P = 0.188) in the PS-matched cohort. Logistic regression analysis revealed that the TIVA group had a 12% (OR: 0.88, 95% CI: 0.86, 0.90; P < 0.0.001) lower postoperative complication rate than the inhalation anesthesia group.</p><p><strong>Conclusions: </strong>There was no significant association between the type of anesthesia and postoperative 90-day mortality in patients who underwent cranial neurosurgery in South Korea. However, propofol-based TIVA was associated with a lower incidence of postoperative complications than inhalation anesthesia.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468966","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}
Kyuho Lee, Seung Ho Choi, Sangil Kim, Hae Dong Kim, Hyejin Oh, Seung Hyun Kim
{"title":"Comparison of remimazolam and midazolam for preventing intraoperative nausea and vomiting during cesarean section under spinal anesthesia: a randomized controlled trial.","authors":"Kyuho Lee, Seung Ho Choi, Sangil Kim, Hae Dong Kim, Hyejin Oh, Seung Hyun Kim","doi":"10.4097/kja.24311","DOIUrl":"https://doi.org/10.4097/kja.24311","url":null,"abstract":"<p><strong>Background: </strong>Preventing intraoperative nausea and vomiting (IONV) is crucial for maternal safety during cesarean section under spinal anesthesia. While midazolam is known to prevent IONV, we hypothesized that remimazolam would be superior due to its minimal hemodynamic effects. We compared the effects of the two drugs on IONV.</p><p><strong>Methods: </strong>Parturients scheduled for cesarean section were randomly assigned to receive either midazolam or remimazolam. They received midazolam 2 mg or remimazolam 5 mg, with additional doses administered upon request. The primary outcome measure was the incidence of newly developed IONV during sedation. Other outcomes included overall IONV, rescue antiemetic use, shivering, hemodynamic variables, sedation scale scores, and satisfaction scores.</p><p><strong>Results: </strong>Data from 80 participants were analyzed. Deeper sedation was induced in the remimazolam group (PGroup × Time < 0.001) despite comparable hemodynamic trends between the groups. The incidence of overall IONV was comparable between the two groups (27.5% in the midazolam group vs. 17.5% in the remimazolam group, absolute risk reduction [ARR]: 0.100, 95% confidence interval [CI] [-0.082, 0.282], P = 0.284); however, newly developed IONV during sedation was significantly reduced in the remimazolam group (20.0% vs. 5.0%, ARR: 0.150, 95% CI [0.009, 0.291], P = 0.043). The need for rescue antiemetics was also lower in the remimazolam group (15.0% vs. 2.5%, ARR: 0.125, 95% CI [0.004, 0.246], P = 0.048).</p><p><strong>Conclusion: </strong>Remimazolam significantly reduced the incidence and severity of newly developed IONV compared with midazolam, with minimal impact on hemodynamics, making it a useful sedative option for cesarean section.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391596","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":"Current evidence on the use of sugammadex for neuromuscular blockade antagonism during electroconvulsive therapy - a narrative review.","authors":"Vivek Arora, Laurence Henson, Sandeep Kataria","doi":"10.4097/kja.24234","DOIUrl":"https://doi.org/10.4097/kja.24234","url":null,"abstract":"<p><p>Depression is a common mental health problem that is associated with significant disability and mortality. Electroconvulsive therapy (ECT) has been demonstrated to be effective at resolving expression of suicidal intent in patients with depression. In less acute situations, patients are usually referred for ECT after several medication trials. Neuromuscular blocking agents (NMBAs) are used to block tonic-clonic motor activity and associated physical harm during the delivery of ECT. Succinylcholine (Sch), with its rapid onset of muscle relaxation, short self-terminating duration of action, and rapid subsequent return of spontaneous ventilation, is the NMBA of choice for ECT. However, the use of Sch is problematic or contraindicated is some situations. Although non-depolarizing NMBAs can be used, the variable time to onset of adequate muscle relaxation and prolonged duration of action have limited their widespread acceptance as alternatives to Sch. Recently, however, with the widespread availability of sugammadex, a chemically modified γ- cyclodextrin that rapidly and predictably reverses the effect of non-depolarizing NMBAs, the muscle relaxation achieved by rocuronium can predictably and effectively be reversed. In situations where Sch is contraindicated or otherwise problematic, rocuronium, followed by pharmacological antagonism with sugammadex, can provide a safe and effective muscle relaxation approach comparable to that of Sch in terms of duration of action. This review provides a summary of the current state of evidence for the use of sugammadex during ECT, which should lend support to further acceptance and future studies of sugammadex in the context of ECT.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391597","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":"Dexmedetomidine alleviates CoCl2-induced hypoxic cellular damage in INS-1 cells by regulating autophagy.","authors":"Jin Ha Park, Ju Eun Oh, Namo Kim, Young-Lan Kwak","doi":"10.4097/kja.24457","DOIUrl":"https://doi.org/10.4097/kja.24457","url":null,"abstract":"<p><strong>Background: </strong>Ischemia-reperfusion (I/R) injury is inevitable during the perioperative period. The pancreas is susceptible to I/R injury. Autophagy, a self-digestion process, is upregulated during I/R injury and strongly induced by hypoxia. This study aims to determine whether dexmedetomidine can decrease pancreatic β-cell damage by regulating autophagy under hypoxia.</p><p><strong>Methods: </strong>INS-1 rat insulinoma cells were cultured in dexmedetomidine before being exposed to cobalt chloride (CoCl2)-induced hypoxia. Cell viability and the expression of autophagy-related proteins (light chain 3B [LC3B]-II, p62, and ATGs) were assessed. The expression of apoptosis-related proteins (BCL-2 and P-BAD) were also evaluated. CoCl2-treated INS-1 cells were pretreated with the autophagosome formation inhibitor, 3-methyladenine (3-MA), to compare its effects with those of dexmedetomidine. Bafilomycin-A1 (Baf-A1) that inhibits autophagosome degradation was used to confirm the changes in autophagosome formation induced by dexmedetomidine.</p><p><strong>Results: </strong>Dexmedetomidine attenuated the increased expression of autophagic proteins (LC3B-II, p62, and ATGs) and reversed the CoCl2-induced reduction in the proliferation of INS-1 cells after hypoxia. Dexmedetomidine also alleviated the decreased expression of the anti-apoptotic protein (BCL-2) and the increased expression of apoptotic protein (BAX). Dexmedetomidine reduces the activation of autophagy through inhibiting autophagosome formation, as confirmed by a decrease in LC3B-II/I ratio, a marker of autophagosome formation, in LC3B turnover assay combined with Baf-A1.</p><p><strong>Conclusions: </strong>Dexmedetomidine alleviates the degree of cellular damage in INS-1 cells against CoCl2-induced hypoxia by regulating autophagosome formation. These results provide a basis for further studies to confirm these effects in clinical practice.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361729","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}
Young-Eun Jang, Jung-Bin Park, Pyoyoon Kang, Sang-Hwan Ji, Eun-Hee Kim, Ji-Hyun Lee, Hee-Soo Kim, Jin-Tae Kim
{"title":"Risk factors for chloral hydrate sedation failure in pediatric patients: a retrospective analysis.","authors":"Young-Eun Jang, Jung-Bin Park, Pyoyoon Kang, Sang-Hwan Ji, Eun-Hee Kim, Ji-Hyun Lee, Hee-Soo Kim, Jin-Tae Kim","doi":"10.4097/kja.24125","DOIUrl":"10.4097/kja.24125","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the risk factors for chloral hydrate sedation failure and complications in a tertiary children's hospital in South Korea.</p><p><strong>Methods: </strong>A retrospective analysis of pediatric procedural sedation with chloral hydrate between January 1, 2021, and March 30, 2022, was performed. The collected data included patient characteristics, sedation history, and procedure. Multivariable regression analysis was performed to identify the risk factors for procedural sedation failure and complications.</p><p><strong>Results: </strong>A total of 6,691 procedural sedation were included in the analysis; sedation failure following chloral hydrate (50 mg/kg) occurred in 1,457 patients (21.8%) and was associated with a higher rate of overall complications compared to those with successful sedation (17.5% [225/1457] vs. 6.2% [322/5234]; P < 0.001, odds ratio: 3.236). In the multivariable regression analysis, the following factors were associated with increased risk of sedation failure: general ward or intensive care unit inpatient (compared with outpatient); congenital syndrome; oxygen dependency; history of sedation failure or complications with chloral hydrate; procedure more than 60 min; and magnetic resonance imaging, radiotherapy, or procedures with painful or intense stimuli (all P values < 0.05). Factors contributing to the complications included general ward inpatient, congenital syndromes, congenital heart disease, preterm birth, oxygen dependency, history of complications with chloral hydrate, and current sedation failure with chloral hydrate (all P values < 0.05).</p><p><strong>Conclusions: </strong>To achieve successful sedation with chloral hydrate, the patient's sedation history, risk factors, and the type and duration of the procedure should be considered.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141476903","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}
Su Yeon Kim, Hyo-Seok Na, Jung-Hee Ryu, Hyun-Jung Shin
{"title":"The effect of non-steroidal anti-inflammatory drugs on postoperative delirium: a meta-analysis.","authors":"Su Yeon Kim, Hyo-Seok Na, Jung-Hee Ryu, Hyun-Jung Shin","doi":"10.4097/kja.24325","DOIUrl":"10.4097/kja.24325","url":null,"abstract":"<p><strong>Background: </strong>Neuroinflammation is postulated as a potential mechanism underlying postoperative delirium. This study aimed to investigate the impact of non-steroidal anti-inflammatory drug (NSAID) use on postoperative delirium.</p><p><strong>Methods: </strong>We conducted a literature search in electronic databases, including PubMed, EMBASE, CENTRAL, and Web of Science, to identify eligible randomized controlled studies. The primary outcome was the incidence of postoperative delirium, and the secondary outcomes included pain scores and the amounts of opioid used at 24 h postoperatively. We estimated the effect size through calculating the odds ratios (ORs) or mean differences (MDs) with 95% CIs, as appropriate.</p><p><strong>Results: </strong>In the analysis of eight studies involving 1,238 participants, the incidence of postoperative delirium was 11% and 19% in the NSAID and control groups, respectively, with a significant reduction in the NSAID group (OR: 0.54, 95% CI [0.38, 0.7], P = 0.0001, I2 = 0%). NSAID use had a significant effect on postoperative pain reduction (MD: -0.75, 95% CI [-1.37, -0.13], P = 0.0172, I2 = 88%). Significant lower postoperative opioid consumption was observed in the NSAID group (MD: -2.88, 95% CI [-3.54, -2.22], P = 0.0000; I2 = 0%).</p><p><strong>Conclusions: </strong>NSAID administration reduced the incidence of postoperative delirium, severity of pain, and opioid dose used.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893717","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":"Comprehensive guidelines for appropriate statistical analysis methods in research.","authors":"Jonghae Kim, Dong Hyuck Kim, Sang Gyu Kwak","doi":"10.4097/kja.24016","DOIUrl":"10.4097/kja.24016","url":null,"abstract":"<p><strong>Background: </strong>The selection of statistical analysis methods in research is a critical and nuanced task that requires a scientific and rational approach. Aligning the chosen method with the specifics of the research design and hypothesis is paramount, as it can significantly impact the reliability and quality of the research outcomes.</p><p><strong>Methods: </strong>This study explores a comprehensive guideline for systematically choosing appropriate statistical analysis methods, with a particular focus on the statistical hypothesis testing stage and categorization of variables. By providing a detailed examination of these aspects, this study aims to provide researchers with a solid foundation for informed methodological decision making. Moving beyond theoretical considerations, this study delves into the practical realm by examining the null and alternative hypotheses tailored to specific statistical methods of analysis. The dynamic relationship between these hypotheses and statistical methods is thoroughly explored, and a carefully crafted flowchart for selecting the statistical analysis method is proposed.</p><p><strong>Results: </strong>Based on the flowchart, we examined whether exemplary research papers appropriately used statistical methods that align with the variables chosen and hypotheses built for the research. This iterative process ensures the adaptability and relevance of this flowchart across diverse research contexts, contributing to both theoretical insights and tangible tools for methodological decision-making.</p><p><strong>Conclusions: </strong>This study emphasizes the importance of a scientific and rational approach for the selection of statistical analysis methods. By providing comprehensive guidelines, insights into the null and alternative hypotheses, and a practical flowchart, this study aims to empower researchers and enhance the overall quality and reliability of scientific studies.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108829","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":"Utilization of the pericapsular nerve group block in preoperative rehabilitation of patients with femoral neck fractures -a case series.","authors":"Zhuan Jin, Daisuke Sugiyama, Fumiya Higo, Takahiro Hirata, Osamu Kobayashi, Hiroshi Morimatsu, Kenichi Ueda","doi":"10.4097/kja.24232","DOIUrl":"10.4097/kja.24232","url":null,"abstract":"<p><strong>Background: </strong>Elderly patients with femoral neck fractures, particularly those with severe comorbidities or living in regions with limited medical resources, may experience delays in surgical treatment. Although the benefits of preoperative rehabilitation (prehabilitation) in hip arthroplasty have been reported, pain management remains a challenge. The pericapsular nerve group (PENG) block, known for its exceptional analgesic effect and motor function preservation, may be a promising intervention during prehabilitation in these patients.</p><p><strong>Case: </strong>We enrolled ten patients with Garden classification 3-4 femoral neck fractures scheduled for hip arthroplasty. After receiving a PENG block with 20 ml of 0.375% ropivacaine, all patients underwent initial prehabilitation sessions comprising 9 mobility levels, ranging from bed-sitting to walking. One patient was excluded due to experiencing high blood pressure during prehabilitation. Six of the nine remaining patients (66.7%) were successfully transferred from bed to wheelchair.</p><p><strong>Conclusions: </strong>The PENG block enhanced prehabilitation for patients with femoral neck fractures undergoing hip arthroplasty.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419701","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}