Ah Ran Oh, Jungchan Park, Chung Soo Kim, Sangmin Maria Lee, Seung Yeon Yoo
{"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":"https://doi.org/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/L 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 d 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% (2,447 / 62,600) within 7 d 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":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Young-Eun Jang, Eun-Young Joo, Jung-Bin Park, Sang-Hwan Ji, Eun-Hee Kim, Ji-Hyun Lee, Hee-Soo Kim, Jin-Tae Kim
{"title":"Comparison of combined intranasal dexmedetomidine and ketamine versus chloral hydrate for pediatric procedural sedation: a randomized controlled trial.","authors":"Young-Eun Jang, Eun-Young Joo, Jung-Bin Park, Sang-Hwan Ji, Eun-Hee Kim, Ji-Hyun Lee, Hee-Soo Kim, Jin-Tae Kim","doi":"10.4097/kja.24815","DOIUrl":"https://doi.org/10.4097/kja.24815","url":null,"abstract":"<p><strong>Background: </strong>We hypothesized that intranasal combination of dexmedetomidine (2 μg/kg) and ketamine (3 mg/kg) (IN DEXKET) improves the success rate of sedation in pediatric patients compared with chloral hydrate (CH; 50 mg/kg).</p><p><strong>Methods: </strong>This prospective, two-center, single-blinded, randomized controlled trial involved 136 pediatric patients (aged < 7 years) requiring procedural sedation. The participants were randomized to receive CH or IN DEXKET via a mucosal atomizer device. The primary outcome was the success rate of sedation (Pediatric Sedation State Scale, scores 1-3) within 15 min. The secondary outcomes included sedation failure at 30 min and overall complications of first-attempt sedation.</p><p><strong>Results: </strong>After excluding eight patients, 128 were included (CH = 66, IN DEXKET = 62). IN DEXKET showed a similar sedation success rate (75.8% [47/62] vs. 66.7% [44/66]; P = 0.330) but a lower complication rate (3.2% [2/62] vs. 16.7% [11/66]; P = 0.017) than CH. In the subgroup analysis for patients aged < 1 year, IN DEXKET showed a reduced complication rate than CH (2.6% [1/38] vs. 22.9% [8/35]; P = 0.012). In the subgroup analysis of children aged 1-7 years, IN DEXKET showed a higher sedation success rate within 15 min (79.2% [19/24] vs. 51.6% [16/31]; P = 0.049) and a lower sedation failure after 30 min (0% vs. 29.0% [9/31]; P = 0.003) than CH.</p><p><strong>Conclusions: </strong>The intranasal combination of dexmedetomidine (2 μg/kg) and ketamine (3 mg/kg) is a safe and effective alternative to CH (50 mg/kg) for sedation in pediatric patients aged < 7 years.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780373","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}
WooJin Jung, Kwan Lee, Hyung-Hwan Kim, Chiyeon Lim
{"title":"How to construct analysis of covariance in clinical trials : ANCOVA with one covariate in a completely randomized design structure.","authors":"WooJin Jung, Kwan Lee, Hyung-Hwan Kim, Chiyeon Lim","doi":"10.4097/kja.24820","DOIUrl":"https://doi.org/10.4097/kja.24820","url":null,"abstract":"<p><p>Analysis of covariance (ANCOVA) is a statistical method used to assess mean differences between groups by considering factors such as covariates or fixed effects and is often used to assess efficacy endpoints in clinical trials. When performing ANCOVA, the slope of the regression model should be the same for all treatment groups, with no interaction between the group and the covariate. Therefore, before analysis, the significance of the full ANCOVA model with interactions must be tested. If the interaction in the full model is statistically significant, the model that includes the interaction should be used; otherwise, ANCOVA using a reduced model without the interaction should be performed. If the ANCOVA model is not significant, this analysis method is not appropriate and a multivariate analysis or individual regression line estimation can be considered. If the difference in means between the groups is tested by ANCOVA, the confidence interval for the adjusted mean (least-squares mean) should be calculated and tested. Because the results may change depending on the covariates used in the ANCOVA model, the covariates should be predefined before performing the analysis. If a new covariate must be defined after a clinical trial is initiated, it should be specified in the statistical analysis plan. This is considered a major amendment; thus, the covariates must be redefined before clinical trial completion and must be described in the clinical study report. A clear report describing whether the redefinition of the covariates affected the sample size or decision-making is also necessary.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780376","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}
Jiyoun Lee, Jung-Hee Ryu, Jin-Hee Kim, Sung-Hee Han, Jin-Woo Park
{"title":"Effects of a virtual reality digital twin of the operating theatre on anxiety in pediatric surgery patients: a randomized controlled trial.","authors":"Jiyoun Lee, Jung-Hee Ryu, Jin-Hee Kim, Sung-Hee Han, Jin-Woo Park","doi":"10.4097/kja.24874","DOIUrl":"https://doi.org/10.4097/kja.24874","url":null,"abstract":"<p><strong>Background: </strong>Sevoflurane-based volatile induction and maintenance of anesthesia (VIMA) is common in pediatric outpatient surgery but can elevate preoperative anxiety in unfamiliar settings. This study compared the effects of immersive 3D virtual reality (VR) digital twin that precisely simulated the operating theatre environment with those of two-dimensional (2D) video education on preoperative anxiety in pediatric patients undergoing VIMA.</p><p><strong>Methods: </strong>In total, 102 pediatric patients undergoing elective ambulatory surgery were randomly assigned to either the VR or tablet group. Identical preoperative education was provided through a 3D VR digital twin or tablet video. Preoperative anxiety, induction compliance, and procedural behavior during anesthesia induction were assessed using the modified Yale Preoperative Anxiety Scale (mYPAS), induction compliance checklist (ICC), and procedural behavior rating scale (PBRS), respectively. The VIMA induction times, and parental satisfaction were recorded.</p><p><strong>Results: </strong>Children in the VR group exhibited lower mYPAS (33.3 [23.3-49.2] versus 46.7 [33.3-55.8], P = 0.022), higher ICC (P = 0.007), and lower PBRS (0.0 [0.0-1.0] versus 1.0 [0.0-2.0], P = 0.009) scores than those in the tablet group. The VIMA induction time was also shorter in the VR group (305.0 [253.5-392.5] versus 382.0 [329.0-480.0] s, P = 0.002), although parental satisfaction was comparable between the two groups.</p><p><strong>Conclusions: </strong>Compared with video education, preoperative education utilizing an immersive 3D VR digital twin enhanced the efficacy of VIMA process, resulting in reduced preoperative anxiety, increased compliance, lower distress during anesthetic induction, and shorter induction time.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764239","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}
Jeong-Jin Min, Eun Jung Oh, Hyun Ji Hwang, Sungwoo Jo, Hyunsung Cho, Chungsu Kim, Jong-Hwan Lee
{"title":"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, Hyun Ji Hwang, Sungwoo Jo, Hyunsung Cho, Chungsu Kim, Jong-Hwan Lee","doi":"10.4097/kja.24537","DOIUrl":"10.4097/kja.24537","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam is a novel ultra-short-acting benzodiazepine known for its hemodynamic stability over propofol. However, its hemodynamic effects compared to those of etomidate are not well established. This study aimed to determine whether the use of remimazolam is non-inferior to etomidate with regard to the occurrence of post-induction hypotension in patients undergoing coronary artery bypass grafting.</p><p><strong>Methods: </strong>Patients were randomly assigned to either the remimazolam group (6 mg/kg/h) or the etomidate group (0.3 mg/kg) for induction of anesthesia. Anesthetic depth was adjusted based on the bispectral index. Primary outcome was the incidence of post-induction hypotension, defined as a mean arterial pressure less than 65 mmHg within 15 min after endotracheal intubation, with a non-inferiority margin of 12%.</p><p><strong>Results: </strong>A total of 144 patients were finally analyzed. Incidence of post-induction hypotension was 36/71 (50.7%) in the remimazolam group and 25/73 (34.2%) in the etomidate group, with a rate difference of 16.5% (95% CI [3.0-32.6]) between the two groups that was beyond the prespecified non-inferiority margin of 12.0%. The number of patients who needed vasopressors was similar in the two groups.</p><p><strong>Conclusions: </strong>In this non-inferiority trial, remimazolam failed to show non-inferiority to etomidate in terms of post-induction hypotension when used as an induction drug for general anesthesia in patients undergoing coronary artery bypass grafting. However, different doses or infusion techniques of remimazolam should be compared with etomidate in various patient groups to fully assess its hemodynamic non-inferiority during induction of anesthesia.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"139-147"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922009","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}
Elif Sarikaya Ozel, Cengiz Kaya, Esra Turunc, Yasemin B Ustun, Halil Cebeci, Burhan Dost
{"title":"Analgesic efficacy of the external oblique intercostal fascial plane block on postoperative acute pain in laparoscopic sleeve gastrectomy: a randomized controlled trial.","authors":"Elif Sarikaya Ozel, Cengiz Kaya, Esra Turunc, Yasemin B Ustun, Halil Cebeci, Burhan Dost","doi":"10.4097/kja.24569","DOIUrl":"10.4097/kja.24569","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic sleeve gastrectomy (LSG) causes significant postoperative pain, necessitating effective multimodal analgesia strategies. This study evaluated the efficacy of the external oblique intercostal block (EOIB) in this context.</p><p><strong>Methods: </strong>This prospective, randomized, controlled, single-blind study conducted between April and December 2023 included 60 patients who underwent LSG. Patients were divided into the EOIB (30 ml 0.25% bupivacaine/side) and control (no block) groups. The primary outcome was the cumulative intravenous morphine milligram equivalent (MME) consumption in the first 24 h postoperatively. Secondary outcomes included 12-h MME consumption, pain scores, intraoperative remifentanil use, rescue analgesia requirements, time to first analgesic request, nausea/vomiting scores, antiemetic use, and American Pain Society Patient Outcome Questionnaire-Revised Turkish Version (APS-POQ-R-TR) scores.</p><p><strong>Results: </strong>The control group had significantly higher median opioid consumption than the EOIB group at 12 (14.4 vs. 5.8 mg; P < 0.001) and 24 h (25.9 vs. 10.6 mg; P < 0.001) postoperatively. The need for rescue analgesics did not differ significantly (43.3 vs. 23.3%; P = 0.1). The EOIB group exhibited significantly higher patient satisfaction (APS-POQ-R-TR score 2.91 vs. 4.42; P < 0.001) and consistently lower pain scores across all time points (P < 0.001). The EOIB group had lower nausea/vomiting scores (P < 0.001), fewer patients requiring antiemetics (16.7% vs. 40%; P = 0.045), longer time to first morphine request (57.5 vs. 25 min; P < 0.001), and lower remifentanil use (850 vs. 1050 μg; P < 0.001).</p><p><strong>Conclusions: </strong>The preoperative EOIB, as a part of multimodal analgesia, provides effective analgesia for acute pain in patients undergoing LSG.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"159-170"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007848","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":"Post-anesthesia care unit delirium in children with moyamoya disease undergoing indirect revascularization: incidence and risk factors.","authors":"Kun Liu, Lin He","doi":"10.4097/kja.24481","DOIUrl":"10.4097/kja.24481","url":null,"abstract":"<p><strong>Background: </strong>Delirium in the post-anesthesia care unit (PACU) may be associated with worse outcomes in children with moyamoya disease (MMD). This retrospective study aimed to describe the prevalence of PACU delirium in children with MMD and investigate its risk factors.</p><p><strong>Methods: </strong>Patients with MMD aged < 15 years who underwent indirect revascularization between January 2014 and October 2023 were included in this study. Delirium was assessed using the Pediatric Anesthesia Emergence Delirium Scale. Potential risk factors for PACU delirium were evaluated using multivariate logistic regression.</p><p><strong>Results: </strong>PACU delirium occurred in 245 (33%) of the 750 hemispheric procedures performed in 522 patients. Delirium was associated with a higher incidence in patients undergoing the first revascularization (37%) than in those undergoing the second (25%; P = 0.002). Cerebral infarction as the initial presentation (odds ratio [OR]: 4.64, first revascularization), high pediatric moyamoya magnetic resonance imaging (MRI) score (OR: 2.75, first revascularization; OR: 3.50, second revascularization), and high intraoperative mean arterial pressure variability (mmHg/min) (OR: 9.17, first revascularization; OR: 8.82, second revascularization) were associated with PACU delirium. Conversely, total intravenous anesthesia (TIVA) was associated with a lower incidence of PACU delirium (OR: 0.46, first revascularization; OR: 0.25, second revascularization).</p><p><strong>Conclusions: </strong>A significant proportion of patients with MMD developed delirium in the PACU. High intraoperative blood pressure variability and preoperative MRI lesions are independent risk factors for PACU delirium in children with MMD. TIVA may exert a protective effect against PACU delirium. Further studies are required to clarify the causality of these associations.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"129-138"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864813","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":"Comment on \"Cardiac arrest due to coronary vasospasm after sugammadex administration -a case report-\".","authors":"Balaji Vaithialingam","doi":"10.4097/kja.24915","DOIUrl":"https://doi.org/10.4097/kja.24915","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":"78 2","pages":"178-179"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803198","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}
Ji-In Park, Hyo-Seok Na, Ji-Na Kim, Jung-Hee Ryu, Howon Jang, Hyun-Jung Shin
{"title":"Effect of remimazolam on postoperative delirium and cognitive function in adults undergoing general anesthesia or procedural sedation: a meta-analysis of randomized controlled trials.","authors":"Ji-In Park, Hyo-Seok Na, Ji-Na Kim, Jung-Hee Ryu, Howon Jang, Hyun-Jung Shin","doi":"10.4097/kja.24493","DOIUrl":"10.4097/kja.24493","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam is a novel short-acting benzodiazepine. This study compared the effects of remimazolam and propofol on cognitive function in adult patients after surgery or other procedures.</p><p><strong>Methods: </strong>We searched electronic databases, including PubMed, Embase, CENTRAL, Web of Science, and Scopus, for relevant studies. The primary outcome was the proportion of participants who experienced delirium or impaired cognitive function postoperatively. Secondary outcomes included the incidence of hypotension, bradycardia, and postoperative nausea and vomiting. We estimated the odds ratios (OR) and mean differences (MD) with 95% CIs using a random-effects model.</p><p><strong>Results: </strong>In total, 1295 patients from 11 randomized controlled trials were included. The incidence of postoperative delirium was 8.0% in the remimazolam group and 10.4% in the propofol group that was not significantly different (OR: 0.74, 95% CI [0.39-1.42], P = 0.369, I2 = 32%). More favorable cognitive function, as assessed using the Mini-Mental State Examination, was observed in the remimazolam group compared to the propofol group (MD: 1.06, 95% CI [0.32-1.80], P = 0.005, I2 = 89%). Remimazolam lowered the incidence of hypotension (OR: 0.28, 95% CI [0.21-0.37], P = 0.000, I2 = 0%) compared to propofol.</p><p><strong>Conclusions: </strong>Remimazolam did not increase the risk of postoperative delirium and maintained cognitive function well, providing hemodynamic stability during surgery compared to propofol.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"118-128"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922004","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}