Korean Journal of Anesthesiology最新文献

{"title":"Effects of Sugammadex and Rocuronium on the 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":"https://doi.org/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":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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":"https://doi.org/10.4097/kja.25442","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recto-intercostal 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":"https://doi.org/10.4097/kja.25355","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical applications and potential use of the oxygen reserve index during the perioperative period.","authors":"Yu Kyung Bae, Junghee Ryu","doi":"10.4097/kja.25316","DOIUrl":"10.4097/kja.25316","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":"78 3","pages":"183-186"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225840","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":"A simple sonographic approach to thoracic transforaminal epidural injections for zoster-associated pain involving multiple nerves: an exploratory prospective cohort study.","authors":"Shuyue Zheng, Dan Wang, Li Yue, Liangliang He","doi":"10.4097/kja.24818","DOIUrl":"10.4097/kja.24818","url":null,"abstract":"<p><strong>Background: </strong>A simple superoposterior approach to thoracic transforaminal epidural injections (TFEIs) under ultrasonographic guidance was proposed to reduce zoster-associated pain (ZAP) involving multiple thoracic nerves and the likelihood of transitioning to postherpetic neuralgia (PHN).</p><p><strong>Methods: </strong>Patients were prospectively enrolled. Primary endpoints were the burden of illness (BOI) scores and epidural contrast spread. Secondary endpoints included number of needle insertion attempts, sensory blockade, hemodynamic changes, procedure time, radiation dose, adverse events, rescue analgesics, PHN incidence and EuroQoL 5-Dimension scores.</p><p><strong>Results: </strong>Thirty-five injections were performed in 27 patients. Median levels of cephalad-caudad epidural contrast spread were 3, 4, and 5 ml following injections of 2, 3, and 4 ml. Dorsal epidural spread was observed at levels 3, 4, and 5, whereas concurrent ventral spread was observed at levels 2, 3, and 4. BOI scores at 30-180 days significantly decreased (mean difference: -25.3, 95% CI [-57.4 to 6.6], P = 0.005), accounting for reduced rescue analgesic requirements and PHN occurrence and improved EuroQoL 5-Dimension scores. Median sensory blockade at 5 min post-procedure was at level 2, 3, and 4 after 2, 3, and 4 ml of therapeutic injectate. No significant hemodynamic changes were noted at 15 min post-injection. No serious adverse events were observed.</p><p><strong>Conclusions: </strong>Spread of thoracic epidural contrast to all involved nerves was confirmed using this novel technique. Simplified needle placement reduced the technical difficulty and risk of complications. It might be a promising alternative approach for ZAP.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"236-247"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382715","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":"Successful removal of a large intratracheal tumor using the injection-time-controllable manual jet ventilator via translaryngeal approach -a case report.","authors":"Darhae Eum, Hyun Joo Kim, Wyun Kon Park","doi":"10.4097/kja.24918","DOIUrl":"10.4097/kja.24918","url":null,"abstract":"<p><strong>Background: </strong>Removal of intratracheal tumors is challenging due to the difficulty in securing a patent airway before surgery. We report a case of successful removal using jet ventilation with an injection-time-controllable manual jet ventilator.</p><p><strong>Cases: </strong>A 3.3 cm-long intratracheal mass was located 5 cm below the vocal cords and obstructing 70%-80% of the trachea. Following induction, a rigid telescope under suspension laryngoscopy was used to guide the careful insertion of a hard and long catheter (inner diameter: 1.8 mm; outer diameter: 3 mm; length: 50 cm) beyond the tumor, enabling jet ventilation. The soft, lobulated mass was gradually excised using long forceps under endoscopic visualization. Anesthesia was maintained using total intravenous anesthesia. The operation lasted for 1 h and 45 min.</p><p><strong>Conclusions: </strong>This device ensured oxygenation and ventilation during the endoscopic removal of a large intratracheal tumor. This approach highlights its utility in managing challenging airway obstructions.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"285-290"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557214","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":"A seizure case induced by topical application of tranexamic acid in a local incision.","authors":"Yanping Wu, Xin Xiong, Quan Hu, Meiling Wang, Yongbing Wu","doi":"10.4097/kja.24931","DOIUrl":"10.4097/kja.24931","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"292-294"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123178","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":"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":"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":"248-260"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142489/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver transplantation outcomes in patients with primary tricuspid regurgitation with coaptation defects: a retrospective analysis in a high-volume transplant center.","authors":"Kyoung-Sun Kim, Sun-Young Ha, Seong-Mi Yang, Hye-Mee Kwon, Sung-Hoon Kim, In-Gu Jun, Jun-Gol Song, Gyu-Sam Hwang","doi":"10.4097/kja.24540","DOIUrl":"10.4097/kja.24540","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular diseases are the leading cause of mortality after liver transplantation (LT). Although the impact of secondary tricuspid regurgitation (TR) with severe pulmonary hypertension (PH) is well investigated, the impact of primary TR with tricuspid valve incompetence (TVI) on LT outcomes remains unclear. We aimed to investigate the prevalence and impact of primary TR with TVI on LT outcomes in a large-volume LT center.</p><p><strong>Methods: </strong>We retrospectively examined 5 512 consecutive LT recipients who underwent routine pretransplant echocardiography between 2008 and 2020. Patients were categorized based on the presence of anatomical TVI, specifically defined by incomplete coaptation, coaptation failure, prolapse, and flail leaflets of tricuspid valve (TV). Propensity score (PS)-based inverse probability weighting (IPW) was used to balance clinical and cardiovascular risk variables. The outcomes were one-year cumulative all-cause mortality and 30-day major adverse cardiovascular events (MACE).</p><p><strong>Results: </strong>Anatomical TVI was identified in 14 patients (0.3%). Although rare, these patients exhibited significantly lower post-LT one-year survival rates (64.3% vs. 91.5%, P < 0.001) and higher 30-day MACE rates (42.9% vs. 16.9%, P = 0.026) than patients without TVI. They also had worse survival irrespective of echocardiographic evidence of PH (P < 0.001) and exhibited higher one-year mortality (IPW-adjusted hazard ratio: 4.09, P = 0.002) and increased 30-day MACE rates (IPW-adjusted odds ratio: 1.24, P = 0.048).</p><p><strong>Conclusions: </strong>Primary TR with anatomical TVI was associated with significantly reduced one-year survival and increased post-LT MACE rates. These patients should be prioritized similarly to those with secondary TR with severe PH, with appropriate pretransplant evaluations and treatments to improve survival outcomes.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"261-271"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710428","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":"Revisiting anesthesia-induced preconditioning for neuroprotection in the aging brain: a narrative review.","authors":"Tao Zhang, Woosuk Chung, Beverley A Orser","doi":"10.4097/kja.25073","DOIUrl":"10.4097/kja.25073","url":null,"abstract":"<p><p>The growing number of older adults undergoing surgery necessitates that we address the adverse effects of overt and covert perioperative stroke. Preclinical studies have suggested that anesthesia-induced preconditioning may provide neuroprotection by preserving mitochondrial function, activating cytosolic signaling pathways, and reducing neuroinflammation. However, these promising findings from animal studies have not yet translated into improved clinical outcomes. The discordance between preclinical and clinical outcomes may be due to age-related mitochondrial dysfunction and other comorbidities in older human populations, which reduce the effectiveness of anesthetic preconditioning. Mitochondria, which are central to the effectiveness of preconditioning, may be therapeutic targets to restore the neuroprotective effects of anesthetic preconditioning in the aging brain. Emerging evidence suggests that physical prehabilitation, a key component of Enhanced Recovery After Surgery programs, may influence mitochondrial function and could thus, restore anesthesia-induced preconditioning. Although further research is needed to determine the impact of physical prehabilitation on mitochondrial function and anesthetic preconditioning, incorporating physical prehabilitation into perioperative care might enhance neurological outcomes for older patients undergoing surgery.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"187-198"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670280","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}