Korean Journal of Anesthesiology最新文献

Investigating the impact of hyperbilirubinemia on cognitive dysfunction in adult zebrafish: an in vivo model. 研究高胆红素血症对成年斑马鱼认知功能障碍的影响：体内模型。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-09-08 DOI: 10.4097/kja.25089

Won Kee Min, Suhyun Kim, Sun Hwa Lee, Sang Hun Kim, Yoon Ji Choi

{"title":"Investigating the impact of hyperbilirubinemia on cognitive dysfunction in adult zebrafish: an in vivo model.","authors":"Won Kee Min, Suhyun Kim, Sun Hwa Lee, Sang Hun Kim, Yoon Ji Choi","doi":"10.4097/kja.25089","DOIUrl":"https://doi.org/10.4097/kja.25089","url":null,"abstract":"Background: Despite the well-known effects of elevated bilirubin in neonates, its neurotoxic potential in adults remains uncertain. In perioperative and hepatic disease contexts, transient bilirubin elevations are common; however, their direct contribution to cognitive dysfunction has not been clearly established. This study aimed to determine whether transient bilirubin elevation alone can impair cognition and disrupt blood-brain barrier (BBB) function in adult zebrafish, and to compare these effects with those of liver injury.Methods: Adult zebrafish were assigned to either a bilirubin-injected group (retro-orbital injection of bilirubin) or a liver injury group (hepatocyte-specific ablation using a nitroreductase/metronidazole system). Cognitive performance was assessed using the T-maze test, and BBB integrity was evaluated using Evans blue staining. Expression of inflammatory genes (il1b, stat1b, ifng1) in brain tissue was analyzed via reverse transcription quantitative polymerase chain reaction.Results: Zebrafish injected with bilirubin exhibited impaired spatial learning without locomotor deficits, accompanied by marked Evans blue accumulation, indicating BBB disruption. Zebrafish in the liver injury group exhibited similar cognitive impairment and a modest increase in BBB permeability, yet displayed significantly higher expression of inflammatory genes. These findings suggest that, although both models induce behavioral deficits, their underlying mechanisms may differ.Conclusion: Transient bilirubin elevation alone was sufficient to impair cognition and disrupt BBB function in adult zebrafish, even in the absence of overt liver damage or systemic inflammation. Although inflammation is more pronounced during liver injury, bilirubin itself may exert direct neurovascular effects. These results support considering bilirubin levels as a modifiable risk factor for perioperative neurocognitive dysfunction.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015780","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}

引用次数: 0

The association between dexmedetomidine use and delirium in critically ill surgical patients: a retrospective cohort study. 危重外科患者右美托咪定使用与谵妄的关系：一项回顾性队列研究。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-09-03 DOI: 10.4097/kja.25217

Jiwoo Suh, KyeongTeak Oh, JiYeon Choi, Jeongmin Kim

{"title":"The association between dexmedetomidine use and delirium in critically ill surgical patients: a retrospective cohort study.","authors":"Jiwoo Suh, KyeongTeak Oh, JiYeon Choi, Jeongmin Kim","doi":"10.4097/kja.25217","DOIUrl":"10.4097/kja.25217","url":null,"abstract":"Background: Delirium is a common complication among critically ill patients. This study analyzed trends in dexmedetomidine use and its association with delirium incidence, severity, and outcomes in a surgical intensive care unit (ICU).Methods: A retrospective cohort study was performed in the surgical ICU of a tertiary academic center in South Korea, including 6,140 adult patients admitted from 2017 to 2023. Patients were grouped by dexmedetomidine exposure. Delirium was assessed using the Intensive Care Delirium Screening Checklist (ICDSC). Outcomes included delirium incidence, ICU length of stay (LOS), and one-year postoperative survival. Multivariate logistic regression identified delirium risk factors; Kaplan-Meier analysis assessed survival.Results: Dexmedetomidine use increased over time. Patients receiving dexmedetomidine had higher delirium incidence (46.1% vs. 13.9%, P < 0.001) and longer ICU stays (5.7 vs. 2.1 d, P < 0.001). They received 0.37 ± 0.16 µg/kg/h for 9.4 ± 6.5 h/d over 2.3 ± 4.0 d on average. Independent delirium risk factors were dexmedetomidine use (odds ratio [OR] 3.14; 95% CI 2.43-4.06), older age, psychiatric medication, and higher American Society of Anesthesiologists (ASA) physical status classification and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. One-year postoperative survival was lower in the dexmedetomidine group (92.7% vs. 94.5%, P = 0.015), likely due to greater illness severity.Conclusions: Dexmedetomidine was mainly used in high-risk, severely ill patients, reflecting its role in managing severe symptoms rather than preventing delirium. These results highlight the need for personalized sedation strategies to optimize dexmedetomidine use in the ICU setting.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959153","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}

引用次数: 0

Analysis and development of risk prediction models for chronic opioid use after surgery: a cohort study using the nationwide database. 术后慢性阿片类药物使用风险预测模型的分析和发展：一项使用全国数据库的队列研究。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-08-28 DOI: 10.4097/kja.24831

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

{"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":"https://doi.org/10.4097/kja.24831","url":null,"abstract":"Background: 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).Methods: 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.Results: PCOU occurred in 9 308 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.Conclusions: 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.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Rectus sheath block provides superior analgesia over quadratus lumborum block in single-port total laparoscopic hysterectomy: a prospective, randomized trial. 在单孔全腹腔镜子宫切除术中，直肌鞘阻滞比腰方肌阻滞提供更好的镇痛效果：一项前瞻性随机试验。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-08-22 DOI: 10.4097/kja.25174

Dongju Kim, Seunguk Bang, Jihyun Chung, Hyun-Jung Shin, Eunwon Lee

{"title":"Rectus sheath block provides superior analgesia over quadratus lumborum block in single-port total laparoscopic hysterectomy: a prospective, randomized trial.","authors":"Dongju Kim, Seunguk Bang, Jihyun Chung, Hyun-Jung Shin, Eunwon Lee","doi":"10.4097/kja.25174","DOIUrl":"https://doi.org/10.4097/kja.25174","url":null,"abstract":"Background: With the growing adoption of minimally invasive surgery, single-port total laparoscopic hysterectomy (TLH) is gaining popularity. However, unlike multi-port TLH, evidence on optimal pain management strategies for single-port TLH remains limited. Given the key role of regional anesthesia in multimodal analgesia, identifying the more effective block technique is clinically relevant. This study aimed to compare the analgesic efficacy of the quadratus lumborum block (QLB) and rectus sheath block (RSB) in patients undergoing single-port TLH. We hypothesized that QLB would result in lower 24-hour cumulative opioid consumption than RSB.Methods: In this prospective, randomized trial, 62 patients undergoing single-port TLH were assigned to receive either RSB or QLB. The primary outcome was 24-hour cumulative opioid consumption. Secondary outcomes included time to first patient-controlled analgesia (PCA) bolus, pain scores, and the need for rescue analgesia.Results: Data from 52 patients were analyzed (RSB: 27; QLB: 25). Median 24-hour opioid consumption was significantly lower in the RSB group (277.9 versus 459.1 μg; P = 0.007). Although the median time to first PCA bolus was similar between groups, Kaplan-Meier survival analysis revealed a marginal but statistically significant difference favoring RSB (P = 0.047). Notably, no patients in the RSB group required rescue analgesia, compared to 20% in the QLB group (P = 0.020).Conclusions: RSB provided superior postoperative analgesia compared to QLB in single-port TLH, reducing both opioid consumption and the need for rescue analgesia. These findings support RSB as the preferred block within a multimodal analgesia strategy for this procedure.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959108","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}

引用次数: 0

Sex-specific associations of preoperative serum uric acid levels with mortality and morbidity in non-cardiac surgeries: a single-center retrospective study. 术前血清尿酸水平与非心脏手术死亡率和发病率的性别特异性关联：一项单中心回顾性研究

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-08-22 DOI: 10.4097/kja.25517

Ji-Hoon Sim, Chan-Sik Kim, Bumwoo Park

{"title":"Sex-specific associations of preoperative serum uric acid levels with mortality and morbidity in non-cardiac surgeries: a single-center retrospective study.","authors":"Ji-Hoon Sim, Chan-Sik Kim, Bumwoo Park","doi":"10.4097/kja.25517","DOIUrl":"https://doi.org/10.4097/kja.25517","url":null,"abstract":"Background: The sex-specific association between serum uric acid (SUA) levels and postoperative outcomes in elective non-cardiac surgery remains unclear. This study aimed to identify sex-specific SUA thresholds and their impact on short- and long-term outcomes.Methods: A retrospective analysis of 295,267 patients (2012-2021) undergoing non-cardiac surgery was conducted. Patients were stratified by preoperative SUA levels: for males (< 4 to ≥ 9 mg/dl) and females (< 3 to ≥ 8 mg/dl), with mid-range levels as reference. Mortality (30 d to overall) and complications were assessed using Cox and logistic regression. Cubic splines evaluated nonlinear trends, with subgroup analyses by age and surgical risk.Results: SUA levels exhibited a nonlinear, sex-specific association with postoperative outcomes. The estimated lower-risk SUA range was 5.08-7.63 mg/dl in males and 3.34-5.35 mg/dl in females. In Cox and spline analyses, a U-shaped association between SUA and mortality was observed in both sexes, with significant risks at both low (< 4 mg/dl) and high (≥ 9 mg/dl) levels in males, and predominantly at low levels (< 3 mg/dl) in females. The types of complications varied subtly between sexes. Within SUA ranges of 4-6 mg/dl (males) and 3-4 mg/dl (females), composite and specific complication risks were lower than at either extreme, showing a protective effect, with reduced risk of acute kidney injury (AKI) in males and pneumonia in females. Additionally, extreme SUA levels were significantly associated with increased mortality and complications, particularly in low-risk surgical patients.Conclusions: Preoperative SUA levels show a nonlinear, sex-specific association with postoperative outcomes, highlighting the need for sex- and risk-based perioperative stratification.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959172","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}

引用次数: 0

Hypotension prediction index in the prediction of better outcomes: a systemic review and meta-analysis. 低血压预测指数预测更好的结果：一项系统回顾和荟萃分析。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-08-18 DOI: 10.4097/kja.25249

Yi Liu, Bei Liu, Wei Xiong, Chen Wang, Kunxin Yang, Wudi Ma, Liangtian Lan, Ming Wei, Nan Jiang, Xia Feng

{"title":"Hypotension prediction index in the prediction of better outcomes: a systemic review and meta-analysis.","authors":"Yi Liu, Bei Liu, Wei Xiong, Chen Wang, Kunxin Yang, Wudi Ma, Liangtian Lan, Ming Wei, Nan Jiang, Xia Feng","doi":"10.4097/kja.25249","DOIUrl":"10.4097/kja.25249","url":null,"abstract":"Background: The hypotension prediction index (HPI) is an algorithm designed to predict hypotension. Some studies have reported that HPI-guided hemodynamic management strategies decrease intraoperative hypotension and complications; however, the effect of HPI on reducing perioperative complications are controversial. This meta-analysis aimed to assess the efficacy of the HPI in reducing major complications and intraoperative hypotension.Methods: We conducted this meta-analysis according to the PRISMA statement and Cochrane Handbook guidelines. A comprehensive literature review was conducted to identify studies focusing on the efficacy of HPI-guided management in reducing intraoperative hypotension and postoperative complications. The PubMed, Embase, Scopus, and Web of Science databases were searched, and the resulting data were combined to calculate the pooled mean differences (MDs) or risk ratios (RRs) with 95% CIs of both randomized controlled trials (RCTs) and retrospective studies, as appropriate. Heterogeneity and potential publication bias were also assessed.Results: Nineteen articles (12 RCTs and 7 retrospective studies) with 2,570 recruited patients were included in this meta-analysis. The critical evaluation of the study quality revealed a low risk of bias in the included RCTs. Among the non-randomized trials, one was rated 7, two were rated 8, and the remaining four were rated 9 on the Newcastle-Ottawa Scale, indicating high quality and a low risk of bias. HPI-guided management significantly reduced intraoperative hypotension and associated major complications (RR = 0.79, 95% CI [0.69, 0.90], I2 = 0; P = 0.0005). Blood loss and length of hospital stay were comparable between the groups.Conclusions: HPI-guided management significantly reduced intraoperative hypotension and major complications.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873877","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}

引用次数: 0

Response to "Comment on Axillary serratus anterior plane block as a novel approach to anesthetizing the intercostobrachial nerve for upper arm arteriovenous fistula creation surgery -three case reports-". 对“腋锯肌前平面阻滞作为一种麻醉肋间臂神经的新方法”的评论”的回复。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-02 DOI: 10.4097/kja.25275

Chi Ho Chan, Jia Yin Lim, Abey M V Mathews

引用次数: 0

Heterogeneity in meta-analysis: a path toward more meaningful clinical evidence. 荟萃分析的异质性：获得更有意义的临床证据的途径。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-08-01 Epub Date: 2025-07-07 DOI: 10.4097/kja.25541

Sangseok Lee

引用次数: 0

Intertruncal versus classical approach to supraclavicular brachial plexus block on sensory-motor blockade for upper extremity surgery: a randomized controlled non-inferiority trial. 上肢手术中锁骨上臂丛阻滞的截间与经典入路：一项随机对照非效性试验。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-08-01 Epub Date: 2025-03-19 DOI: 10.4097/kja.24526

Zhipeng Wang, Jinyan Guo, Hanbin Xie, Guoliang Sun, Jianqiang Guan, Weifeng Yao, Quehua Luo

{"title":"Intertruncal versus classical approach to supraclavicular brachial plexus block on sensory-motor blockade for upper extremity surgery: a randomized controlled non-inferiority trial.","authors":"Zhipeng Wang, Jinyan Guo, Hanbin Xie, Guoliang Sun, Jianqiang Guan, Weifeng Yao, Quehua Luo","doi":"10.4097/kja.24526","DOIUrl":"10.4097/kja.24526","url":null,"abstract":"Background: As the characteristics of the intertruncal approach to the supraclavicular block (IA-SCB) are uncertain, we aimed to compare its effect on sensory-motor blockade with that of the classical approach (CA) within 30 min post-block.Methods: In total, 122 patients undergoing elbow, forearm, wrist, or hand surgery were randomly assigned to receive CA-SCB or IA-SCB. Both groups received identical local anesthetic agents (1% lidocaine and 0.5% ropivacaine) in 25 ml total. The IA-SCB group received 15 ml between the middle and inferior trunks and 10 ml between the superior and middle trunks, while the CA-SCB group received 15 ml in the corner pocket and 10 ml in the center of the neural clusters. Sensory-motor blockade of all four terminal nerves was assessed every 5 min for 30 min. The non-inferiority threshold aimed to exclude the possibility that the IA-SCB was > 5% inferior to the CA-SCB in terms of the proportion of patients with complete sensory blockade at 20 min post-block.Results: Complete sensory blockade at 20 min post-block was 79.3% and 72.7% with the CA-SCB and IA-SCB, respectively, exceeding the non-inferiority margin of -5% (-6.6%, 95% CI [-22.3% to 9.1%]; P value for non-inferiority = 0.206). Additionally, the IA-SCB showed an inferior musculocutaneous nerve blockade, longer performance time, and higher incidence of hemidiaphragmatic paresis.Conclusions: Our findings do not confirm the non-inferiority of the IA-SCB to the CA-SCB in achieving complete sensory blockade at 20 min post-block. Further research may be necessary to establish its efficacy in regional anesthesia.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":"78 4","pages":"321-330"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753711","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}

引用次数: 0

Methods for achieving equilibration during expiration in a modified Rapid-O2 oxygen insufflation device. 在改进的快速- o2氧气充气装置中呼气时实现平衡的方法。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-08-01 DOI: 10.4097/kja.25396

Darhae Eum, Hyun Joo Kim, Wyun Kon Park

引用次数: 0