Korean Journal of Anesthesiology最新文献

{"title":"Prehabilitation in patients with diabetes: targeting metabolic dysfunction to improve perioperative outcomes.","authors":"Youn Yi Jo, Jung Ju Choi, Chun Gon Park, Ga Hee Kim, Hyun Jeong Kwak","doi":"10.4097/kja.26387","DOIUrl":"https://doi.org/10.4097/kja.26387","url":null,"abstract":"<p><p>Patients with diabetes mellitus experience disproportionately worse postoperative outcomes, reflecting an underlying metabolic dysfunction that conventional perioperative optimization strategies fail to address. Although prehabilitation improves outcomes in selected surgical populations, its effectiveness in diabetes remains inconsistent, suggesting a mismatch between intervention strategies and the mechanisms driving perioperative risk. This review aimed to evaluate the role of metabolic dysfunction in perioperative risk among patients with diabetes and to propose a mechanism-informed prehabilitation framework targeting key metabolic disturbances. Evidence from clinical studies, systematic reviews, and perioperative guidelines was synthesized to develop a structured framework linking metabolic targets with targeted interventions within perioperative care pathways. Key metabolic disturbances, including insulin resistance, impaired metabolic flexibility, mitochondrial dysfunction, inflammation, and glycemic variability, amplify the surgical stress response and impair recovery in these patients. Conventional multimodal prehabilitation fails to adequately address these mechanisms. A targeted metabolic optimization approach incorporating exercise-based conditioning, nutritional optimization, glycemic management (including continuous glucose monitoring), and pharmacological modulation enables targeted interventions across these domains. Individualization strategies based on dominant metabolic features improves clinical applicability. The integration of this approach within perioperative pathways, including enhanced recovery after surgery (ERAS), provides a structured strategy to improve metabolic stability and perioperative resilience. Prehabilitation in patients with diabetes should shift from generalized multimodal strategies to targeted strategies involving metabolic optimization aligned with the underlying pathophysiology. A personalized and mechanism-informed approach integrated within the ERAS pathways may improve perioperative outcomes in this high-risk population. Prospective studies are needed to validate this strategy.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839806","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":"Success rate and block characteristics of L5-S1 spinal anesthesia with hypobaric bupivacaine in total hip and knee arthroplasty.","authors":"Iskandar Khalid, Wendy Wang, Rachel Chin, Seung Cheol Paul Kim, Madeline Marquis, Jayanta Chowdhury, Ki Jinn Chin","doi":"10.4097/kja.26019","DOIUrl":"https://doi.org/10.4097/kja.26019","url":null,"abstract":"<p><strong>Background: </strong>Spinal anesthesia in older patients can be technically challenging due to degenerative spinal disease. The L5-S1 interspace often remains accessible and is a useful fallback; however, it has been associated with higher rates of therapeutic failure due to inadequate block height. Injection of hypobaric local anesthetic may promote cranial intrathecal spread and address this limitation. We investigated this by evaluating the efficacy and block characteristics of low-dose hypobaric bupivacaine injected at the L5-S1 level in a prospective observational study.</p><p><strong>Methods: </strong>Fifty-four patients undergoing elective total hip or knee arthroplasty received ultrasound-assisted spinal anesthesia at L5-S1 with 10 mg of 0.33% hypobaric bupivacaine. The primary outcome was surgical completion without conversion to general anesthesia, supplemental opioids, or local anesthetic infiltration. Secondary outcomes included adequate anesthesia for surgical incision, block pharmacodynamics, hemodynamic stability, adverse effects, patient satisfaction, and surgeon-perceived quality of anesthesia.</p><p><strong>Results: </strong>Surgical completion without anesthetic supplementation was successful in 50 patients (92.6%, 95% CI 82.1-97.8%). Adequate anesthesia for surgical incision was achieved in 53 patients (98.2%, 95% CI 90.1-100%). Four patients required supplemental opioids: one for surgical incision, and three for surgical completion following prolonged injection-to-incision intervals (47-59 minutes) due to unanticipated delays in operating room readiness. No patients required conversion to general anesthesia. Full motor recovery occurred within 198 ± 53 minutes. Patient and surgeon satisfaction with quality of anesthesia was high.</p><p><strong>Conclusions: </strong>Hypobaric 0.33% bupivacaine injected at L5-S1 may be a useful fallback option in lower-extremity arthroplasty if challenging spinal anatomy renders other interspaces inaccessible.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839844","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":"Rethinking publication bias: from mechanical correction to sensitivity-based interpretation.","authors":"Sangseok Lee","doi":"10.4097/kja.26474","DOIUrl":"https://doi.org/10.4097/kja.26474","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839820","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":"Discriminative ability for abnormal ventilatory function using acoustic pattern of inhale and exhale in patients receiving pressure-controlled ventilation.","authors":"Kyu-Min Kang, Hyun-Seok Kim, Woo-Jin Kim, Woo-Young Seo, Yong-Seok Park, Kyoung-Sun Kim, Sung-Hoon Kim","doi":"10.4097/kja.251087","DOIUrl":"https://doi.org/10.4097/kja.251087","url":null,"abstract":"<p><strong>Background: </strong>Despite various available methods for monitoring a patient's respiratory system, conventional monitors provide limited ventilatory function information. This study explored the feasibility of intraoperative lung sound patterns to discriminate preoperatively diagnosed ventilatory dysfunction.</p><p><strong>Methods: </strong>Forty-five patients who had undergone preoperative pulmonary function testing were enrolled for analysis, comprising 15 patients per normal, obstructive, and restrictive group. High-fidelity lung sounds were recorded intraoperatively using esophageal stethoscopes equipped with digital microphone devices. After signal processing, morphological features of the acoustic data, including the inhale/exhale peak ratio (I/Ep), were extracted. Their discriminative abilities for obstructive and restrictive types were assessed and compared with conventional monitoring parameters.</p><p><strong>Results: </strong>I/Ep showed strong discriminative performance, with an area under the receiver operating characteristic curve of 0.950 (95% CI: 0.887-0.991) for obstructive and 0.950 (95% CI: 0.867-0.995) for restrictive types. The median values of I/Ep were 2.9 in the restrictive, 2.2 in the normal, and 1.5 in the obstructive group (P < 0.001). Conventional ventilatory parameters (compliance, peak inspiratory pressure, and slope of end-tidal CO2) did not significantly differ among the groups.</p><p><strong>Conclusions: </strong>Our study demonstrated that the I/Ep derived from intraoperative acoustic data differed according to preoperatively diagnosed ventilatory dysfunction. Hence, acoustic inhale and exhale patterns contain clinically useful information not captured by conventional ventilator parameters. Further studies are warranted to explore the clinical application of acoustic feature analysis for real-time intraoperative monitoring.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774803","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 between the automated TEG®6s and viscoelastic analyzer Haema T4.","authors":"Nikolaus F Hofmann, Herbert Schöchl, Johannes Zipperle, Daniel Oberladstätter, Felix Schmitt, Gerhard Fritsch, Johannes Gratz","doi":"10.4097/kja.25895","DOIUrl":"https://doi.org/10.4097/kja.25895","url":null,"abstract":"<p><strong>Background: </strong>Viscoelastic testing is increasingly being used for point-of-care coagulation management. This study compared the Haema T4 (HT4, Medcaptain®), a novel viscoelastic analyzer, with the TEG®6s (Haemonetics®), as they use similar assays but different measurement technologies.</p><p><strong>Methods: </strong>Combined extrinsic-intrinsic activation (CRT), intrinsic activation (CK/kaolin), and fibrinogen polymerization (CFF/FIB) assays were performed using both devices. Activated clotting time (ACT), reaction time (r-time), kinetic time (k-time), and maximum amplitude (MA) were assessed under various experimental conditions.</p><p><strong>Results: </strong>The TEG®6s delivered higher absolute values for ACT, r-time, and k-time but lower MA values than the HT4. A weak correlation for ACT was demonstrated between the devices for the CRT assay (r = 0.36, 95% CI: 0.08-0.59, P = 0.011), with wide limits of agreement (-23.4 to 146.6 s) and substantial bias (61.6 ± 43.4 s). In contrast, strong correlations for MA were demonstrated for the CRT (r = 0.91, 95% CI: 0.84-0.95) and CK/kaolin assays (r = 0.95, 95% CI: 0.91-0.97), with minimal bias (-1.2 ± 5.6 mm and -4.8 ± 2.3 mm, respectively). For the CFF/FIB assays, MA displayed a strong correlation (r = 0.85, 95% CI: 0.75-0.92) with a bias of -5.9 ± 8.6 mm.</p><p><strong>Conclusions: </strong>Although several parameters showed a strong correlation, agreement between the HT4 and TEG®6s was limited, indicating that results between the devices are not interchangeable. Device-specific reference ranges must be determined and clinical outcome studies are required before incorporating the HT4 into clinical practice.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774834","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":"Blamed but not at fault: Anti-obesity medication adverse effects misidentified as perioperative complications - a comprehensive review and medicolegal warning for anesthesiologists.","authors":"Hyun Jeong Kwak, Jung Ju Choi, Dongchul Lee, Youn Yi Jo","doi":"10.4097/kja.26375","DOIUrl":"https://doi.org/10.4097/kja.26375","url":null,"abstract":"<p><p>The rapid proliferation of anti-obesity medications (AOMs), including glucagon-like peptide-1 receptor agonists (GLP-1 RAs), the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 agonist tirzepatide, and non-incretin agents, including orlistat, phentermine, and bupropion/naltrexone, has created an underappreciated perioperative patient safety hazard. Existing guidelines have focused narrowly on GLP-1 RAs and aspiration risk, leaving some critical gaps unaddressed: (1) the misidentification trap, whereby drug-induced adverse effects, including acute pancreatitis, bowel obstruction, sudden visual loss, and neuropsychiatric dysfunction, are clinically and radiographically indistinguishable from surgical or anesthetic complications, exposing clinicians to unwarranted blame, and (2) the full perioperative risk profile of non-GLP-1 AOM classes. This narrative review synthesizes the current pharmacovigilance evidence, consensus guidelines, and clinical case data to address these gaps. Non-arteritic anterior ischemic optic neuropathy (NAION) from semaglutide (HR 7.64; World Health Organization safety alert 2025) may be attributed to anesthetic corneal injury, emotional lability may be misinterpreted as emergence delirium, drug-induced pancreatitis from GLP-1 RAs (adjusted HR 9.09 vs. comparator) may be misattributed to the operating surgeon, and bowel obstruction from premature postoperative GLP-1 RA resumption has prompted unnecessary re-laparotomy. Structured preoperative AOM documentation, explicit postoperative hold orders, and the inclusion of drug etiology in postoperative differentials constitute the defensible standard of care in the era of pharmacological obesity management.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774794","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":"Intraoperative hypotension during liver transplantation is associated with long-term mortality.","authors":"Akira Katayama, Ezeldeen Abuelkasem, Leon C Su, David W Wang","doi":"10.4097/kja.25965","DOIUrl":"https://doi.org/10.4097/kja.25965","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative hypotension (IOH) is common during liver transplantation (LT); however, its impact on long-term mortality remains unclear. We investigated the association between IOH and 1-year mortality using various mean arterial pressure (MAP) thresholds and exposure durations.</p><p><strong>Methods: </strong>This retrospective observational cohort study included 1063 patients who underwent LT. We defined IOH as an MAP < 65 mmHg and examined each threshold in 5 mmHg increments to < 40 mmHg. Our primary outcome was 1-year mortality after LT. Multivariate logistic regression was used to control for confounding variables while assessing the association between IOH and 1-year mortality.</p><p><strong>Results: </strong>The 1-year mortality after LT was 7.1%. Only moderate-to-severe IOH showed independent associations with 1-year mortality: MAP < 55 mmHg for ≥ 43 minutes (hazard ratio [HR] 2.48, 95% CI: 1.05-5.86; P = 0.038), MAP < 50 mmHg for ≥ 14 min (HR 2.60, 95% CI: 1.01-6.65; P = 0.047), MAP < 45 mmHg for ≥ 13 min (HR 4.98, 95% CI: 1.18-21.0; P = 0.029), and MAP < 40 mmHg for ≥ 5 min (HR 6.72, 95% CI: 1.56-28.9; P = 0.010), whereas longer exposure durations at MAP < 65 or < 60 mmHg were not independently associated with increased mortality. Furthermore, both a lower MAP and longer exposure duration for each threshold increased the predicted probability of 1-year mortality.</p><p><strong>Conclusions: </strong>Moderate-to-severe hypotension was independently associated with increased 1-year mortality after LT. These findings underscore the importance of intraoperative blood pressure management in LT recipients.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774934","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":"An electrical fire in the operating room: lessons from a real-world emergency.","authors":"Ki Tae Jung","doi":"10.4097/kja.26041","DOIUrl":"https://doi.org/10.4097/kja.26041","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839774","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":"Impact of spinal cord stimulation on healthcare utilization and costs in complex regional pain syndrome: analysis of South Korea's National Health Insurance claims data.","authors":"Cho Long Kim, HyeongSu Kim, Sungyeon Jung, Jae Hun Kim","doi":"10.4097/kja.25954","DOIUrl":"https://doi.org/10.4097/kja.25954","url":null,"abstract":"<p><strong>Background: </strong>Long-term economic impact of spinal cord stimulation (SCS) in Korea remains limited. This retrospective observational study evaluated healthcare utilization and costs associated with SCS in patients with complex regional pain syndrome (CRPS).</p><p><strong>Methods: </strong>Using claims data from South Korea's National Health Insurance Sharing Service (NHISS), we identified patients with CRPS who underwent trial or permanent SCS between 2005 and 2015. Patients were categorized into an SCS (permanent implantation) and a non-SCS (trial only) groups. Healthcare utilization and costs were analyzed over a one-year period before and after the index date.</p><p><strong>Results: </strong>The non-SCS group demonstrated a statistically significant increase in total hospitalization days (from 6.9 ± 22.6 to 17.0 ± 54.5, P = 0.02) and mean length of stay (from 2.6 ± 5.6 to 6.0 ± 17.5, P = 0.01). In contrast, the SCS group showed no significant changes in these hospitalization metrics. Between-group comparisons demonstrated significant differences in changes in hospitalization days and length of stay (P = 0.02). In addition, total healthcare costs increased significantly in the non-SCS group (from USD 2,448 ± 5,162 to USD 3,527 ± 6,943, P = 0.03), whereas no significant change was observed in the SCS group.</p><p><strong>Conclusions: </strong>SCS was associated with more favorable short-term healthcare utilization patterns, including stable hospitalization metrics and reduced procedure-related costs, compared with trial-only patients with CRPS. However, causal interpretation is limited by the observational design and residual confounding. These findings suggest a potential role of SCS in modifying healthcare utilization trajectories among patients with refractory CRPS.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627802","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":"Impact of ERAS implementation on the quality of recovery following robotic laparoscopic gynecological surgery: a randomized controlled trial.","authors":"Seung Woo Song, Hun Ju Lee, Jung Hwan Ahn, Nalai Kim, San-Hui Lee","doi":"10.4097/kja.25462","DOIUrl":"https://doi.org/10.4097/kja.25462","url":null,"abstract":"<p><strong>Background: </strong>In the gynecology field, robotic laparoscopic surgery is increasingly being used to enhance the quality of care. The Enhanced Recovery After Surgery (ERAS) program, which improves patient outcomes, is becoming the standard of care, but its impact on gynecological patients remains unclear. We compared the effect of ERAS implementation and conventional care for robotic gynecological surgery.</p><p><strong>Methods: </strong>This parallel-group, randomized controlled trial included patients aged 20-70 years undergoing robotic gynecological surgery at a single tertiary medical center in the Republic of Korea. Patients were randomized to conventional care and ERAS groups in a 1:1 ratio. The customized ERAS protocol encompassed minimized fasting, pre-emptive analgesia, transversus abdominis block, and early ambulation. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24-h and 1-week postoperatively. Secondary outcomes included postoperative pain, ClavienDindo grade ≥ 3 complications, readmission, and length of hospital stay.</p><p><strong>Results: </strong>Of the 66 enrolled patients, data of 65 were analyzed (conventional care, n = 32; ERAS, n = 33). Compared with conventional care, ERAS resulted in a significantly better quality of recovery at 24-h (QoR-15 scores: 93 [71117] vs. 124 [103135], P < 0.001) and 1-week postoperatively (QoR-15 scores: 135 [131142] vs. 142 [136148], P = 0.002). Additionally, the ERAS group had less severe postoperative pain and a shorter length of hospital stay. Complication and readmission rates were comparable between the groups.</p><p><strong>Conclusions: </strong>ERAS implementation in robotic gynecological surgery enhanced the quality of recovery and provided better pain control than conventional care, without affecting patient safety.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627603","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}