Korean Journal of Anesthesiology最新文献

{"title":"Analgesic mechanism of Panaphix in spinal nerve-ligated rats: involvement of microglial inflammatory cytokines.","authors":"Myong-Hwan Karm, Hyun-Jung Kwon, Doo-Hwan Kim, Jun-Seok Lee, Minsu Han, Eun Ha Kim, Chan-Sik Kim, Jin-Woo Shin, Seong-Soo Choi","doi":"10.4097/kja.25771","DOIUrl":"https://doi.org/10.4097/kja.25771","url":null,"abstract":"<p><strong>Background: </strong>Neuropathic pain, a chronic and debilitating condition caused by damage to the nervous system, remains challenging to treat due to its complex pathophysiology and resistance to analgesics. This study investigated the analgesic effects of Panaphix (PAX-1), a novel pharmacological agent, in a rat model of neuropathic pain induced by spinal nerve ligation (SNL).</p><p><strong>Methods: </strong>Male Sprague-Dawley rats underwent SNL to induce neuropathic pain. PAX-1 (0.1, 1, or 10 mg/kg) or vehicle was administered orally once daily for seven consecutive days starting on postoperative day 8. Mechanical allodynia was evaluated using the von Frey filament test, and the dorsal root ganglia were analyzed using an enzyme-linked immunosorbent assay and immunofluorescence to evaluate tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) expression levels.</p><p><strong>Results: </strong>PAX-1 significantly alleviated mechanical allodynia induced by SNL in a dose-dependent manner, and 1 mg/kg was selected as the optimal dose for subsequent analyses. PAX-1 markedly reduced IL-1β expression in microglia and partially decreased TNF-α immunoreactivity within the dorsal root ganglion, while showing minimal effects on the expression of astrocytic cytokines.</p><p><strong>Conclusions: </strong>PAX-1 demonstrated potent anti-allodynic and anti-inflammatory effects in an SNL-induced neuropathic pain model. These findings indicate that PAX-1 may exert analgesic effects primarily through modulation of IL-1β-mediated microglial activation, suggesting its therapeutic potential for neuropathic pain management.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880120","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":"Preoperative serum amyloid A: a practical window into neuroinflammatory vulnerability for postoperative delirium.","authors":"Jae Hoon Lee","doi":"10.4097/kja.26744","DOIUrl":"https://doi.org/10.4097/kja.26744","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873803","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 perioperative neurocognitive risk reduction in older surgical patients: mobility-preserving analgesia, early mobilization, and multidisciplinary care.","authors":"Keisuke Nakazawa","doi":"10.4097/kja.26138","DOIUrl":"https://doi.org/10.4097/kja.26138","url":null,"abstract":"<p><p>Perioperative neurocognitive risk in older surgical patients may be influenced not only by intraoperative anesthetic management, but also by postoperative factors that are modifiable, including pain, opioid exposure, immobility, and delayed rehabilitation. Large randomized trials that compared general anesthesia with neuraxial anesthesia in older patients undergoing hip fracture surgery found no significant differences in the incidence of postoperative delirium (POD) or functional outcomes. These findings have been widely interpreted as evidence that the anesthetic modality used has little impact on perioperative neurocognitive disorders (PND); however, neuraxial techniques and peripheral nerve blocks (PNBs) were not evaluated separately and postoperative analgesic strategies and early mobilization were not standardized in these studies. In this narrative review, we re-examine the current evidence and propose a shift in emphasis from the traditional dichotomy of \"general versus regional anesthesia\" toward postoperative analgesia, opioid minimization, and early mobilization. We found that, although neuroinflammation is relevant to the biological context of postoperative cognitive decline, direct evidence indicating that PNBs attenuate systemic inflammatory responses or improve neurocognitive outcomes via this mechanism in humans remains limited. Motor-sparing PNBs may be considered potential enablers of effective analgesia, reduced opioid exposure, and early mobilization within a multidisciplinary perioperative pathway, rather than as interventions with an established direct anti-inflammatory or neuroprotective effect. We review procedure-specific recommendations from the PROSPECT guidelines, discuss the role of PNBs within a Brain-Enhanced Recovery After Surgery (Brain-ERAS) framework, and identify priorities for the prospective evaluation of neurocognitive outcomes in older surgical patients.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685141","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":"Reflection on \"Hemodynamic stability with remimazolam versus propofol during anesthesia induction in hypertensive patients: a meta-analysis with trial sequential analysis of randomized controlled trials\".","authors":"Abhijit Sukumaran Nair, Tuhin Mistry","doi":"10.4097/kja.26633","DOIUrl":"https://doi.org/10.4097/kja.26633","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669876","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":"Interpreting relative risks and odds ratios after propensity score matching: practical guidance for clinical research.","authors":"Jonghae Kim, Boohwi Hong, Dong-Kyu Lee, EunJin Ahn, Hye Jin Kim, Hyun Kang, Junyong In, Sangseok Lee, Sang Gyu Kwak","doi":"10.4097/kja.25973","DOIUrl":"10.4097/kja.25973","url":null,"abstract":"<p><p>In observational studies, using relative risks (RRs) or odds ratios (ORs) influences the interpretation and generalizability of results, particularly after propensity-score matching (PSM). Here, we explain the theoretical and practical differences between the RR and OR across varying event probabilities and examine the influence of PSM. We illustrate the behaviors of the RR, OR, and their ratios mathematically and graphically across event probabilities. Using a simulated dataset with a binary outcome and three covariates (age, sex, and body mass index), we demonstrate how PSM can change event rates, RRs, ORs, and RR collapsibility. The OR departs from unity more steeply than does the RR as the event probabilities diverge, whereas both measures converge for probabilities below 0.10. When groups have similar event probabilities, the OR and RR diverge minimally, even at high probabilities. PSM shifts the covariate distributions and alters the event rates, RRs, and ORs. The difference between the RR and OR increases when the event rate exceeds 0.10, but remains small at lower event rates. The weighted averages of sex-specific RRs closely approximate the marginal RR, illustrating the collapsibility of an RR. Interpreting the RR and OR after PSM requires caution. While the OR may overestimate or underestimate associations, depending on the event rates, the RR is generally suitable as a marginal measure, but PSM modifies the study population, making the matched sample a product of statistical modeling. Reporting ORs after PSM is generally appropriate, but cross-checking with a collapsible measure, such as the marginal RR, can help to evaluate effect estimate robustness.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"405-413"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592984","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":"How important is intraoperative blood pressure for surgical outcomes?","authors":"Bon-Wook Koo","doi":"10.4097/kja.26724","DOIUrl":"10.4097/kja.26724","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"377-378"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412254","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":"Comment on \"Opioid-based versus opioid-sparing patient-controlled analgesia using ketorolac and nefopam after total knee arthroplasty: a randomized, double-blind, non-inferiority trial\".","authors":"Cheng-Wei Lu","doi":"10.4097/kja.26250","DOIUrl":"10.4097/kja.26250","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"455"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581667","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":"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":"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":"434-445"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439151/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of preoperative comorbidity and intraoperative hypotension on postoperative acute kidney injury after non-cardiac surgery: a structural equation modeling-based mediation analysis.","authors":"Woo-Young Jo, Hyeonhoon Lee, Jayoun Kim, Won Ho Kim, Hee-Pyoung Park, Hyoun-Joong Kong, Hyung-Chul Lee","doi":"10.4097/kja.25765","DOIUrl":"10.4097/kja.25765","url":null,"abstract":"<p><strong>Background: </strong>Preoperative comorbidities are associated with postoperative acute kidney injury (AKI). However, whether this association is direct or mediated by intraoperative hypotension (IOH) is unclear. We hypothesized that IOH mediates the relationship between preoperative comorbidities and postoperative AKI.</p><p><strong>Methods: </strong>Data from adult patients undergoing non-cardiac surgery under general anesthesia were analyzed. Inverse probability of treatment weighting (IPTW) was applied to achieve a balance between the exposure groups by reducing the baseline differences in the measured covariates. Structural equation modeling (SEM)-based mediation analysis was conducted using the American Society of Anesthesiologists physical status (ASA-PS) classification ≥ 3 as an input and postoperative AKI as an outcome. IOH (duration of mean arterial pressure < 60 mmHg), along with albumin and hemoglobin levels, was considered a mediator. We also performed interaction analysis between patient sex and age.</p><p><strong>Results: </strong>After IPTW, 8643.9 (10.8%) patients had an ASA-PS of ≥ 3. AKI occurred more frequently (4.5% vs. 6.9%, P < 0.001) in patients with ASA-PS ≥ 3. ASA-PS ≥ 3 was associated with a total effect estimate of 0.02 on the log-odds of postoperative AKI (P < 0.001). Of the total effect of ASA-PS ≥ 3 on postoperative AKI, 48% was significantly mediated by IOH (26%) and hypoalbuminemia (26%), though anemia showed no significance. The effect of high ASA-PS scores on postoperative AKI was significantly modified by sex, but not by age.</p><p><strong>Conclusions: </strong>High ASA-PS scores increase AKI risk after non-cardiac surgery, a relationship partially mediated by statistically significant pathways involving IOH and hypoalbuminemia.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"426-433"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146219994","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":"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":"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":"414-425"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439148/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}