Korean Journal of Anesthesiology最新文献_第2页

Enhancing postoperative recovery with multimodal prehabilitation: the journey begins before surgery. 通过多模式康复增强术后恢复：手术前就开始了。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-10-01 Epub Date: 2025-07-18 DOI: 10.4097/kja.25320

Ah-Reum Cho, Wariya Vongchaiudomchoke, Detlef Balde, Do Jun Kim, Francesco Carli

{"title":"Enhancing postoperative recovery with multimodal prehabilitation: the journey begins before surgery.","authors":"Ah-Reum Cho, Wariya Vongchaiudomchoke, Detlef Balde, Do Jun Kim, Francesco Carli","doi":"10.4097/kja.25320","DOIUrl":"10.4097/kja.25320","url":null,"abstract":"This narrative review explores multimodal prehabilitation, a patient-centered, evidence-based, and multidisciplinary approach to enhance postoperative recovery. It shifts the focus from traditional intraoperative and postoperative care to a comprehensive process beginning at diagnosis. Multimodal prehabilitation integrates exercise, nutrition, and psychological strategies to improve preoperative functional capacity and physiological reserve, enabling better management of surgical stress. The review examines prehabilitation's clinical efficacy, highlighting enhanced functional capacity as a key outcome. It details prehabilitation components: exercise (aerobic, resistance, and respiratory muscle training), nutritional optimization targeting modifiable risk factors such as malnutrition and sarcopenia, and psychological support to lower anxiety and boost patient motivation and adherence. Individualized approaches are emphasized due to significant patient variability. This review also presents a successful multimodal prehabilitation program implemented at the Montreal General Hospital, which has a strong track record in this area. The program is structured around four key phases: screening, assessment, intervention, and follow-up. It also discusses the barriers to implementation and the roles of stakeholders, including the government, hospitals, healthcare professionals, and patients and their families, within the context of South Korea's unique healthcare system and socio-cultural environment.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"401-417"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675184","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

Advancing risk prediction in intracranial aneurysm clipping. 推进颅内动脉瘤夹闭的风险预测。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-10-01 Epub Date: 2025-09-11 DOI: 10.4097/kja.25779

Seongheon Lee

引用次数: 0

Diagnosis of flexor hallucis longus tenosynovitis using the cross-sectional area of the flexor hallucis longus tendon. 利用拇长屈肌腱的横截面积诊断拇长屈肌腱滑膜炎。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-10-01 Epub Date: 2025-05-23 DOI: 10.4097/kja.24773

SoYoon Park, Young Uk Kim

{"title":"Diagnosis of flexor hallucis longus tenosynovitis using the cross-sectional area of the flexor hallucis longus tendon.","authors":"SoYoon Park, Young Uk Kim","doi":"10.4097/kja.24773","DOIUrl":"10.4097/kja.24773","url":null,"abstract":"Background: Flexor hallucis longus tenosynovitis (FHLTS) is the inflammation of the sheath through which the flexor hallucis longus tendon (FHLT) passes. The FHLT thickness (FHLTT) is correlated with ankle pain. Thus, the FHLTT is considered a characteristic FHLTS feature. However, asymmetrical thickening of the FHLT can occur at any point. Therefore, we used the FHLT cross-sectional area (FHLTCSA) as a new morphological parameter to diagnose FHLTS.Methods: 26 participants in the Control group (Group 1) and 26 in the FHLTS group (Group 2) underwent magnetic resonance imaging. The FHLTCSA was calculated for the ligament based on the images showing the maximum hypertrophic changes. The FHLTT was measured based on the images showing the FHLT with the maximum thickness.Results: The mean FHLTCSA was 7.86 ± 1.88 mm2 and 13.11 ± 2.31 mm2 in Groups 1 and 2, respectively. The average FHLTT was 2.35 ± 0.55 mm and 2.91 ± 0.37 mm in Groups 1 and 2, respectively. The FHLTCSA (P < 0.001) and FHLTT (P < 0.001) in Group 2 were significantly greater than those in Group 1. Receiver operating characteristic curve analysis revealed that the optimal cutoff value for the FHLTCSA was 10.37 mm2, with a sensitivity of 92.3%, a specificity of 92.3%, and an area under the curve (AUC) of 0.97. The optimal cutoff value for the FHLTT was 2.71 mm, with a sensitivity of 76.9%, a specificity of 76.9%, and an AUC of 0.84.Conclusions: The FHLTCSA is a sensitive morphological parameter for assessing FHLTS.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"482-487"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128001","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

Analysis of interaction effect between within- and between-subject factors in repeated measures analysis of variance for longitudinal data. 纵向数据重复测量方差分析中受试者内部和受试者之间因素的相互作用分析。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-10-01 Epub Date: 2025-09-18 DOI: 10.4097/kja.22617

Jonghae Kim, Jae Hong Park, Tae Kyun Kim

{"title":"Analysis of interaction effect between within- and between-subject factors in repeated measures analysis of variance for longitudinal data.","authors":"Jonghae Kim, Jae Hong Park, Tae Kyun Kim","doi":"10.4097/kja.22617","DOIUrl":"10.4097/kja.22617","url":null,"abstract":"Repeated measures analysis of variance (RM-ANOVA) is a specialized form of analysis of variance used for analyzing data involving repeated measurements, such as longitudinal data commonly encountered in anesthesia and pain medicine research. When data are collected at multiple time points across more than one group, RM-ANOVA evaluates the between-subject (group) effect, within-subject (time) effect, and interaction between these two factors. The group-by-time interaction effect indicates whether changes in an outcome variable over the study period differ among groups. Analyzing interaction contrasts between specific time points is particularly useful for identifying intervals where this interaction effect is significant. For instance, if an outcome variable is measured at multiple time points in two groups, the interaction contrast for any two time points represents the difference between the change in the outcome variable over that interval in one group and the corresponding change in the other group. An independent two-sample Student's t-test can then compare these differences to determine the statistical significance of the group-by-time interaction for the selected time points. Thus, incorporating interaction contrast analysis into RM-ANOVA enhances the interpretation of longitudinal data by pinpointing specific time intervals where significant interactions occur.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"418-428"},"PeriodicalIF":6.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081179","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

Comment on "Hypotension after induction of anesthesia with remimazolam or etomidate: a non-inferiority randomized controlled trial in patients undergoing coronary artery bypass grafting". 评论“雷马唑仑或依托咪酯诱导麻醉后低血压：冠状动脉搭桥术患者的非劣效性随机对照试验”。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-10-01 Epub Date: 2025-06-24 DOI: 10.4097/kja.25380

Melike Korkmaz Toker, Başak Altıparmak

引用次数: 0

Optimal remimazolam infusion rate for general anesthesia induction in elderly patients: a dose determination study by the k-in-a-row method. 老年患者全麻诱导最佳雷马唑仑输注速率：k-in-a-row法剂量测定研究。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-09-24 DOI: 10.4097/kja.25446

Heejoon Jeong, Hyun Joo Ahn

{"title":"Optimal remimazolam infusion rate for general anesthesia induction in elderly patients: a dose determination study by the k-in-a-row method.","authors":"Heejoon Jeong, Hyun Joo Ahn","doi":"10.4097/kja.25446","DOIUrl":"https://doi.org/10.4097/kja.25446","url":null,"abstract":"Background: Elderly patients commonly experience sudden hypotension after propofol administration for anesthesia induction. Remimazolam, a novel anesthetic agent, offers superior hemodynamic stability, and thus represents a potentially safer alternative to propofol in this vulnerable population. However, the optimal infusion rate of remimazolam for inducing general anesthesia in elderly patients remains unclear. This study aimed to determine the effective infusion rate of remimazolam for general anesthesia induction in elderly patients.Methods: This study enrolled consecutive patients aged ≥ 65 with an American Society of Anesthesiologists (ASA) physical status I-III who underwent elective surgery. The 50% (50% effective dose [ED50]) and 90% (90% effective dose [ED90]) effective infusion rates of remimazolam for inducing general anesthesia were estimated using the k-in-a-row method. Successful anesthesia induction was defined as achieving a Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score of ≤ 1 within 2 min of initiating remimazolam infusion. The initial infusion rate was set at 0.1 mg/kg/min, with subsequent adjustments made in increments/decrements of 0.02 mg/kg/min. According to the k-in-a-row method, the infusion rate increased after failure, but decreased only after k = 6 consecutive successes.Results: A total of 50 patients were enrolled in this study. The estimated ED50 and ED90 for achieving an MOAA/S score ≤ 1 within 2 min from the start of remimazolam infusion were 0.10 mg/kg/min (90% CI [0.08-0.11]) and 0.13 mg/kg/min (0.12-0.19), respectively. Hemodynamic stability was maintained across all tested doses during the induction period, and none of the patients required vasopressors or inotropes.Conclusions: An infusion rate of 0.13 mg/kg/min of remimazolam effectively induces general anesthesia in elderly patients, while preserving hemodynamic stability.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137959","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

Association between preoperative serum amyloid A levels and postoperative delirium in older adults undergoing hip surgery: a retrospective study. 老年髋关节手术患者术前血清淀粉样蛋白A水平与术后谵妄的关系：一项回顾性研究。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-09-23 DOI: 10.4097/kja.25523

Hyun-Jung Shin, Bon-Wook Koo, Hyo-Seok Na

{"title":"Association between preoperative serum amyloid A levels and postoperative delirium in older adults undergoing hip surgery: a retrospective study.","authors":"Hyun-Jung Shin, Bon-Wook Koo, Hyo-Seok Na","doi":"10.4097/kja.25523","DOIUrl":"https://doi.org/10.4097/kja.25523","url":null,"abstract":"Background: Postoperative delirium (POD) is a common and serious complication in older adults. Prior studies have validated serum amyloid A (SAA) as a potential biomarker for various inflammatory conditions; however, its role in POD is poorly characterized. This study aimed to examine the association between preoperative SAA levels and the occurrence of POD.Methods: This study comprised a retrospective review of the electronic medical records of patients aged 60 and older who underwent hip surgery between April 2022 and January 2024. Cognitive function was assessed using the Nursing Delirium Screening Scale (Nu-DESC), while diagnosis was confirmed by psychiatrists using the Confusion Assessment Method (CAM). The associations between POD occurrence and preoperative/postoperative SAA levels and other patient, anesthesia, and surgical factors were analyzed using logistic regression models.Results: Of 731 patients, delirium occurred in 121 patients (16.6%) within the first five postoperative days (five-day POD). Preoperative SAA levels were significantly higher in the POD group (91.2 mg/L) than the non-POD group (6.6 mg/L) (P < 0.001). Logistic regression showed that preoperative SAA levels were independently associated with POD occurrence (odds ratio [OR]: 1.005, 95% CI: 1.002‒1.008; P < 0.001). Age (P < 0.001), height (P = 0.006), and preoperative albumin levels (P = 0.008) were also identified as significant factors influencing POD risk.Conclusions: Elevated preoperative SAA levels were associated with an increased risk of five-day POD in older adults undergoing hip surgery. Further research is required to explore the clinical utility of SAA as a biomarker for predicting POD.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124997","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

Evolving perspectives on blood transfusion in obstetric hemorrhage: a narrative review. 不断发展的观点对输血在产科出血：叙述回顾。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-09-23 DOI: 10.4097/kja.25413

Yoon Ji Choi, Sang Hun Kim

{"title":"Evolving perspectives on blood transfusion in obstetric hemorrhage: a narrative review.","authors":"Yoon Ji Choi, Sang Hun Kim","doi":"10.4097/kja.25413","DOIUrl":"https://doi.org/10.4097/kja.25413","url":null,"abstract":"Globally, postpartum hemorrhage is still among the most significant factors in preventable maternal morbidity and mortality. Although early recognition and intervention have improved with advances in obstetric care, transfusion practices are often based on fixed thresholds that may not accurately reflect the unique physiological changes that occur during pregnancy or in the clinical context of acute bleeding. In this narrative review, we propose a phase-specific, patient-centered transfusion strategy for the preoperative, intraoperative, and postpartum periods. Key components of this strategy include proactive anemia correction during pregnancy, timely administration of uterotonic agents, early implementation of antifibrinolytic therapy, such as tranexamic acid within 3 h of bleeding onset, and appropriate activation of massive transfusion protocols when severe hemorrhage is ongoing. Clinical decision-making should be based on continuous assessment of maternal status, rather than on static hemoglobin values. Point-of-care coagulation monitoring, including thromboelastography and rotational thromboelastometry, can allow rapid identification of coagulopathy and support goal-directed transfusion. For high-risk populations, such as those with placenta accreta spectrum or those who decline allogeneic transfusion, strategies can include intraoperative cell salvage and non-blood interventions. Balanced transfusion approaches, using equal ratios of red blood cells, plasma, and platelets, at an early stage have demonstrated improved outcomes. Standardized protocols, multidisciplinary collaboration, and the integration of emerging technologies may further improve safety, minimize unnecessary transfusions, and promote consistency of care in the management of obstetric hemorrhage.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125027","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

Association between non-anemic iron deficiency and outcomes following off-pump coronary artery bypass surgery: A retrospective analysis. 非贫血性铁缺乏与非体外循环冠状动脉搭桥手术后预后的关系：回顾性分析。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-09-16 DOI: 10.4097/kja.25022

Heesoo Shin, Hye Bin Kim, Jae-Kwang Shim, Jong-Wook Song, Seo-Hee Ko, Young-Lan Kwak

{"title":"Association between non-anemic iron deficiency and outcomes following off-pump coronary artery bypass surgery: A retrospective analysis.","authors":"Heesoo Shin, Hye Bin Kim, Jae-Kwang Shim, Jong-Wook Song, Seo-Hee Ko, Young-Lan Kwak","doi":"10.4097/kja.25022","DOIUrl":"https://doi.org/10.4097/kja.25022","url":null,"abstract":"Background: Non-anemic iron deficiency (ID) may be harmful during cardiac surgery with cardiopulmonary bypass. However, its impact on off-pump coronary artery bypass (OPCAB) remains unclear. This study examined the association between non-anemic ID and outcomes following OPCAB.Methods: This single-center retrospective study included non-anemic patients who underwent OPCAB between November 2016 and May 2023. Patients were classified by preoperative ID status, defined as serum ferritin < 100 μg/L or 100-300 μg/L with C-reactive protein > 5 mg/L or transferrin saturation < 20%. The risk of primary outcome, defined as the composite of acute kidney injury, permanent stroke, deep sternal wound infection, hemostatic reoperation, prolonged mechanical ventilation, delirium, myocardial infarction, and 30-day mortality, was compared using multivariable logistic regression. Mediation analysis was performed to determine the indirect effects of non-anemic ID via perioperative red blood cell (RBC) transfusion.Results: Of the 433 non-anemic patients, 229 (52.9%) had ID. The incidence of composite outcome was similar between patients with and without ID (30.1% vs. 22.5%, P = 0.075). ID was not significantly associated with the composite outcome, whereas perioperative transfusion (odds ratio: 2.101, 95% confidence interval [1.169-3.778], P = 0.013) showed significant associations. Perioperative RBC transfusion was more common in patients with ID (25.8% vs 10.8%, P < 0.001). Mediation analysis suggested that RBC transfusion partially mediated the effect of ID on the composite outcome.Conclusions: Preoperative ID was not associated with adverse outcomes in non-anemic patients who had undergone OPCAB. However, its indirect impact via RBC transfusion warrants further investigation.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069947","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

Three-dimensional bioprinting in drug delivery: a broad-spectrum review. 三维生物打印在给药中的应用：广谱综述。

IF 6.3 4区医学

Korean Journal of Anesthesiology Pub Date : 2025-09-15 DOI: 10.4097/kja.25473

Dongju Kim, Seunguk Bang

引用次数: 0