{"title":"When the usual spaces fail: the role of L5-S1 spinal anesthesia in the difficult spine.","authors":"Ji Seon Jeong","doi":"10.4097/kja.26684","DOIUrl":"10.4097/kja.26684","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"382-383"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412309","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}
Whitney N Kuwamoto, Grace C Eddy, Edward R Mariano, Eric S Schwenk
{"title":"An update on the role of multimodal analgesia in perioperative pain management.","authors":"Whitney N Kuwamoto, Grace C Eddy, Edward R Mariano, Eric S Schwenk","doi":"10.4097/kja.26304","DOIUrl":"10.4097/kja.26304","url":null,"abstract":"<p><p>Multimodal analgesia has become a foundational principle of acute perioperative pain management and enhanced recovery and involves the application of nonpharmacologic, pharmacologic, and/or interventional techniques. The overall goal of this approach is to apply a combination of different modalities that target discrete points along the pain pathway and thereby avoid the overreliance on opioids and associated side effects. Since our review in 2018, there have been significant developments that have prompted an updated review of multimodal analgesia. In this article, we identify and summarize important trends that influence the current approach to acute perioperative pain management as well as provide an updated clinical guide on multimodal analgesia with an emphasis on novel therapies. While a continued emphasis on multimodal opioid-sparing analgesia remains, additional evidence, newer regional techniques, and novel agents such as suzetrigine have emerged since our last review and have expanded options for perioperative pain management. In addition, special situations require specific recommendations, such as when designing a perioperative pain management plan for surgical patients who have opioid tolerance or live with opioid use disorder. These complex patients are at a higher risk for poor postoperative pain control and other adverse outcomes. This review includes suggested guidance on tailoring multimodal analgesia in this population with patient-specific therapies that can be added for appropriate indications and are supported by available evidence and guidelines.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"384-394"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148031899","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":"From association to attribution: intraoperative hypotension and hypoalbuminemia as partial pathways linking comorbidity to postoperative kidney injury.","authors":"Ki Tae Jung","doi":"10.4097/kja.26638","DOIUrl":"10.4097/kja.26638","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"379-381"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412246","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 \"Association between preoperative hyperglycemia and adverse cardiac events after non-cardiac surgery: a multicenter cohort study\".","authors":"Sang Gyu Kwak","doi":"10.4097/kja.26225","DOIUrl":"10.4097/kja.26225","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"457"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147973393","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}
Hyun Jeong Kwak, Jung Ju Choi, Dongchul Lee, Youn Yi Jo
{"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":"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 (hazard ratio [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":"395-404"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439146/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Response to \"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":"Jiwon Han, Seihee Min","doi":"10.4097/kja.26298","DOIUrl":"10.4097/kja.26298","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"456"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412305","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 season when journals line up.","authors":"Younsuk Lee","doi":"10.4097/kja.26772","DOIUrl":"10.4097/kja.26772","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"373-376"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412248","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":"Extrafascial out-of-plane continuous interscalene block using the C6 transverse process as a bony landmark -A case series.","authors":"Keisuke Nakazawa, Panramon Vanichvithya, Genki Iwama, Takefumi Kamiya, Osamu Kitajima, Shunichi Takagi, Kazuyoshi Nakanishi, Takahiro Suzuki","doi":"10.4097/kja.26278","DOIUrl":"10.4097/kja.26278","url":null,"abstract":"<p><strong>Background: </strong>Background: Extrafascial interscalene block has been proposed to reduce phrenic nerve involvement while maintaining analgesic efficacy for shoulder surgery. However, a reproducible continuous catheter technique using a clear anatomical landmark has not been well described.</p><p><strong>Case: </strong>We describe a case series of six patients undergoing shoulder surgery who received a continuous extrafascial interscalene block using the C6 transverse process as a bony landmark. Under ultrasound guidance, an 18-gauge Tuohy needle was advanced in a cranial-to-caudal out-of-plane trajectory toward the posterior tubercle of C6, and a catheter was placed within the middle scalene muscle. Continuous levobupivacaine infusion was maintained for 24 hours as part of multimodal analgesia.</p><p><strong>Conclusions: </strong>Conclusions: This technique was associated with favorable postoperative analgesic profiles within a standardized multimodal regimen, without clinically apparent respiratory compromise. Given the absence of a control group, findings should be interpreted as hypothesis-generating. The C6 bony endpoint may improve reproducibility.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"446-454"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412341","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":"Accuracy of ultrasound-measured skin-to-hyoid bone distance for predicting difficult mask ventilation in patients with obesity: a prospective observational study.","authors":"Ömer Keklicek","doi":"10.4097/kja.26832","DOIUrl":"https://doi.org/10.4097/kja.26832","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630921","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":"Comment on \"The Effects of perioperative ketamine and esketamine administration on postoperative nausea and vomiting in patients undergoing general anesthesia: A systematic review and meta-analysis\".","authors":"Abhijit Sukumaran Nair, Tuhin Mistry","doi":"10.4097/kja.26379","DOIUrl":"https://doi.org/10.4097/kja.26379","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620574","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}