Korean Journal of Anesthesiology最新文献

{"title":"A novel method of ultrasound-guided zygomaticotemporal nerve block for awake craniotomy.","authors":"Takehito Sato, Masashi Takakura, Kanako Ozeki, Koichi Akiyama","doi":"10.4097/kja.25643","DOIUrl":"https://doi.org/10.4097/kja.25643","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030173","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":"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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","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}

{"title":"Insulin augments vasodilatory response elicited by amlodipine via nitric oxide-dependent vasodilation in isolated rat aortas.","authors":"Soo Hee Lee, Kyeong-Eon Park, Seong-Ho Ok, Gyujin Sim, Ju-Tae Sohn","doi":"10.4097/kja.25416","DOIUrl":"https://doi.org/10.4097/kja.25416","url":null,"abstract":"<p><strong>Background: </strong>High-dose insulin and euglycemic therapy are widely used to treat calcium channel blocker toxicity. However, the effect of insulin on vasodilation evoked by the dihydropyridine calcium channel blocker amlodipine remains unknown. This study examined the effect of insulin on amlodipine-induced vasodilation in isolated rat aortas with specific emphasis on mechanisms associated with nitric oxide (NO).</p><p><strong>Methods: </strong>The study assessed the roles of NW-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase inhibitor; methylene blue, a general guanylate cyclase suppressor; 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ), a selective inhibitor of NO-sensitive guanylate cyclase; and endothelial removal in modulating the NO-dependent signaling cascade underlying amlodipine-induced vasodilation. This study explored how insulin and various pharmacological inhibitors influenced the vasodilatory effects of amlodipine and verapamil in rat aortic tissues with or without an intact endothelium.</p><p><strong>Results: </strong>In aortas with intact endothelium, amlodipine-induced relaxation was significantly suppressed by L-NAME, methylene blue, and ODQ. Insulin enhanced amlodipine-induced vasodilation in endothelium-intact aortas, whereas it had no effect on the vasodilatory response to amlodipine in endothelium-denuded aortas. Moreover, L-NAME, methylene blue, and ODQ eliminated insulin-mediated augmentation of amlodipine-induced vasodilation in endothelium-intact aortas. However, in endothelium-intact aortas, insulin exhibited no impact on the vasodilatory effects triggered by verapamil. Amlodipine increased endothelial nitric oxide synthase (eNOS) phosphorylation in human umbilical vein endothelial cells (HUVECs). Additionally, combined treatment with insulin and amlodipine further increased amlodipine-induced eNOS phosphorylation in HUVECs.</p><p><strong>Conclusions: </strong>These findings suggest that insulin contributes to the amplification of amlodipine's NO-dependent vasodilatory response in aortas, which appears to be mediated by increased NO production.</p>","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":"145015745","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":"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":"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","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}

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","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}

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Preoperative SUA levels show a nonlinear, sex-specific association with postoperative outcomes, highlighting the need for sex- and risk-based perioperative stratification.</p>","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}

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>HPI-guided management significantly reduced intraoperative hypotension and major complications.</p>","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}

{"title":"Costoclavicular Brachial Plexus Block for Shoulder Surgery: A Narrative Review.","authors":"Samita Pirotesak, Nazanin Fallah, Reef Alruqaie, Karoll Rodelo, Juan Francisco Asenjo, Julián Aliste","doi":"10.4097/kja.25422","DOIUrl":"https://doi.org/10.4097/kja.25422","url":null,"abstract":"<p><p>The costoclavicular block is a proximal approach for blocking the brachial plexus in the infraclavicular fossa. Whether the costoclavicular block offers advantages over lateral paracoracoid approaches has been debated. However, diaphragm-sparing anesthesia for shoulder surgery has recently reignited interest in the costoclavicular space. In this review, we examine the costoclavicular block as an alternative to the interscalene block for shoulder surgery, focusing on minimizing involvement of the phrenic nerve. We conducted a systematic search of MEDLINE, EMBASE, and Google Scholar databases using the search terms \"costoclavicular block\" and \"shoulder surgery,\" to identify relevant studies published up to April 2025. Only randomized trials meeting rigorous inclusion criteria, i.e., those that were prospectively registered, used blinded assessment, and provided sample size justification, were included. The findings of these studies suggested that local anesthetic deposition in the costoclavicular space can reliably anesthetize the brachial plexus cords, achieving a high rate of suprascapular nerve blockade, while sparing the diaphragm. The effectiveness of the anesthesia and analgesia provided by this block depends on use of the appropriate local anesthetic volume and concentration. Further research is needed to validate these findings. Nevertheless, the evidence to date indicates that the costoclavicular block is a promising alternative for patients at risk of hemidiaphragmatic paralysis.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775767","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":"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-\".","authors":"Chi Ho Chan, Jia Yin Lim, Abey M V Mathews","doi":"10.4097/kja.25275","DOIUrl":"10.4097/kja.25275","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"397-398"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000854","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":"Heterogeneity in meta-analysis: a path toward more meaningful clinical evidence.","authors":"Sangseok Lee","doi":"10.4097/kja.25541","DOIUrl":"10.4097/kja.25541","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"297-298"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584276","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}