Korean Journal of Anesthesiology最新文献

{"title":"Korean consensus-based recommendations for preanesthetic gastric ultrasound and anesthetic considerations for GLP-1 receptor agonist-based therapy: a consensus statement from Clinical Practice Guideline Committee of the Korean Society of Anesthesiologists.","authors":"Yu Jeong Bang, Jeong-Hyun Choi, Jeong-Jin Min, Sun Young Park, Won Kyu Choi, Jin-Young Hwang, Bon-Nyeo Koo","doi":"10.4097/kja.26655","DOIUrl":"https://doi.org/10.4097/kja.26655","url":null,"abstract":"<p><p>Pulmonary aspiration during anesthesia remains an uncommon but clinically significant perioperative complication associated with substantial morbidity and mortality. Although contemporary fasting guidelines recommend minimum fasting intervals to reduce aspiration risk, adherence does not guarantee an empty stomach, particularly in patients with delayed gastric emptying or those receiving medications that impair gastrointestinal motility, such as glucagon-like peptide-1 receptor agonist (GLP-1 RA)-based therapies. Preanesthetic gastric ultrasound has emerged as a practical point-of-care modality for the qualitative and quantitative assessment of gastric content and volume, enabling individualized aspiration risk stratification in selected patients. However, the current evidence base remains insufficient to formally support evidence-graded clinical practice guidelines. The consensus-based recommendations presented in this guideline were developed through expert discussion and review of the available literature, in which robust evidence is lacking. They provide practical guidance on the indications for preanesthetic gastric ultrasound, core examination principles and interpretation, integration of ultrasound findings into perioperative decision-making, management when gastric ultrasound is not feasible, and anesthetic strategies for patients with a full stomach. Special recommendations are included for patients receiving GLP-1 RA-based therapies, emphasizing the continuation of these medications in most patients with individualized risk assessment, consideration of a 24-h clear liquid diet, and the use of gastric ultrasound when delayed gastric emptying is suspected. Preanesthetic gastric ultrasound provides a practical bedside method for assessing gastric content and estimating aspiration risk in patients undergoing anesthesia. These recommendations are intended to support, not replace, clinical judgment and should be refined through future prospective outcome-based studies.</p>","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":"148620638","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":"Comparative analgesic effects of lidocaine-dexmedetomidine co-administration in major laparoscopic gynecologic surgery: a randomized controlled trial.","authors":"Yu Jeong Bang, Justin Sangwook Ko, RyungA Kang, Tae Soo Hahm, Chug Su Kim, So Myung Kong, Yoo-Young Lee, Chel Hun Choi, Minsuk Chae","doi":"10.4097/kja.26205","DOIUrl":"https://doi.org/10.4097/kja.26205","url":null,"abstract":"<p><strong>Background: </strong>The intraoperative co-administration of lidocaine and dexmedetomidine has been proposed as an opioid-sparing strategy; however, its effectiveness as an intraoperative multimodal analgesia (MMA) strategy remains unclear. We evaluated its effect on postoperative opioid consumption in patients undergoing major laparoscopic gynecologic surgery.</p><p><strong>Methods: </strong>We conducted a randomized controlled trial comparing intraoperative placebo with lidocaine-dexmedetomidine co-administration in patients undergoing major laparoscopic gynecologic surgery within a standardized Enhanced Recovery after Surgery (ERAS) pathway. Patients were assigned to receive intraoperative placebo or lidocaine at 1.5 mg/kg/h co-administered with dexmedetomidine at either 0.4 or 0.7 μg/kg/h. The primary outcome was 24-h cumulative opioid consumption.</p><p><strong>Results: </strong>Twenty-four-hour cumulative opioid consumption differed significantly between the groups (P = 0.004). Median morphine-equivalent dose was 16.6 mg (12.1, 22.3) in the control group, 11.3 mg (8.1, 19.5) in the lidocaine-dexmedetomidine 0.4 group, and 11.1 mg (6.8, 16.5) in the 0.7 group, corresponding to relative reductions of 32% and 33% in median consumption, respectively. Both dexmedetomidine doses (0.4 and 0.7 μg/kg/h), when co-administered with lidocaine, were associated with significantly lower opioid consumption than the control group, with no significant differences between the two doses. Pain scores during mobilization were lower in both treatment groups during the first 48 h postoperatively, without an increase in adverse events.</p><p><strong>Conclusion: </strong>Intraoperative co-administration of lidocaine and dexmedetomidine effectively reduced postoperative opioid consumption and pain during mobilization as an intraoperative MMA strategy within an ERAS pathway. The higher dexmedetomidine dose provided no additional opioid-sparing benefit during the first 24 postoperative hours.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604460","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 \"Comparison between the automated TEG®6s and viscoelastic analyzer Haema T4\".","authors":"Shingo Kawashima, Atsushi Kobayashi, Wakana Kawashima, Masahiko Ohashi, Hiroyuki Kinoshita","doi":"10.4097/kja.26492","DOIUrl":"https://doi.org/10.4097/kja.26492","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592308","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":"Reply to the \"Comment on 'Comparison between the automated TEG®6s and viscoelastic analyzer Haema T4'\".","authors":"Nikolaus F Hofmann, Herbert Schöchl, Johannes Zipperle, Johannes Gratz","doi":"10.4097/kja.26612","DOIUrl":"https://doi.org/10.4097/kja.26612","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592303","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":"Perioperative management of modern dermatologic medications: an anesthesia-focused narrative review.","authors":"Oğuz Kaan Şimşek, Fatih Can Aba, Yusuf Yılmaz","doi":"10.4097/kja.26703","DOIUrl":"https://doi.org/10.4097/kja.26703","url":null,"abstract":"<p><p>Dermatologic diseases are highly prevalent worldwide and are managed with a broad pharmacologic spectrum ranging from topical agents to biologic therapies. Increasing life expectancy and chronic comorbidities have raised the surgical needs of these patients, creating a demand for careful perioperative management of wound healing, hemostasis, and infection risk, particularly in those receiving immunosuppressive or biologic agents. The existing literature, however, is scattered and largely extrapolated from dermatology, rheumatology, and orthopedic sources. This narrative review aims to provide an anesthesia-focused, evidence-based, drug-class-organized framework for the perioperative management of dermatologic medications in adults undergoing non-dermatologic surgery. Topical agents, systemic retinoids, conventional immunosuppressants, systemic corticosteroids, biologic agents, small molecules, and antimicrobial/antimalarial drugs are reviewed with respect to indications, pharmacokinetics, current guideline recommendations, and clinically relevant drug-anesthesia interactions. In general, most dermatologic medications, including topical agents, conventional immunosuppressants, and oral retinoids, can be safely continued perioperatively. However, biologic agents warrant half-life-based timing, Janus kinase inhibitors should be withheld at least three days before high-infection-risk surgery, and patients on chronic systemic corticosteroids require an individualized stress-dose approach. Specific interactions (isotretinoin-succinylcholine, dapsone-prilocaine, cyclosporine-CYP3A4 substrates, and hydroxychloroquine-QT-prolonging agents) require targeted attention. Because the evidence base is heterogeneous and largely observational, the recommendations are directional rather than definitive, and anesthesiologist-led prospective multicenter studies are needed.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592238","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 \"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":"Seung Eun Song, Hyun Jung Kim","doi":"10.4097/kja.26792","DOIUrl":"https://doi.org/10.4097/kja.26792","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592279","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 'The effect of perioperative ketamine and esketamine administration on postoperative nausea and vomiting in patients undergoing general anesthesia: a systematic review and meta-analysis'\".","authors":"Kwon Hui Seo","doi":"10.4097/kja.26472","DOIUrl":"https://doi.org/10.4097/kja.26472","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592253","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":"Comparative study of recovery characteristics between remimazolam anesthesia with flumazenil and desflurane anesthesia for closed reduction of nasal bone fracture: a randomized controlled trial.","authors":"So Young Lee, Kwang Ho Shin, Jonghae Kim","doi":"10.4097/kja.26094","DOIUrl":"https://doi.org/10.4097/kja.26094","url":null,"abstract":"<p><strong>Background: </strong>In otorhinolaryngologic surgery, immediate and smooth emergence from general anesthesia is important for patient safety. Therefore, we compared the recovery profile of desflurane to that of remimazolam with flumazenil reversal in patients undergoing nasal bone fracture reduction surgery.</p><p><strong>Methods: </strong>In this randomized controlled trial, patients were randomly assigned to the Desflurane (n=29) or Remimazolam group (n=29), which received desflurane or remimazolam, respectively, for anesthesia maintenance. Flumazenil (0.2 mg) was administered at the end of surgery in the Remimazolam group. The primary outcome was the time from anesthetic agent discontinuation to the point at which patients could follow a verbal command (emergence time). Secondary outcomes included time to first eye opening, time to extubation, incidence of emergence agitation, cough severity, and adverse events in the postanesthesia care unit.</p><p><strong>Results: </strong>The emergence time was significantly shorter in the Remimazolam group than in the Desflurane group (317±111 s [mean±SD] vs. 512±138 s; mean difference: 195 s; 95% CI [129-261]; P<0.001). The times to first eye opening (256±106 s vs. 452±124 s; P<0.001) and extubation (343±104 s vs. 500±130 s; P<0.001) were shorter, and emergence agitation was less frequent (6/29 [20.7%] vs. 14/29 [48.3%]; P=0.027) in the Remimazolam group than in the Desflurane group. The Remimazolam group experienced less severe coughing than the Desflurane group did (P=0.003). There were no significant differences in adverse events between the groups.</p><p><strong>Conclusions: </strong>Compared with desflurane, remimazolam with flumazenil hastens recovery and reduces emergence agitation and cough severity in patients undergoing nasal bone fracture reduction surgery.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397065","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":"Video laryngeal mask-guided placement of electromyographic endotracheal tubes for intraoperative neuromonitoring during thyroidectomy: a simulator-based feasibility report.","authors":"Cheng-Che Lee, Tzu-Yen Huang, Che-Wei Wu, Kuang-I Cheng, I-Cheng Lu","doi":"10.4097/kja.26430","DOIUrl":"https://doi.org/10.4097/kja.26430","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352474","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":"From association to causation: interpreting propensity score-based analyses in real-world evidence.","authors":"EunJin Ahn, Sang Gyu Kwak","doi":"10.4097/kja.26332","DOIUrl":"https://doi.org/10.4097/kja.26332","url":null,"abstract":"<p><p>Propensity score (PS) methods are widely used in real-world evidence studies to reduce confounders and to approximate randomized comparisons. However, statistical adjustment is often misinterpreted as evidence of causality, leading to overgeneralization and inappropriate clinical conclusions. In this statistical round, we present a clinically oriented framework for interpreting PS-based analyses, focusing on key principles of causal inference, including the definition of the estimand (average treatment effect [ATE] vs. average treatment effect on the treated [ATT]), covariate selection based on causal structure, assessment of positivity and overlap, and evaluation of robustness to unmeasured confounders. Using recent anesthesiology studies, we demonstrate that discrepancies between the analytical methods and interpretations are common. PS matching typically estimates the ATT and may not be generalizable to the entire population, whereas inverse probability of treatment weighting aims to estimate the ATE but may yield unstable estimates in the presence of limited overlap. Even with well-balanced covariates, unmeasured confounders remain a critical limitation. Failure to account for these issues may lead to biased estimates and overinterpretation of observational associations as causal effects. Causal interpretations of PS-based analyses require an alignment among the target estimand, underlying assumptions, and analytical methods. Rather than relying solely on statistical adjustment, researchers and clinicians should critically evaluate overlap, confounders, and generalizability. Transitioning from association to causation requires both advanced statistical methods and rigorous and transparent interpretations grounded in causal reasoning.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352466","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}