Korean Journal of Anesthesiology最新文献

{"title":"Thoracoabdominal nerves block through the perichondrial approach: a narrative review.","authors":"Peiqi Shao, Jinghan Liang, Huili Li, Songchao Xu, Danxu Ma, Ruijuan Guo, Yun Wang","doi":"10.4097/kja.25856","DOIUrl":"10.4097/kja.25856","url":null,"abstract":"<p><p>The thoracoabdominal nerves block using the perichondrial approach (TAPA) was first described by Tulgar et al. as a trunk nerve block technique designed to provide analgesia for abdominal surgery. Subsequently, the modified TAPA (M-TAPA) was proposed, in which a local anesthetic was injected only at the lower aspect of the costal cartilage. More recently, a re-modified TAPA was developed to achieve a more consistent blockade of the lateral cutaneous nerve branches. Despite increasing clinical adoption of the TAPA and its modifications, many important details remain insufficiently understood. In this review, we provide a comprehensive update on the available cadaveric and clinical studies of the TAPA and its modifications. The PubMed, Embase, and Web of Science databases were searched, and 276 studies of interest were identified. After excluding irrelevant articles, 75 studies were finally included in the review. The literature indicated that, among these techniques, the M-TAPA has been extensively studied. The anterior sensory coverage achieved by the M-TAPA was marginally better and more stable than its lateral coverage. The TAPA and its modifications are applicable to surgery in the abdominal and inguinal regions. Single-shot and continuous infusions have been described. To date, no complications associated with these blocks have been reported. Thus, the various TAPA blocks are promising techniques. Randomized controlled trials of high methodological quality are required to elucidate the roles of these techniques further.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"497-515"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988101","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":"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":"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":"466-487"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624820/pdf/","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":"OA","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":"10.4097/kja.26472","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"574-576"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624815/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction or explanation: a clinician's guide to logistic regression.","authors":"Junyong In, Dong Kyu Lee","doi":"10.4097/kja.26348","DOIUrl":"https://doi.org/10.4097/kja.26348","url":null,"abstract":"<p><p>Logistic regression is a statistical method used for exploratory and predictive purposes in clinical research. While it is widely used, logistic regression results reported across studies have been inconsistent, particularly in terms of model estimation, validation, and interpretation, even though most studies have clarified their analytical purposes. Reports frequently do not adequately describe how the logistic regression models were evaluated in a purpose-specific manner, particularly regarding underlying assumptions, diagnostic procedures, and performance assessments. Therefore, the interpretability, reproducibility, and clinical applicability of the results presented are frequently limited. We reviewed papers published in the Korean Journal of Anesthesiology (KJA) between 2021 and 2024 that used logistic regression and examined reporting practices, focusing on whether the model evaluation was consistent with the stated analytical purpose. Based on our findings, we then outline the core assumptions required for the appropriate use of logistic regression and introduce key diagnostic tools with practical guidance on their application according to analytical purposes. We also describe statistically robust approaches for reporting the results of logistic regression analyses used for exploratory and predictive purposes, as well as study designs that intentionally incorporate both these aims. With this article, we hope to help researchers establish clear analytical objectives and to adopt systematic reporting practices when using logistic regression, thereby strengthening the basis for research findings to serve as scientifically credible evidence for clinical decision-making.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069735","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":"Comparison of total versus ideal body weight-based remimazolam dosing for sedation in overweight and obese patients undergoing knee arthroplasty under spinal anesthesia: a randomized controlled trial.","authors":"Hansol Kim, Minjung Jang, Seokha Yoo, Young-Jin Lim, Jin-Tae Kim","doi":"10.4097/kja.26499","DOIUrl":"https://doi.org/10.4097/kja.26499","url":null,"abstract":"<p><strong>Background: </strong>Obesity poses sedation challenges owing to altered pharmacokinetics. However, the optimal weight scalar for remimazolam administration in overweight and obese patients remains controversial. This study compared the efficacy and safety of total body weight (TBW)- vs. ideal body weight (IBW)-based remimazolam dosing.</p><p><strong>Methods: </strong>In this patient- and outcome assessor-blinded randomized trial, 110 patients of body mass index (BMI) ≥ 25 kg/m2 undergoing elective knee arthroplasty under spinal anesthesia received TBW- or IBW-based remimazolam. A 0.075 mg/kg loading dose was followed by continuous infusion to maintain moderate sedation. The primary outcome was the incidence of intraoperative respiratory depression. Secondary outcomes included sedation quality, recovery profiles, and pharmacokinetic/pharmacodynamic simulations.</p><p><strong>Results: </strong>Of 102 analyzed patients, respiratory depression was significantly more frequent in the TBW group (45.1% vs. 25.5%; relative risk [RR] 1.77; 95% CI 1.02 to 3.06; P = 0.038). TBW-based dosing, older age, and male sex were independent risk factors. Recovery times were longer in the TBW group (median difference 5.0 min, 95% CI 1.0 to 10.0, P = 0.016). This difference was numerically larger in patients with BMI ≥ 30 kg/m2 (mean difference 14.2 min), but no subgroup comparison remained significant after Benjamini-Hochberg adjustment. Post-hoc Eleveld model simulations generally underestimated sedation depth. The estimated loading dose associated with a 10% risk of respiratory depression was 0.024 mg/kg.</p><p><strong>Conclusions: </strong>TBW-based remimazolam dosing increased the risk of transient respiratory depression and prolonged recovery compared to IBW-based dosing in overweight and obese patients. Conservative IBW-based dosing appeared safer under the present protocol; further loading-dose reduction remains an exploratory hypothesis requiring dose-finding and pharmacokinetic validation.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912636","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":"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}