Korean Journal of Anesthesiology最新文献_第4页

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". 对“全膝关节置换术后以阿片类药物为基础与不使用阿片类药物的患者控制的酮罗拉酸和奈福泮镇痛”的评论。

IF 4 4区医学

Korean Journal of Anesthesiology Pub Date : 2026-08-01 Epub Date: 2026-03-31 DOI: 10.4097/kja.26250

Cheng-Wei Lu

引用次数: 0

The impact of preoperative comorbidity and intraoperative hypotension on postoperative acute kidney injury after non-cardiac surgery: a structural equation modeling-based mediation analysis. 术前合并症和术中低血压对非心脏手术后急性肾损伤的影响：基于结构方程模型的中介分析

IF 4 4区医学

Korean Journal of Anesthesiology Pub Date : 2026-08-01 Epub Date: 2026-02-19 DOI: 10.4097/kja.25765

Woo-Young Jo, Hyeonhoon Lee, Jayoun Kim, Won Ho Kim, Hee-Pyoung Park, Hyoun-Joong Kong, Hyung-Chul Lee

{"title":"The impact of preoperative comorbidity and intraoperative hypotension on postoperative acute kidney injury after non-cardiac surgery: a structural equation modeling-based mediation analysis.","authors":"Woo-Young Jo, Hyeonhoon Lee, Jayoun Kim, Won Ho Kim, Hee-Pyoung Park, Hyoun-Joong Kong, Hyung-Chul Lee","doi":"10.4097/kja.25765","DOIUrl":"10.4097/kja.25765","url":null,"abstract":"Background: Preoperative comorbidities are associated with postoperative acute kidney injury (AKI). However, whether this association is direct or mediated by intraoperative hypotension (IOH) is unclear. We hypothesized that IOH mediates the relationship between preoperative comorbidities and postoperative AKI.Methods: Data from adult patients undergoing non-cardiac surgery under general anesthesia were analyzed. Inverse probability of treatment weighting (IPTW) was applied to achieve a balance between the exposure groups by reducing the baseline differences in the measured covariates. Structural equation modeling (SEM)-based mediation analysis was conducted using the American Society of Anesthesiologists physical status (ASA-PS) classification ≥ 3 as an input and postoperative AKI as an outcome. IOH (duration of mean arterial pressure < 60 mmHg), along with albumin and hemoglobin levels, was considered a mediator. We also performed interaction analysis between patient sex and age.Results: After IPTW, 8643.9 (10.8%) patients had an ASA-PS of ≥ 3. AKI occurred more frequently (4.5% vs. 6.9%, P < 0.001) in patients with ASA-PS ≥ 3. ASA-PS ≥ 3 was associated with a total effect estimate of 0.02 on the log-odds of postoperative AKI (P < 0.001). Of the total effect of ASA-PS ≥ 3 on postoperative AKI, 48% was significantly mediated by IOH (26%) and hypoalbuminemia (26%), though anemia showed no significance. The effect of high ASA-PS scores on postoperative AKI was significantly modified by sex, but not by age.Conclusions: High ASA-PS scores increase AKI risk after non-cardiac surgery, a relationship partially mediated by statistically significant pathways involving IOH and hypoalbuminemia.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"426-433"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146219994","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

Intraoperative hypotension during liver transplantation is associated with long-term mortality. 肝移植术中低血压与长期死亡率相关。

IF 4 4区医学

Korean Journal of Anesthesiology Pub Date : 2026-08-01 Epub Date: 2026-04-23 DOI: 10.4097/kja.25965

Akira Katayama, Ezeldeen Abuelkasem, Leon C Su, David W Wang

{"title":"Intraoperative hypotension during liver transplantation is associated with long-term mortality.","authors":"Akira Katayama, Ezeldeen Abuelkasem, Leon C Su, David W Wang","doi":"10.4097/kja.25965","DOIUrl":"10.4097/kja.25965","url":null,"abstract":"Background: Intraoperative hypotension (IOH) is common during liver transplantation (LT); however, its impact on long-term mortality remains unclear. We investigated the association between IOH and 1-year mortality using various mean arterial pressure (MAP) thresholds and exposure durations.Methods: This retrospective observational cohort study included 1063 patients who underwent LT. We defined IOH as an MAP < 65 mmHg and examined each threshold in 5 mmHg increments to < 40 mmHg. Our primary outcome was 1-year mortality after LT. Multivariate logistic regression was used to control for confounding variables while assessing the association between IOH and 1-year mortality.Results: The 1-year mortality after LT was 7.1%. Only moderate-to-severe IOH showed independent associations with 1-year mortality: MAP < 55 mmHg for ≥ 43 minutes (hazard ratio [HR] = 2.48, 95% CI [1.05-5.86], P = 0.038), MAP < 50 mmHg for ≥ 14 min (HR = 2.60, 95% CI [1.01-6.65], P = 0.047), MAP < 45 mmHg for ≥ 13 min (HR = 4.98, 95% CI [1.18-21.0], P = 0.029), and MAP < 40 mmHg for ≥ 5 min (HR = 6.72, 95% CI [1.56-28.9], P = 0.010), whereas longer exposure durations at MAP < 65 or < 60 mmHg were not independently associated with increased mortality. Furthermore, both a lower MAP and longer exposure duration for each threshold increased the predicted probability of 1-year mortality.Conclusions: Moderate-to-severe hypotension was independently associated with increased 1-year mortality after LT. These findings underscore the importance of intraoperative blood pressure management in LT recipients.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"414-425"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774934","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

When the usual spaces fail: the role of L5-S1 spinal anesthesia in the difficult spine. 当常规间隙失败时：L5-S1脊髓麻醉在困难脊柱中的作用。

IF 4 4区医学

Korean Journal of Anesthesiology Pub Date : 2026-08-01 Epub Date: 2026-07-06 DOI: 10.4097/kja.26684

Ji Seon Jeong

引用次数: 0

From association to attribution: intraoperative hypotension and hypoalbuminemia as partial pathways linking comorbidity to postoperative kidney injury. 从关联到归因：术中低血压和低白蛋白血症是连接合并症与术后肾损伤的部分途径。

IF 4 4区医学

Korean Journal of Anesthesiology Pub Date : 2026-08-01 Epub Date: 2026-07-06 DOI: 10.4097/kja.26638

Ki Tae Jung

引用次数: 0

An update on the role of multimodal analgesia in perioperative pain management. 多模式镇痛在围手术期疼痛管理中的作用。

IF 4 4区医学

Korean Journal of Anesthesiology Pub Date : 2026-08-01 Epub Date: 2026-05-27 DOI: 10.4097/kja.26304

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":"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.","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}

引用次数: 0

Comment on "Association between preoperative hyperglycemia and adverse cardiac events after non-cardiac surgery: a multicenter cohort study". 关于“术前高血糖与非心脏手术后不良心脏事件之间的关系”的方法学考虑。

IF 4 4区医学

Korean Journal of Anesthesiology Pub Date : 2026-08-01 Epub Date: 2026-05-19 DOI: 10.4097/kja.26225

Sang Gyu Kwak

引用次数: 0

Blamed but not at fault: anti-obesity medication adverse effects misidentified as perioperative complications - a comprehensive review and medicolegal warning for anesthesiologists. 被指责但没有过错：抗肥胖药物的副作用被误认为是围手术期并发症——对麻醉师的全面审查和医学法律警告。

IF 4 4区医学

Korean Journal of Anesthesiology Pub Date : 2026-08-01 Epub Date: 2026-04-28 DOI: 10.4097/kja.26375

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":"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.","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}

引用次数: 0

Extrafascial out-of-plane continuous interscalene block using the C6 transverse process as a bony landmark -A case series. 使用C6横突作为骨标记的筋膜外面外连续斜角肌间阻滞：一个病例系列。

IF 4 4区医学

Korean Journal of Anesthesiology Pub Date : 2026-08-01 Epub Date: 2026-07-07 DOI: 10.4097/kja.26278

Keisuke Nakazawa, Panramon Vanichvithya, Genki Iwama, Takefumi Kamiya, Osamu Kitajima, Shunichi Takagi, Kazuyoshi Nakanishi, Takahiro Suzuki

{"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":"Background: 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.Case: 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.Conclusions: 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.","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}

引用次数: 0

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". 对“全膝关节置换术后基于阿片类药物与保留阿片类药物的患者控制镇痛：一项随机、双盲、非劣效性试验”的回应。

IF 4 4区医学

Korean Journal of Anesthesiology Pub Date : 2026-08-01 Epub Date: 2026-07-07 DOI: 10.4097/kja.26298

Jiwon Han, Seihee Min

引用次数: 0