Korean Journal of Anesthesiology最新文献

{"title":"Modified approach to external oblique intercostal block: a proof-of-concept pilot case series and anatomical evaluation -a case series.","authors":"Takashi Fujino, Koichiro Ichimura, Hidaka Anetai, Izumi Kawagoe","doi":"10.4097/kja.24832","DOIUrl":"10.4097/kja.24832","url":null,"abstract":"<p><strong>Background: </strong>Regional anesthesia techniques that provide analgesia to the entire lateral abdomen are limited. We present a modified external oblique intercostal block for complete lateral abdominal analgesia with a single injection.</p><p><strong>Case: </strong>We performed a modified version of the external oblique intercostal block unilaterally at the tenth rib along the mid-axillary line in three patients undergoing robot-assisted partial nephrectomy (two single injections, one catheter placement) and tested the technique on a cadaver with 20 ml of dye bilaterally. All patients reported good postoperative pain relief without complications and had consistent sensory coverage of the T8-T12 dermatomes from the anterior-to-posterior axillary line. Anatomical assessment confirmed consistent bilateral staining of the lateral cutaneous branches T8-T12.</p><p><strong>Conclusions: </strong>Conclusions: The initial clinical success and anatomical findings of the modified approach to the external oblique intercostal block suggest that this technique may be an effective option for lateral abdominal analgesia.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"171-176"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007853","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":"Effect of remimazolam on intraoperative hemodynamic stability in patients undergoing cerebrovascular bypass surgery: a prospective randomized controlled trial.","authors":"Chang-Hoon Koo, Si Un Lee, Hyeong-Geun Kim, Soowon Lee, Yu Kyung Bae, Ah-Young Oh, Young-Tae Jeon, Jung-Hee Ryu","doi":"10.4097/kja.24538","DOIUrl":"10.4097/kja.24538","url":null,"abstract":"<p><strong>Background: </strong>Maintenance of stable blood pressure (BP) during cerebrovascular bypass surgery is crucial to prevent cerebral ischemia. We compared the effect of remimazolam anesthesia with that of propofol-induced and desflurane-maintained anesthesia on intraoperative hemodynamic stability and the need for vasoactive agents in patients undergoing cerebrovascular bypass surgery.</p><p><strong>Methods: </strong>Sixty-five patients were randomized into remimazolam (n = 31, remimazolam-based intravenous anesthesia) and control groups (n = 34, propofol-induced and desflurane-maintained anesthesia). The primary outcome was the occurrence of intraoperative hypotension. The secondary outcomes included hypotension duration, lowest mean BP (MBP), generalized average real variability (ARV) of MBP, and consumption of phenylephrine, norepinephrine, or remifentanil.</p><p><strong>Results: </strong>Occurrence rate and duration of hypotension were significantly lower in the remimazolam group (38.7% vs. 73.5%, P = 0.005; 0 [0, 10] vs. 7.5 [1.25, 25] min, P = 0.008). Remimazolam also showed better outcomes for lowest MBP (78 [73, 84] vs. 69.5 [66.25, 75.8] mmHg, P < 0.001) and generalized ARV of MBP (1.42 ± 0.49 vs. 1.66 ± 0.52 mmHg/min, P = 0.036). The remimazolam group required less phenylephrine (20 [0, 65] vs. 100 [60, 130] μg, P < 0.001), less norepinephrine (162 [0, 365.5] vs. 1335 [998.5, 1637.5] μg, P < 0.001), and more remifentanil (1750 [1454.5, 2184.5] vs. 531 [431, 746.5] μg, P < 0.001) than the control group.</p><p><strong>Conclusions: </strong>Remimazolam anesthesia may provide better hemodynamic stability during cerebrovascular bypass surgery than propofol-induced and desflurane-maintained anesthesia.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"148-158"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023804","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":"A comprehensive analysis of propofol abuse, addiction and neuropharmacological aspects: an updated review.","authors":"Tayfun Uzbay, Andleeb Shahzadi","doi":"10.4097/kja.24707","DOIUrl":"10.4097/kja.24707","url":null,"abstract":"<p><p>This review aims to assess the existing studies on propofol, a relatively new intravenous anesthetic, related to its abuse and addictive potential and to explain the neurobiological and neuropharmacological aspects of propofol addiction. Several neurobiological factors related to complex processes in the brain influence propofol abuse and addiction. In this review, we assessed the literature regarding propofol abuse and addiction, including both experimental and clinical studies. We selected articles from animal studies, case reports, clinical trials, meta-analyses, narrative reviews, and systematic reviews to extract all relevant crucial quantitative data with a measure of neurobiological and neuropharmacological aspects. Thus, the main goal of this study was to investigate the current literature and discuss the association between the central nervous system and propofol abuse and addiction in the context of addictive behavior. Current data suggest that propofol has a strong addictive potential and produces prominent addiction in both animals and humans. Thus, medical practitioners should exercise caution with propofol use, and we argue that this drug should be added to the list of controlled substances.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"91-104"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829265","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":"A modified hip pericapsular nerve block on postoperative pain and functional outcomes after total hip arthroplasty: a prospective, double-blind, randomized controlled study.","authors":"Jian Hu, Qiuru Wang, Jie Hu, Chunyu Gong, Jing Yang","doi":"10.4097/kja.24593","DOIUrl":"https://doi.org/10.4097/kja.24593","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to explore the efficacy and safety of the hip pericapsular nerve block (hip-PNB), which combines the anterior pericapsular nerve group (PENG) and posterior pericapsular deep-gluteal (PPD) blocks, on postoperative pain and functional outcomes after total hip arthroplasty (THA) via the posterolateral approach.</p><p><strong>Methods: </strong>Seventy patients undergoing THA were allocated to either the nerve block group (Group N, hip-PNB + sham local infiltration analgesia [LIA]) or the control group (Group C, sham hip-PNB + LIA). The primary outcome was cumulative morphine consumption in the first 24 h postoperatively. Secondary outcomes included visual analog scale pain scores at rest and during movement postoperatively, time to first rescue analgesia, cumulative morphine consumption during hospitalization, opioid consumption during surgery, postoperative recovery, and postoperative complications.</p><p><strong>Results: </strong>Compared with Group C, Group N consumed significantly less morphine in the first 24 h (10 [0-10] mg vs. 10 [10-20] mg; P < 0.001) and throughout hospitalization (10 [0-20] mg vs. 20 [20-30] mg; P < 0.001) and had less opioid consumption perioperatively. Group N also had significantly lower pain scores at rest and during movement in the first 24 h, required rescue analgesia later, and had faster recovery postoperatively than Group C. No significant intergroup differences were observed in quadriceps muscle strength or postoperative complication rates.</p><p><strong>Conclusions: </strong>Compared to LIA, Hip-PNB has better postoperative analgesia and enhances recovery in patients undergoing THA.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615803","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":"Efficacy of Pectoral Nerve II Block for Flap Dissection-Related Pain Following Robot-Assisted Transaxillary Thyroidectomy: A Prospective, Randomized Controlled Trial.","authors":"Min Suk Chae, Kwangsoon Kim","doi":"10.4097/kja.24914","DOIUrl":"https://doi.org/10.4097/kja.24914","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted transaxillary thyroidectomy (RATT) involves extensive flap dissection, leading to significant postoperative pain. This study evaluated the efficacy of pectoral nerve II (PECS II) block in pain relief, opioid reduction, and recovery enhancement.</p><p><strong>Methods: </strong>This prospective, randomized controlled trial included 83 patients undergoing elective RATT for thyroid conditions. Patients were assigned to the block group (n = 42) or non-block group (n = 41). Pain was assessed using the visual analog scale (VAS) at 1, 4, 24, and 48 hours postoperatively. Secondary outcomes included opioid consumption and Quality of Recovery-15 (QoR-15K) scores at discharge.</p><p><strong>Results: </strong>The PECS II block group had significantly lower VAS scores at 1 h (3.6 ± 2.5 vs. 6.3 ± 2.3, P < 0.001), 4 h (2.6 ± 2.1 vs. 4.3 ± 2.5, P = 0.002), and 24 h (2.0 ± 1.6 vs. 3.2 ± 2.0, P = 0.002). Opioid consumption was significantly lower in the block group (median: 1 [0.75, 3] vs. 3 [2, 3.5], P = 0.001). QoR-15K pain subdimension scores were higher in the block group (14.5 [12, 17] vs. 10 [8, 14], P < 0.001), while other recovery aspects were comparable.</p><p><strong>Conclusions: </strong>The PECS II block significantly reduces pain and opioid use in RATT patients, enhancing recovery quality. This opioid-sparing approach supports multimodal pain management, ensuring safer and more comfortable postoperative recovery.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483396","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":"Bicarbonate-buffered solution versus Plasma-Lyte™ in orthotopic adult liver transplantation: a pilot open-label, randomized, non-inferiority trial.","authors":"Fumitaka Yanase, Laurence Weinberg, Michael Jiang, Varun Peri, Rebecca Caragata, Jian Wen Chan, Lachlan F Miles, Shervin Tosif, Louise Ellard, Peter McCall, Brett Pearce, David A Story, Param Pillai, Antony Leaver, Hannah Perlman, Jinesh Patel, Glenn Eastwood, Dong Kyu Lee, Rinaldo Bellomo","doi":"10.4097/kja.24677","DOIUrl":"https://doi.org/10.4097/kja.24677","url":null,"abstract":"<p><strong>Background: </strong>The ideal intravenous (IV) maintenance and resuscitation fluid for patients undergoing orthotopic liver transplantation (OLT) remains unknown. We aimed to determine whether bicarbonate-buffered solution was non-inferior to Plasma-Lyte™ in preventing metabolic acidosis during OLT.</p><p><strong>Methods: </strong>We conducted a pilot single-center, open-label, randomized trial to compare the physiological effects of intravascular volume maintenance with a bicarbonate-buffered solution vs. Plasma-Lyte™ in adults undergoing OLT. Non-inferiority was defined as a median difference in the standard base excess (SBE) of less than -2.5 mEq/L. The primary endpoint was the standard base excess (SBE) at 5 minutes post-reperfusion. Quantile regression analysis was applied to confirm non-inferiority. Secondary endpoints included other forms of acid-base and electrolyte imbalances at pre-specified time points and postoperative complications.</p><p><strong>Results: </strong>We randomized 52 adults undergoing OLT. The median (interquartile range [IQR]) volume infused was 5000 (3125, 7000) ml in the bicarbonate-buffered solution group and 5500 (4000, 10,500) ml in the Plasma-Lyte™ group (P = 0.37). The median (IQR) SBE at 5 minutes post-reperfusion was -4.857 (-6.231, -3.565) mEq/L in patients receiving bicarbonate-buffered solution and -4.749 (-7.574, -2.963) mEq/L amongst those in the Plasma-Lyte™ group. The estimated median difference by quantile regression was -0.043 mEq/L (95% CI -1.988 to 1.902 mEq/L; (one-sided P = 0.015). There were no significant differences in the acid-base secondary outcomes, number of complications, or patient mortality. There were no reported adverse events or safety concerns associated with the use of either solution.</p><p><strong>Conclusions: </strong>A bicarbonate-buffered solution was non-inferior to Plasma-Lyte™ for maintaining acid-base homeostasis post-reperfusion in OLT patients.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441285","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":"Heterogeneity in meta-analyses: an unavoidable challenge worth exploring.","authors":"Geun Joo Choi, Hyun Kang","doi":"10.4097/kja.25001","DOIUrl":"https://doi.org/10.4097/kja.25001","url":null,"abstract":"<p><p>Heterogeneity is a critical but unavoidable aspect of meta-analyses that reflects differences in study outcomes beyond what is expected by chance. These variations arise from differences in the study populations, interventions, methodologies, and measurement tools and can influence key meta-analytical outputs, including pooled effect sizes, confidence intervals, and overall conclusions. Systematic reviews and meta-analyses combine evidence from diverse studies; thus, a clear understanding of heterogeneity is necessary for reliable and meaningful interpretations of the results. This review examines the concepts, sources, measurement techniques, and implications of this heterogeneity. Statistical tools (e.g. Cochran's Q, I², and τ²) quantify heterogeneity, whereas τ and prediction intervals, as they use the same units, aid in the intuitive understanding of heterogeneity. The choice between fixed- and random-effects models can also significantly affect the handling and interpretation of heterogeneity in meta-analyses. Effective management strategies include subgroup analyses, sensitivity analyses, and meta-regressions, which identify sources of variability and strengthen the robustness of the findings. Although heterogeneity complicates the synthesis of a single effect size, it offers valuable insights into patterns and differences among studies. Recognizing and understanding heterogeneity is vital for accurately synthesizing the evidence, which can indicate whether an intervention has consistent effects, benefits, or harms. Rather than viewing heterogeneity as inherently good or bad, researchers and clinicians should consider it a key component of systematic reviews and meta-analyses, allowing for a deeper understanding and more nuanced application of pooled findings. Addressing heterogeneity ultimately enhances the reliability, applicability, and overall impact of the conclusions of meta-analyses.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433402","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":"Mortality and factors associated with acute exacerbation after noncardiac surgery in patients with interstitial pneumonia: a retrospective study.","authors":"Kaoru Umehara, Kazuhiro Shirozu, Taichi Ando, Kentaro Tokuda, Kei Makishima, Kazuya Imura, Shota Tsumura, Shinnosuke Takamori, Ken Yamaura","doi":"10.4097/kja.24656","DOIUrl":"https://doi.org/10.4097/kja.24656","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbation of interstitial pneumonia (AE-IP) is associated with high mortality rates. Although the risk factors for AE-IP have been extensively studied, given the small sample sizes, only a few risk factors have been established. This study aimed to investigate the postoperative mortality and factors associated with AE-IP.</p><p><strong>Methods: </strong>This retrospective study included 482 patients with a preoperative diagnosis of IP who underwent noncardiac surgery between December 2012 and April 2020. AE-IP was diagnosed by a radiologist using computed tomography when worsening respiratory symptoms were observed within 1 month postoperatively. The Cox proportional hazards model was used to compare mortality rates. Candidate factors associated with AE-IP were identified through logistic regression analysis using the variable selection method, followed by case-control analysis using propensity score matching to determine possible factors associated with AE-IP.</p><p><strong>Results: </strong>The multivariable-adjusted hazard ratios for all-cause and IP-related deaths were significantly higher in patients with AE-IP than in those without AE-IP. Multivariable analysis with variable selection suggested that male sex, higher C-reactive protein (CRP) levels, fraction of inspired oxygen (FiO2) ≥ 60%, and non-lung surgery were candidate factors associated with AE-IP. Case-control analysis using propensity score matching demonstrated that patients with AE-IP had higher CRP levels (P = 0.044) and frequency of FiO2 ≥ 60% (P = 0.035) than those without AE-IP. Furthermore, a positive, nearly linear relationship was observed between FiO2 ≥ 60% duration and AE-IP incidence.</p><p><strong>Conclusions: </strong>Intraoperative management with FiO2 ≥ 60% and high preoperative CRP levels were significantly associated with postoperative AE-IP.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080296","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 Effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: a propensity score-matched, non-inferiority study\".","authors":"Ji-Hyeon Kim, Jae-Sik Nam","doi":"10.4097/kja.24740","DOIUrl":"10.4097/kja.24740","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"87-88"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623240","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":"High-flow nasal oxygenation: a transformative tool in airway management.","authors":"Hye-Mee Kwon","doi":"10.4097/kja.25038","DOIUrl":"10.4097/kja.25038","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":"78 1","pages":"1-2"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080314","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}