Korean Journal of Anesthesiology最新文献

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Case: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","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}

{"title":"Accuracy of ultrasound-measured skin-to-hyoid bone distance for predicting difficult mask ventilation in patients with obesity: a prospective observational study.","authors":"Ömer Keklicek","doi":"10.4097/kja.26832","DOIUrl":"https://doi.org/10.4097/kja.26832","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630921","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":"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":"Association of dexmedetomidine with improved survival in ICU delirium.","authors":"Yiwen Huang, Lixia Zhu, Yuechu Zhao, Xiaofei Yan, Qi Chen, Ting Li, Zhi Cao, Hongbin Li, Lingying Qu, Kai Gao, Xiaoxin Gao, Boliu Liang, Wenqiang Jiang, Weifeng Li, Bei Hu","doi":"10.4097/kja.251060","DOIUrl":"https://doi.org/10.4097/kja.251060","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit (ICU) delirium is common in critically ill patients and portends poor outcomes. Although dexmedetomidine (DEX) provides arousable sedation and possible neuroprotection, its survival benefit in established ICU delirium remains unclear. This study assessed the association between DEX initiation within 24 h of ICU admission and mortality in patients with early ICU delirium.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the Medical Information Market for Intensive Care IV database. ICU patients with a positive Confusion Assessment Method for the ICU screen on the first ICU day were included. The propensity score matching balanced baseline characteristics and interventions between the DEX and non-DEX groups. Kaplan-Meier and Cox regression analyses were used to assess ICU mortality, 30-day and 90-day all-cause mortality post ICU admission, together with the dose-response correlations with average daily DEX dose.</p><p><strong>Results: </strong>Among 7,441 eligible patients, matching yielded 2,596 patients, with 1,298 in each group. Mortality was lower in the DEX group than in the non-DEX group (13.33% vs. 18.18%, P = 0.001). Kaplan-Meier analysis showed better 30-day and 90-day survival in the DEX group.Fully adjusted Cox modeling showed DEX use associated with improved survival. (HR 0.67; 95%CI: 0.54-0.82; P < 0.001). This survival advantage persisted across subgroups and showed a dose-response pattern, with a higher daily DEX dose linked to better 30-day and 90-day survival.</p><p><strong>Conclusions: </strong>Early DEX administration was associated with improved short- and long-term survival in ICU patients with delirium. Prospective randomized trials are warranted.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295502","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":"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, Sang Hun Kim, Seongtae Jeong, Hyun Kang, Hyun Jung Kim","doi":"10.4097/kja.25842","DOIUrl":"10.4097/kja.25842","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive patients tend to have an increased risk of hypotension during anesthesia induction, which can result in adverse outcomes. This study aimed to compare hemodynamic stability with remimazolam versus propofol in hypertensive patients.</p><p><strong>Methods: </strong>This meta-analysis analyzed randomized controlled trials investigating the hemodynamic outcomes of remimazolam versus propofol during anesthesia induction in hypertensive adults. A systematic search of electronic databases was conducted in November 2024.</p><p><strong>Results: </strong>Six studies were included in the final analysis. The administration of remimazolam significantly lowered the risk of hypotension (risk ratio [RR] = 0.711, 95% CI [0.545-0.929], I2 = 67.54%) and bradycardia (RR = 0.256, 95% CI [0.101-0.649], I2 = 0.0%). It also resulted in a higher minimum mean arterial pressure (mean difference [MD] = 9.023 mmHg, 95% CI [0.243-17.802], I2 = 97.50%) and higher minimum heart rate (MD = 7.200 beats/min, 95% CI [1.960-12.441], I2 = 86.40%). The trial sequential analysis revealed that none of the outcomes reached the required information size.</p><p><strong>Conclusions: </strong>The administration of remimazolam showed a trend toward superior hemodynamic stability compared with propofol during anesthesia induction in hypertensive patients, especially in minimizing the incidence of hypotension and bradycardia. However, the trial sequential analysis results remain inconclusive, the current evidence is limited by small sample sizes, and larger trials are needed to confirm our findings.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"306-317"},"PeriodicalIF":4.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13244169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592896","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}