Korean Journal of Anesthesiology最新文献

{"title":"An electrical fire in the operating room: lessons from a real-world emergency.","authors":"Ki Tae Jung","doi":"10.4097/kja.26041","DOIUrl":"10.4097/kja.26041","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"370-371"},"PeriodicalIF":4.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13244160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839774","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 ultrasound-guided superior laryngeal nerve block on tracheal tube-related responses during postoperative recovery in craniotomy patients: a randomized controlled trial.","authors":"Jie Xiao, Tao Zhu, Renqing Liu, Shudong Wang, Fang Kang","doi":"10.4097/kja.25908","DOIUrl":"10.4097/kja.25908","url":null,"abstract":"<p><strong>Background: </strong>Coughing and hemodynamic fluctuations during emergence from anesthesia after a craniotomy can result in serious complications. This study evaluated whether the ultrasound-guided superior laryngeal nerve block (SLNB) attenuates these tracheal tube-related responses.</p><p><strong>Methods: </strong>Eighty patients scheduled for elective craniotomy were randomized into the control (Group C, 2 ml 0.9% saline per side) and SLNB (Group S, 2 ml 1% lidocaine per side) group. The primary outcome was the incidence of coughing during the recovery period. Secondary outcomes included the severity of coughing, hemodynamic fluctuations, need for rescue interventions, anesthesia-related parameters, and complications.</p><p><strong>Results: </strong>Compared to controls, the patients in Group S experienced a significantly reduced incidence (78.9% vs. 48.6%; P = 0.006) and severity (P < 0.001) of coughing during emergence. The mean arterial pressure and heart rate were also more stable during and after extubation in Group S than in Group C. Furthermore, Group S required a significantly lower dose of nicardipine during the emergence period (P = 0.032), and both the incidence of and visual analog scale scores for postoperative sore throat at 6 h after extubation were markedly reduced (P = 0.035). No significant differences were noted between the groups in terms of propofol consumption, emergence agitation, extubation time, post-anesthesia care unit stay duration, or complications.</p><p><strong>Conclusions: </strong>The SLNB significantly suppressed extubation-related responses during anesthetic emergence after craniotomy by reducing coughing and attenuating hemodynamic fluctuations, thereby contributing to a smoother emergence profile.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"360-369"},"PeriodicalIF":4.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13244161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627641","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":"Comparison of large language models and conventional machine learning in postoperative outcome prediction: a retrospective, multi-national development and validation study.","authors":"Jipyeong Lee, Hyeonsik Kim, Luke Kim, Leerang Lim, Hyung-Chul Lee, Hyeonhoon Lee","doi":"10.4097/kja.25646","DOIUrl":"10.4097/kja.25646","url":null,"abstract":"<p><strong>Background: </strong>Conventional machine learning (ML) models for predicting surgical outcomes have limitations in generalizability. We explored large language models (LLMs) as scalable alternatives to conventional ML models in predicting postoperative outcomes, including in-hospital 30-day mortality, intensive care unit (ICU) admission, and acute kidney injury (AKI).</p><p><strong>Methods: </strong>This study utilized the Informative Surgical Patient for Innovative Research Environment (INSPIRE) dataset (n = 80 985) from South Korea for model development and internal validation, and the Medical Informatics Operating Room Vitals and Events Repository (MOVER) dataset (n = 6265) from the United States for external validation. The study compared three different LLMs-Generative Pre-trained Transformer [GPT]-4o, Llama-3-70B, and OpenBioLLM-70B-against MLs using various prompt engineering approaches. LLMs were evaluated with different model parameter quantizations (4-bit normalized floating point vs. 16-bit brain floating point).</p><p><strong>Results: </strong>OpenBioLLM-70B was comparable to eXtreme Gradient Boosting (XGBoost) across all tasks (in-hospital 30-day mortality: area under receiver operating characteristic curve [AUROC] 0.782 [95% CI, 0.748-0.813] vs. 0.791 [95% CI, 0.753-0.825]; ICU admission: AUROC 0.595 [95% CI, 0.581-0.609] vs. 0.594 [95% CI, 0.580-0.608]; AKI: AUROC 0.830 [95% CI, 0.802-0.855] vs. 0.823 [95% CI, 0.792-0.851]) during external validation. Open-source LLMs maintained performance with 4-bit quantization, reducing computational requirements by 75%.</p><p><strong>Conclusions: </strong>The findings support the versatility and efficiency of LLMs for clinical decision support through on-premises compatibility, addressing data privacy. Further validation with diverse datasets is needed to ensure their reliability and applicability across different perioperative settings.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"332-352"},"PeriodicalIF":4.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13244168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106013","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":"Early postoperative pain and its association with complications after minimally invasive colorectal cancer surgery: a retrospective cohort study of a multicenter database.","authors":"Taeyup Kim, Ho-Jin Lee, Min Hyun Kim, In Ja Park, Seok-Byung Lim, Rumi Shin, Jung-Man Lee, Dong Woon Lee, Jung Wook Huh, Bon-Wook Koo, Heung-Kwon Oh, Ji Won Park, Seung-Yong Jeong","doi":"10.4097/kja.25956","DOIUrl":"https://doi.org/10.4097/kja.25956","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain may impair recovery; however, its association with postoperative complications remains unclear. We investigated this association in patients undergoing minimally invasive colorectal cancer surgery.</p><p><strong>Methods: </strong>This retrospective multicenter study analyzed data from the Korean Enhanced Recovery After Surgery (ERAS) registry collected between October 2023 and December 2025. Adult patients who underwent colorectal cancer resection at six tertiary institutions were included. Pain intensity on postoperative day one was assessed using the pain/discomfort dimension of the EuroQol 5-Dimension 5-Level questionnaire and categorized as mild, moderate, or severe. The primary outcome was overall postoperative complications, defined as a Comprehensive Complication Index (CCI) score ≥ 8.7. The secondary outcomes were major complications (CCI ≥ 26.2) and length of postoperative hospital stay (LOS). Associations between pain severity and outcomes were evaluated using multivariable binary logistic regression for overall complications, Firth's penalized likelihood logistic regression for major complications, and multivariable linear regression for LOS.</p><p><strong>Results: </strong>A total of 985 patients were included. Compared with mild pain, severe pain was associated with higher odds of overall complications (odds ratio, 1.76; 95% CI, 1.11-2.81), whereas neither moderate nor severe pain was associated with major complications. Moderate and severe pain were both associated with longer LOS (LOS ratios, 1.07 [95% CI, 1.01-1.13] and 1.08 [95% CI, 1.02-1.15], respectively).</p><p><strong>Conclusions: </strong>Severe early postoperative pain was independently associated with a higher complication burden and longer LOS. As causality remains unproven, prospective studies are needed to determine whether optimized pain control can directly reduce complications.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054768","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":"Prehabilitation in patients with diabetes: targeting metabolic dysfunction to improve perioperative outcomes.","authors":"Youn Yi Jo, Jung Ju Choi, Chun Gon Park, Ga Hee Kim, Hyun Jeong Kwak","doi":"10.4097/kja.26387","DOIUrl":"https://doi.org/10.4097/kja.26387","url":null,"abstract":"<p><p>Patients with diabetes mellitus experience disproportionately worse postoperative outcomes, reflecting an underlying metabolic dysfunction that conventional perioperative optimization strategies fail to address. Although prehabilitation improves outcomes in selected surgical populations, its effectiveness in diabetes remains inconsistent, suggesting a mismatch between intervention strategies and the mechanisms driving perioperative risk. This review aimed to evaluate the role of metabolic dysfunction in perioperative risk among patients with diabetes and to propose a mechanism-informed prehabilitation framework targeting key metabolic disturbances. Evidence from clinical studies, systematic reviews, and perioperative guidelines was synthesized to develop a structured framework linking metabolic targets with targeted interventions within perioperative care pathways. Key metabolic disturbances, including insulin resistance, impaired metabolic flexibility, mitochondrial dysfunction, inflammation, and glycemic variability, amplify the surgical stress response and impair recovery in these patients. Conventional multimodal prehabilitation fails to adequately address these mechanisms. A targeted metabolic optimization approach incorporating exercise-based conditioning, nutritional optimization, glycemic management (including continuous glucose monitoring), and pharmacological modulation enables targeted interventions across these domains. Individualization strategies based on dominant metabolic features improves clinical applicability. The integration of this approach within perioperative pathways, including enhanced recovery after surgery (ERAS), provides a structured strategy to improve metabolic stability and perioperative resilience. Prehabilitation in patients with diabetes should shift from generalized multimodal strategies to targeted strategies involving metabolic optimization aligned with the underlying pathophysiology. A personalized and mechanism-informed approach integrated within the ERAS pathways may improve perioperative outcomes in this high-risk population. Prospective studies are needed to validate this strategy.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839806","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":"Discriminative ability for abnormal ventilatory function using acoustic pattern of inhale and exhale in patients receiving pressure-controlled ventilation.","authors":"Kyu-Min Kang, Hyun-Seok Kim, Woo-Jin Kim, Woo-Young Seo, Yong-Seok Park, Kyoung-Sun Kim, Sung-Hoon Kim","doi":"10.4097/kja.251087","DOIUrl":"https://doi.org/10.4097/kja.251087","url":null,"abstract":"<p><strong>Background: </strong>Despite various available methods for monitoring a patient's respiratory system, conventional monitors provide limited ventilatory function information. This study explored the feasibility of intraoperative lung sound patterns to discriminate preoperatively diagnosed ventilatory dysfunction.</p><p><strong>Methods: </strong>Forty-five patients who had undergone preoperative pulmonary function testing were enrolled for analysis, comprising 15 patients per normal, obstructive, and restrictive group. High-fidelity lung sounds were recorded intraoperatively using esophageal stethoscopes equipped with digital microphone devices. After signal processing, morphological features of the acoustic data, including the inhale/exhale peak ratio (I/Ep), were extracted. Their discriminative abilities for obstructive and restrictive types were assessed and compared with conventional monitoring parameters.</p><p><strong>Results: </strong>I/Ep showed strong discriminative performance, with an area under the receiver operating characteristic curve of 0.950 (95% CI: 0.887-0.991) for obstructive and 0.950 (95% CI: 0.867-0.995) for restrictive types. The median values of I/Ep were 2.9 in the restrictive, 2.2 in the normal, and 1.5 in the obstructive group (P < 0.001). Conventional ventilatory parameters (compliance, peak inspiratory pressure, and slope of end-tidal CO2) did not significantly differ among the groups.</p><p><strong>Conclusions: </strong>Our study demonstrated that the I/Ep derived from intraoperative acoustic data differed according to preoperatively diagnosed ventilatory dysfunction. Hence, acoustic inhale and exhale patterns contain clinically useful information not captured by conventional ventilator parameters. Further studies are warranted to explore the clinical application of acoustic feature analysis for real-time intraoperative monitoring.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774803","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 between the automated TEG®6s and viscoelastic analyzer Haema T4.","authors":"Nikolaus F Hofmann, Herbert Schöchl, Johannes Zipperle, Daniel Oberladstätter, Felix Schmitt, Gerhard Fritsch, Johannes Gratz","doi":"10.4097/kja.25895","DOIUrl":"https://doi.org/10.4097/kja.25895","url":null,"abstract":"<p><strong>Background: </strong>Viscoelastic testing is increasingly being used for point-of-care coagulation management. This study compared the Haema T4 (HT4, Medcaptain®), a novel viscoelastic analyzer, with the TEG®6s (Haemonetics®), as they use similar assays but different measurement technologies.</p><p><strong>Methods: </strong>Combined extrinsic-intrinsic activation (CRT), intrinsic activation (CK/kaolin), and fibrinogen polymerization (CFF/FIB) assays were performed using both devices. Activated clotting time (ACT), reaction time (r-time), kinetic time (k-time), and maximum amplitude (MA) were assessed under various experimental conditions.</p><p><strong>Results: </strong>The TEG®6s delivered higher absolute values for ACT, r-time, and k-time but lower MA values than the HT4. A weak correlation for ACT was demonstrated between the devices for the CRT assay (r = 0.36, 95% CI: 0.08-0.59, P = 0.011), with wide limits of agreement (-23.4 to 146.6 s) and substantial bias (61.6 ± 43.4 s). In contrast, strong correlations for MA were demonstrated for the CRT (r = 0.91, 95% CI: 0.84-0.95) and CK/kaolin assays (r = 0.95, 95% CI: 0.91-0.97), with minimal bias (-1.2 ± 5.6 mm and -4.8 ± 2.3 mm, respectively). For the CFF/FIB assays, MA displayed a strong correlation (r = 0.85, 95% CI: 0.75-0.92) with a bias of -5.9 ± 8.6 mm.</p><p><strong>Conclusions: </strong>Although several parameters showed a strong correlation, agreement between the HT4 and TEG®6s was limited, indicating that results between the devices are not interchangeable. Device-specific reference ranges must be determined and clinical outcome studies are required before incorporating the HT4 into clinical practice.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774834","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":"Impact of spinal cord stimulation on healthcare utilization and costs in complex regional pain syndrome: analysis of South Korea's National Health Insurance claims data.","authors":"Cho Long Kim, HyeongSu Kim, Sungyeon Jung, Jae Hun Kim","doi":"10.4097/kja.25954","DOIUrl":"https://doi.org/10.4097/kja.25954","url":null,"abstract":"<p><strong>Background: </strong>Long-term economic impact of spinal cord stimulation (SCS) in Korea remains limited. This retrospective observational study evaluated healthcare utilization and costs associated with SCS in patients with complex regional pain syndrome (CRPS).</p><p><strong>Methods: </strong>Using claims data from South Korea's National Health Insurance Sharing Service (NHISS), we identified patients with CRPS who underwent trial or permanent SCS between 2005 and 2015. Patients were categorized into an SCS (permanent implantation) and a non-SCS (trial only) groups. Healthcare utilization and costs were analyzed over a one-year period before and after the index date.</p><p><strong>Results: </strong>The non-SCS group demonstrated a statistically significant increase in total hospitalization days (from 6.9 ± 22.6 to 17.0 ± 54.5, P = 0.02) and mean length of stay (from 2.6 ± 5.6 to 6.0 ± 17.5, P = 0.01). In contrast, the SCS group showed no significant changes in these hospitalization metrics. Between-group comparisons demonstrated significant differences in changes in hospitalization days and length of stay (P = 0.02). In addition, total healthcare costs increased significantly in the non-SCS group (from USD 2,448 ± 5,162 to USD 3,527 ± 6,943, P = 0.03), whereas no significant change was observed in the SCS group.</p><p><strong>Conclusions: </strong>SCS was associated with more favorable short-term healthcare utilization patterns, including stable hospitalization metrics and reduced procedure-related costs, compared with trial-only patients with CRPS. However, causal interpretation is limited by the observational design and residual confounding. These findings suggest a potential role of SCS in modifying healthcare utilization trajectories among patients with refractory CRPS.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627802","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":"Impact of ERAS implementation on the quality of recovery following robotic laparoscopic gynecological surgery: a randomized controlled trial.","authors":"Seung Woo Song, Hun Ju Lee, Jung Hwan Ahn, Nalai Kim, San-Hui Lee","doi":"10.4097/kja.25462","DOIUrl":"https://doi.org/10.4097/kja.25462","url":null,"abstract":"<p><strong>Background: </strong>In the gynecology field, robotic laparoscopic surgery is increasingly being used to enhance the quality of care. The Enhanced Recovery After Surgery (ERAS) program, which improves patient outcomes, is becoming the standard of care, but its impact on gynecological patients remains unclear. We compared the effect of ERAS implementation and conventional care for robotic gynecological surgery.</p><p><strong>Methods: </strong>This parallel-group, randomized controlled trial included patients aged 20-70 years undergoing robotic gynecological surgery at a single tertiary medical center in the Republic of Korea. Patients were randomized to conventional care and ERAS groups in a 1:1 ratio. The customized ERAS protocol encompassed minimized fasting, pre-emptive analgesia, transversus abdominis block, and early ambulation. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24-h and 1-week postoperatively. Secondary outcomes included postoperative pain, ClavienDindo grade ≥ 3 complications, readmission, and length of hospital stay.</p><p><strong>Results: </strong>Of the 66 enrolled patients, data of 65 were analyzed (conventional care, n = 32; ERAS, n = 33). Compared with conventional care, ERAS resulted in a significantly better quality of recovery at 24-h (QoR-15 scores: 93 [71117] vs. 124 [103135], P < 0.001) and 1-week postoperatively (QoR-15 scores: 135 [131142] vs. 142 [136148], P = 0.002). Additionally, the ERAS group had less severe postoperative pain and a shorter length of hospital stay. Complication and readmission rates were comparable between the groups.</p><p><strong>Conclusions: </strong>ERAS implementation in robotic gynecological surgery enhanced the quality of recovery and provided better pain control than conventional care, without affecting patient safety.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627603","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 flow chart to 3 × 3 matrix: visualizing anesthetic depth and hemodynamics as a complement to Lee, Egan, and Johnson's framework.","authors":"Donald H Lambert, Laura Lambert, Hanzhang Zhao, Mauricio Gonzalez","doi":"10.4097/kja.25958","DOIUrl":"10.4097/kja.25958","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"248-249"},"PeriodicalIF":4.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13066820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105981","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}