Korean Journal of Anesthesiology最新文献

{"title":"Changes in pulse wave transit time variability after interscalene brachial plexus block placement.","authors":"Eun Joo Choi, Jung A Lim, Chang Hyuk Choi, Dong Hyuck Kim, Sungbin Jo, Jonghae Kim","doi":"10.4097/kja.24861","DOIUrl":"10.4097/kja.24861","url":null,"abstract":"<p><strong>Background: </strong>The pulse wave transit time (PWTT) increases with decreased vascular tone resulting from sympathetic blockade caused by regional anesthesia. It oscillates, exhibiting variability due to the interaction between the autonomic nervous and cardiovascular systems. We hypothesized that interscalene brachial plexus block (ISBPB) placement increases the PWTT and reduces the low-frequency power of PWTT variability (LF).</p><p><strong>Methods: </strong>Fifty-six patients receiving an ISBPB were analyzed. The PWTT was defined as the difference in milliseconds (ms) between the R peak of the electrocardiogram and the peak of the second-derivative photoplethysmographic waveform. The LF was calculated by integrating from 0.04 to 0.15 Hz on the power spectrum obtained from fast Fourier transform. The two variables were collected during the 5 min before the end of acclimatization (baseline), between 5 and 10 min after block needle insertion, and between 15 and 20 min after block needle insertion.</p><p><strong>Results: </strong>The PWTT increased significantly (P < 0.001) from baseline (mean [SD]: 155.3 [16.7] ms) to 5-10 min post-needle insertion (166.9 [15.4] ms) (mean difference [MD]: 11.6, 95% CI [9.2-14.0], P < 0.001) and 15-20 min post-needle insertion (165.6 [16.1] ms) (MD: 10.3, 95% CI [7.3-13.2], P < 0.001). The natural log-transformed LF (lnLF) decreased significantly (P < 0.01) from baseline (1.539 [0.560] ln[ms2/Hz]) to 5-10 min post-needle insertion (1.341 [0.617] ln[ms2/Hz]) (MD: -0.198, 95% CI [-0.356 to -0.040], P < 0.01) and 15-20 min post-needle insertion (1.396 [0.548] ln[ms2/Hz]) (MD: -0.144, 95% CI [-0.274 to -0.013], P = 0.03).</p><p><strong>Conclusions: </strong>The post-ISBPB decrease in lnLF and increase in PWTT may be attributable to ISBPB-induced sympathectomy.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"82-94"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120058","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":"Human placental mesenchymal stem cell-derived exosomes carrying hsa-let-7i-5p mitigate lung injury in a murine model of aspiration pneumonia.","authors":"Ching-Wei Chuang, Hong-Phuc Nguyen Vo, Yen-Hua Huang, I-Lin Tsai, Chao-Yuan Chang, Chun-Jen Huang","doi":"10.4097/kja.25037","DOIUrl":"10.4097/kja.25037","url":null,"abstract":"<p><strong>Background: </strong>Aspiration pneumonia (AP), which can be caused by gastric content inhalation into the lower airways, causes acute lung injury (ALI) through complex mechanisms, including inflammation, oxidative stress, and apoptosis. Here, we evaluated the efficacy of exosomes derived from human placental mesenchymal stem cells (hpMSCs) in mitigating ALI in a murine model of AP. We also investigated the role of hsa-let-7i-5p, the most abundant miRNA in hpMSC-derived exosomes, in this respect.</p><p><strong>Methods: </strong>Adult male C57BL/6 mouse AP models were administered hpMSC-derived exosomes (APExo group) or phosphate-buffered saline (AP group) intra-tracheally. After 48 h, the mice were euthanized and evaluated. The effects of hsa-let-7i-5p were assessed by specific inhibition or overexpression.</p><p><strong>Results: </strong>Compared with the APExo group, the AP group exhibited significantly greater ALI, as evidenced by histological damage, increased lung injury scores, impaired lung function, increased leukocyte infiltration, and elevated tissue edema (all P < 0.05). The untreated AP group also showed more inflammation, characterized by nuclear factor-κB upregulation, macrophage M1 polarization, and cytokine level elevation (tumor necrosis factor-α, interleukin-1β, and interleukin-6), as well as increased oxidation and activation of the apoptosis pathway (all P < 0.05). Notably, the therapeutic effects of hpMSC-derived exosomes were compromised by specific inhibition of hsa-let-7i-5p. Furthermore, engineered exosomes derived from genetically modified RAW264.7 overexpressing hsa-let-7i-5p demonstrated therapeutic effects against AP similar to those obtained with hpMSC-derived exosomes.</p><p><strong>Conclusions: </strong>In a murine AP model, intra-tracheal administration of hpMSC-derived exosomes has ALI-mitigating effects, involving inflammation, oxidation, and apoptosis modulation, with hsa-let-7i-5p playing a pivotal mediating role.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"114-129"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528568","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":"Association of preoperative metformin use with postoperative mortality and morbidity in type 2 diabetes patients undergoing noncardiac surgery: a retrospective cohort study.","authors":"Ah Ran Oh, Jungchan Park, Suhyun Lee, Chung Su Kim","doi":"10.4097/kja.25132","DOIUrl":"10.4097/kja.25132","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus (DM) is prevalent among adults, many of whom require surgical interventions. Although metformin may improve postoperative outcomes by reducing inflammation, its effects on postoperative mortality and complications remain unclear. This study aimed to determine whether preoperative metformin use is associated with improved postoperative outcomes after noncardiac surgery.</p><p><strong>Methods: </strong>This retrospective study included adult patients with type 2 DM who underwent noncardiac surgery between 2011 and 2019. Patients were assigned to one of two groups based on the use of preoperative metformin at admission. To evaluate dose-related effects, patients in the metformin group were further divided into low- and high-dose groups based on daily dose (< or ≥ 1,000 mg). The primary outcome was one-year mortality after surgery, and the secondary outcomes were 30-day mortality, five-year mortality, and postoperative complications in major organs within 7 d.</p><p><strong>Results: </strong>Among 22 944 patients, 12 536 (54.6%) were exposed to preoperative metformin. After inverse probability of treatment weighting, preoperative metformin use was associated with a reduced one-year mortality (hazard ratio: 0.76, 95% CI [0.68-0.85]). For secondary outcomes, metformin use decreased postoperative complications in respiratory (odds ratio [OR]: 0.76, 95% CI [0.61-0.93]) and renal systems (OR: 0.66, 95% CI [0.58-0.74]). In a dose-related analysis, both doses were associated with a lower risk of postoperative mortality, with reductions in respiratory complications primarily due to high-dose metformin (OR: 0.69, 95% CI [0.54-0.89]).</p><p><strong>Conclusion: </strong>Preoperative use of metformin is associated with reduced postoperative mortality and complications in diabetic patients undergoing noncardiac surgery.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"95-103"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145482413","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":"Impact of neuromuscular blockade depth on postoperative systemic cytokine release: a systematic review and meta-analysis.","authors":"Soowon Lee, Jung-Hee Ryu, Chang-Hoon Koo, Yu Kyung Bae, Ah-Young Oh","doi":"10.4097/kja.25279","DOIUrl":"10.4097/kja.25279","url":null,"abstract":"<p><strong>Background: </strong>Deep neuromuscular blockade (NMB) optimizes surgical conditions, particularly during laparoscopic procedures. However, its effects on systemic cytokines associated with anesthesia-related complications, including postoperative delirium and cognitive dysfunction, remain unclear. In this review, we quantified the impact of deep NMB on serum cytokine levels.</p><p><strong>Methods: </strong>PubMed, EMBASE, CENTRAL, CINAHL, Scopus, Web of Science, and Google Scholar databases were searched to identify randomized controlled trials (RCTs) evaluating serum cytokine levels in surgical patients under deep or moderate NMB.</p><p><strong>Results: </strong>Eight RCTs, including 661 patients undergoing laparoscopic and orthopedic surgeries, met the inclusion criteria. Immediately postoperatively, meta-analysis suggested a potential reduction in tumor necrosis factor-α (TNF-α, standardized mean difference: -0.46, 95% CI [-0.87 to -0.06], P = 0.03), with no significant differences in interleukin-1β (IL-1β) or interleukin-6 (IL-6) levels. At 24-h and 48-h postoperatively, no significant differences were observed in IL-1β, IL-6, TNF-α, or C-reactive protein levels. Meta-regression analysis indicated that inhalational anesthesia was associated with high IL-1β (estimate = 1.2135, 95% CI [0.5107-1.9162], P < 0.01) and TNF-α levels (estimate = 0.6271, 95% CI [0.0544-1.1997], P = 0.032) immediately postoperatively; however, younger patients exhibited elevated IL-1β levels under moderate NMB at 24-h postoperatively (estimate = 0.0242, 95% CI [0.0065-0.0419], P < 0.01).</p><p><strong>Conclusions: </strong>Deep NMB may be associated with reduced TNF-α levels immediately postoperatively. Inhalational anesthesia and younger age may contribute more to higher serum cytokine levels compared with total intravenous anesthesia and older age, respectively, suggesting a potential immunomodulatory effect of deep NMB. Further studies should clarify its clinical relevance.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"56-68"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445345","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":"From optimization of surgical conditions to modulation of systemic inflammation: revisiting the implications of deep neuromuscular blockade.","authors":"Sangseok Lee","doi":"10.4097/kja.26040","DOIUrl":"10.4097/kja.26040","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":"79 1","pages":"3-5"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086246","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":"Do fascial plane blocks improve respiratory function after breast surgery?","authors":"Ji Seon Jeong","doi":"10.4097/kja.26004","DOIUrl":"10.4097/kja.26004","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":"79 1","pages":"11-12"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086208","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":"Three-dimensional bioprinting in drug delivery: a broad-spectrum review.","authors":"Dongju Kim, Seunguk Bang","doi":"10.4097/kja.25473","DOIUrl":"10.4097/kja.25473","url":null,"abstract":"<p><p>Three-dimensional (3D) bioprinting has emerged as a transformative technology for drug delivery that offers anatomically customized, spatially controlled, and programmable release systems. These innovations hold significant promise in the fields of anesthesiology and pain medicine, particularly for postoperative pain control, where precise, localized, and sustained analgesic effects are desirable. This review highlights the current applications and future directions of 3D bioprinting for the delivery of local anesthetics, anti-inflammatory agents, and neuromodulators. By incorporating patient-specific designs and spatiotemporal release strategies, 3D-printed drug delivery systems can reduce systemic drug exposure, enhance tissue recovery, and improve analgesic efficacy. Despite these advantages, several challenges remain, including issues related to regulatory classification, manufacturing reproducibility, scalability, and long-term biocompatibility. As research advances and interdisciplinary collaboration improves, 3D bioprinting is poised to become an integral tool for personalized and procedure-specific pain management in the perioperative setting.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"28-41"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069937","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":"Impact of ultrasound-guided rhomboid intercostal and serratus anterior plane blocks on respiratory function after modified radical mastectomy: a randomized controlled trial.","authors":"Gizem Akgün, Başak Altıparmak, Ahmet Pınarbaşı, Melike Korkmaz Toker, Sinan Pektaş, Bakiye Uğur","doi":"10.4097/kja.25150","DOIUrl":"10.4097/kja.25150","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the effectiveness of the rhomboid intercostal plane (RIP) and serratus anterior plane (SAP) blocks at enhancing respiratory function in patients undergoing modified radical mastectomy (MRM).</p><p><strong>Methods: </strong>Patients were randomly assigned to the block or control group. The block group received RIP and SAP blocks (20 ml 0.25% bupivacaine each), whereas the control group received no block. The primary outcome was forced expiratory volume in one second (FEV1) 2 h postoperatively. Secondary outcomes included forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow (PEF), forced expiratory flow at 25% to 75% (FEF25-75), pain scores, and opioid requirements.</p><p><strong>Results: </strong>The block and control groups had similar FEV1 values (1.80 ± 0.51 vs. 1.74 ± 0.49, P = 0.659) and FEV1/FVC ratios at 2 h. The block group had higher FVC values at 6 h (2.21 ± 0.76 vs. 1.87 ± 0.48, P = 0.034) and 24 h (2.35 ± 0.65 vs. 1.97 ± 0.53, P = 0.014) and higher PEF and FEF25-75 values at 24 h. Pain scores were lower in the block group at all time points, and opioid consumption was higher in the control group during the first 6 h. The incidence of postoperative nausea and vomiting was similar.</p><p><strong>Conclusions: </strong>This study failed to demonstrate a significant difference in FEV1 values; however, improvements in FVC, PEF, and FEF25-75 indicated a potential positive impact on respiratory function, and combining the RIP and SAP blocks after MRM led to lower pain scores and decreased opioid consumption.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"104-113"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497463","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":"Evolving perspectives on blood transfusion in obstetric hemorrhage: a narrative review.","authors":"Yoon Ji Choi, Sang Hun Kim","doi":"10.4097/kja.25413","DOIUrl":"10.4097/kja.25413","url":null,"abstract":"<p><p>Globally, postpartum hemorrhage is still among the most significant factors in preventable maternal morbidity and mortality. Although early recognition and intervention have improved with advances in obstetric care, transfusion practices are often based on fixed thresholds that may not accurately reflect the unique physiological changes that occur during pregnancy or in the clinical context of acute bleeding. In this narrative review, we propose a phase-specific, patient-centered transfusion strategy for the preoperative, intraoperative, and postpartum periods. Key components of this strategy include proactive anemia correction during pregnancy, timely administration of uterotonic agents, early implementation of antifibrinolytic therapy, such as tranexamic acid within 3 hours of bleeding onset, and appropriate activation of massive transfusion protocols when severe hemorrhage is ongoing. Clinical decision-making should be based on continuous assessment of maternal status, rather than on static hemoglobin values. Point-of-care coagulation monitoring, including thromboelastography and rotational thromboelastometry, can allow rapid identification of coagulopathy and support goal-directed transfusion. For high-risk populations, such as those with placenta accreta spectrum or those who decline allogeneic transfusion, strategies can include intraoperative cell salvage and non-blood interventions. Balanced transfusion approaches, using equal ratios of red blood cells, plasma, and platelets, at an early stage have demonstrated improved outcomes. Standardized protocols, multidisciplinary collaboration, and the integration of emerging technologies may further improve safety, minimize unnecessary transfusions, and promote consistency of care in the management of obstetric hemorrhage.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"13-27"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125027","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":"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":"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 h 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":"69-81"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933392/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}