Anesthesia and pain medicine最新文献

Background: Laparoscopic cholecystectomy has been associated with moderate to severe intensity pain, especially in the early postoperative period. Among pain modalities, the transversus abdominis plane (TAP) block has favorable results and fewer associated adverse effects. Current evidence also reports that intravenous lidocaine infusion is effective in reducing acute postoperative pain and decreases overall opioid requirement. This study aimed to compare intravenous lidocaine infusion and bilateral subcostal TAP block for postoperative analgesia following laparoscopic cholecystectomy.

Methods: Thirty patients were randomly classified into the control, lidocaine, and TAP block groups. Intravenous lidocaine infusion was used in the lidocaine arm intraoperatively, while bilateral subcostal TAP block was placed in the TAP block arm as an intervention. The primary outcome was 24 h average pain score. Secondary outcomes included rescue analgesic consumption, postoperative nausea and vomiting, and patient satisfaction.

Results: Comparative analysis between groups showed that the 24 h mean pain score on the visual analog scale score was significantly decreased in the lidocaine group than the control group (mean difference with 95% confidence interval [CI], 2.47 (1.94, 3.00); P < 0.001). Furthermore, the mean pain score was significantly decreased in the lidocaine group than in the TAP block group (mean difference with 95% CI, 1.14 (0.56, 1.72); P < 0.001).

Conclusions: Intravenous lidocaine infusion is a superior modality for postoperative pain management in laparoscopic cholecystectomy than TAP block or routine management. Lidocaine also helped decrease rescue analgesic consumption and achieved better patient satisfaction.

Background: Extremely premature neonates can have neonatal respiratory distress syndrome. Anesthetic challenges can result, especially during rigid bronchoscopy requiring maintenance of spontaneous ventilation.

Case: 1-day old 560 g female, 23-weeks and 6 days gestation was born with labored breathing and intubated at birth. Four attempts, including one with video-laryngoscopy and visualization of the endotracheal tube going through the vocal cords failed to detect end tidal carbon dioxide (EtCO2). She was extubated onto bilevel positive pressure and transferred for urgent rigid bronchoscopy under anesthesia to rule out tracheoesophageal fistula. Intraoperatively, lack of EtCO2 for over 1 min after 2.5 mm ETT placement over a rigid bronchoscope was noted and overcome using sustained high peak inspiratory pressures.

Conclusions: Lack of preoperative surfactant administration in extremely premature neonates may lead to significant atelectasis with inability to detect EtCO2 after intubation.

Burnout is a widespread occupational issue in the medical field, posing significant risks to both physician health and patient care worldwide. While the COVID-19 pandemic highlighted the impact of systemic factors-such as excessive workloads, administrative burdens, and inefficiencies-in exacerbating physician burnout, discussions about well-being remain limited in South Korea. Given the recent challenges faced by healthcare professionals in Korea, addressing burnout has become urgent to prevent further negative outcomes. Although individual efforts toward wellness are important, they are insufficient without systemic support. Distinguishing between burnout and well-being is crucial for developing targeted interventions. Drawing on global examples, comprehensive strategies-including policy reforms, organizational support, mental health resources, and cultural shifts-are recommended to create a sustainable and supportive environment for anesthesiologists in Korea.

Background: Recently, there have been many cases where sugammadex used in traffic accident patients has been deducted from auto insurance claims. This study aims to investigate the characteristics of sugammadex deductions through retrospective analysis.

Methods: We included patients who underwent general anesthesia after traffic accidents at our institution between January 2019 and December 2023. Data for patients for whom sugammadex payments were deducted from the Auto Insurance Claims Review Department of the Korean Health Insurance Review and Assessment Service were obtained from the hospital's insurance department, and electronic medical records were analyzed. The characteristics of neuromuscular blockade (NMB) and its reversal, including administration time and dosage of neuromuscular blockading agent (NMBA) and reversal agent, intraoperative neuromuscular transmission (NMT) monitoring results, and reasons for sugammadex use, were assessed and analyzed.

Results: A total of 251 patients deducted sugammadex payments during the study period. The deduction rate significantly decreased from 88-100% in previous years to 43.4% in 2023. Sugammadex was used to reverse deep NMB (55.1%) and in high-risk patients (23.1%). Sugammadex was mostly used to reverse deep NMB (55.1%) and in high-risk patients (23.1%). NMT monitoring was documented in 81.3% of cases, with 38.9% showing deep NMB and 33.3% showing moderate NMB. Despite improved NMT documentation after 2021, sugammadex payment deductions persisted.

Conclusions: Sugammadex payment deductions occur despite clinical necessity, particularly in deep and moderate NMB cases. Thorough documentation may help reduce these deductions. Collaboration between healthcare providers and policymakers is required to use reversal agents guided by clinical evidence.

Background: Local anesthetic systemic toxicity (LAST) is a rare life-threatening complication of regional anesthesia. Simulation-based training offers an effective educational approach to improve the management of infrequent events. This quasi-experimental study assessed the impact of a multidisciplinary simulation-based educational intervention on managing LAST as a real peri-operative team.

Methods: Twelve anesthesia trainees and eight nursing staff members participated in the study. The intervention included pre-course learning materials, cognitive aids, and immersive simulation scenarios. Simulation scenarios were conducted at baseline (O1), one week after a boot camp (O2), and six months later (O3). Participants' reactions to the training were evaluated using a 5-point Likert scale, while knowledge acquisition was measured through pre- and post-test questionnaires. Team-based skills acquisition and retention were assessed using a modified checklist from the simulation team assessment tool. Data were analyzed using paired t-tests, with P < 0.05 considered statistically significant.

Results: All participants rated the LAST curriculum as satisfactory to very satisfactory. Significant improvements in both technical and non-technical skills were observed post-intervention (O2), with checklist scores increasing from an average of 39 (4.2) (95% confidence interval [CI], 34.88; 43.11) at O1 to 83.5 (5.7) (95% CI, 77.91; 89.08) at O2 (mean difference, 44.5; P < 0.001). At six months (O3), skill retention was indicated by an average score of 72 (7.8) (95% CI, 62.36; 77.64).

Conclusions: Multidisciplinary, simulation-based educational interventions remarkably improve knowledge and skills related to LAST management, with effective skill retention observed at six months when implemented by multiprofessional teams in real-world settings.

Background: Epidural steroid injections are frequently used to treat chronic radicular pain of a discogenic origin; however, their efficacy remains limited. Magnesium sulfate and dexmedetomidine are emerging adjuvants with the potential to enhance the effectiveness and prolong the therapeutic duration of steroid injections.

Methods: In this randomized, double-blind study, 90 patients with unilateral lower limb radiculopathy due to lumbar disc prolapse who did not respond to conservative treatment for 12 weeks were assigned to three groups. The control group received dexamethasone (4 mg), lidocaine 2% (40 mg), and saline. The magnesium group received magnesium sulfate (200 mg) with dexamethasone and lidocaine. The dexmedetomidine group received dexmedetomidine (50 mg), dexamethasone, lidocaine, and saline. Pain intensity was assessed using the visual analog scale at 1 week and 1, 3, and 6 months post-treatment. Secondary outcomes included the Modified Oswestry Disability Index (MODI), analgesic consumption, and procedure-related complications.

Results: Both magnesium and dexmedetomidine significantly reduced pain, disability, and analgesic consumption for up to 3 months. By 6 months, the magnesium group demonstrated significant improvement in pain scores and MODI and a decline in ibuprofen use compared to the control and dexmedetomidine groups.

Conclusions: Magnesium significantly reduced pain intensity, disability, and analgesic consumption over a 6-month observation period.

Enhanced recovery after surgery (ERAS) is an innovative perioperative management approach designed to shorten the recovery time, improve patient safety and quality of care, and enhance overall satisfaction. Successful implementation of ERAS requires active collaboration between healthcare providers and patients to facilitate a timely return to daily activities. The ERAS protocol, originally developed for colorectal surgery, has gradually been expanded and adapted to other major surgeries, and more recently, to Cesarean deliveries. Enhanced recovery after Cesarean delivery (ERAC) presents unique challenges due to its distinct patient population, comprising relatively young women. Its dual focus on maternal recovery and neonatal well-being sets it apart from conventional ERAS protocols. Several components of the ERAC protocol have been adapted from the ERAS recommendations; however, supporting evidence remains limited. This review examines the current ERAC protocol and considers the types of research needed to establish an evidence-based ERAC protocol in the future.

Background: Patients with cervical spinal cord injury (SCI) can experience pain refractory to aggressive multimodal therapies. Here, we report the use of an intrathecal targeted drug delivery (ITDD) system to treat severe pain in patients with cervical SCI.

Case: A 64-year-old male patient underwent spinal cord stimulation (SCS) for severe cervical SCI. We proceeded with the ITDD system, placing the catheter tip at the C6 level. After placement of the ITDD system, the patient was monitored for regular refills of morphine sulfate in the drug delivery reservoir every 6 months. We reduced the oral morphine equivalent dose from nearly 333.8 mg/day to 133.8 mg/day.

Conclusions: The ITDD system may be a useful treatment option for patients with cervical SCI who have failed conventional treatments and do not show improvement with SCS.