Korean Journal of Anesthesiology最新文献

Trauma anesthesia demands a high level of expertise. In this context, anesthesiologists are required to manage complex physiology and rapidly evolving scenarios in critically injured patients, who often present profound hemodynamic instability. In addition to providing intraoperative anesthesia, trauma anesthesiologists serve as active resuscitationists and are key players in the trauma team from the moment of the patient's arrival. General trauma resuscitation follows the ABCDE approach. The key areas of trauma anesthesia include airway management (A, airway), with rapid sequence induction and strategies for handling difficult airways; ventilation techniques (B, breathing) aimed at protecting the traumatized lungs under pressure; and hemodynamic resuscitation (C, circulation), which incorporates permissive hypotension, implementing massive transfusion protocols, and managing trauma-induced coagulopathy. Neuromonitoring and brain protection (D, disability) are crucial in cases of traumatic brain and spinal cord injuries, requiring precise blood pressure control and intracranial pressure monitoring. Advanced monitoring techniques (E, exposure), which include point-of-care ultrasound and invasive hemodynamic assessment, further enhance intraoperative decision-making. Above all, effective trauma anesthesia hinges on seamless interdisciplinary collaboration (F, force), with decision-making shared between anesthesiologists and trauma surgeons in high-risk surgeries. In this review, we highlight the pivotal role of trauma anesthesiologists in severe hemorrhage management, one of the most critical challenges in trauma resuscitation, and emphasize that an integrated, proactive approach is essential not only for improving immediate survival, but also for optimizing long-term recovery of the patient.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Background: 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.

Methods: 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.

Results: 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]).

Conclusion: Preoperative use of metformin is associated with reduced postoperative mortality and complications in diabetic patients undergoing noncardiac surgery.

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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.

Background: 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).

Methods: 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.

Results: 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.

Conclusions: 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.