Korean Journal of Anesthesiology最新文献

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.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Background: Halogenated anesthetics such as sevoflurane have a high global warming potential (GWP) and should be degraded before atmospheric release. We hypothesized that sevoflurane undergoes oxidative degradation when mixed with ozone and some degradation products can be captured using a water trap.

Methods: In Experiment 1, sevoflurane and its degradation products were monitored in real-time using liquid chromatography-mass spectrometry under three conditions: air control, ozone mixing, and ozone mixing followed by passage through a water trap. In Experiment 2, sevoflurane (7-8%) was delivered into a closed anesthesia circuit, and concentration changes were recorded every 10 s under ozone-present and ozone-absent conditions (six trials each). In Experiment 3, proton nuclear magnetic resonance (¹H NMR, Bruker Ascend 400, 20.1°C) was performed on heavy-water samples from the water trap used in Experiment 2 to assess the solubility of ozone-exposed sevoflurane.

Results: In Experiment 1, ozone accelerated sevoflurane degradation; however, the concentration of the degradation products was not increased in the water trap. In Experiment 2, ozone mixing caused a rapid decline in sevoflurane concentration, decreasing from 7.3% to < 1% within 25-28 s and reaching 0% within 265-288 s, whereas no decrease was found in the ozone-absent trials (P < 0.001). In Experiment 3, ¹H NMR spectra showed clearer sevoflurane signals and minor new peaks after ozone exposure, suggesting enhanced apparent solubility and limited decomposition.

Conclusion: Ozone mixing accelerated sevoflurane degradation and increased its water solubility, suggesting a practical approach for reducing the environmental impact of sevoflurane.

Inhalational anesthetics have long been the cornerstone of general anesthesia in noncardiac surgery owing to their reliable pharmacokinetics, ease of administration, and cardiopulmonary benefits such as bronchodilation and myocardial preconditioning. Total intravenous anesthesia (TIVA), achieved using short-acting agents such as propofol and remifentanil, and supported by target-controlled infusion systems and depth-of-anesthesia monitors, has emerged as a widely adopted alternative. TIVA is associated with improved recovery profiles, reduced incidence of postoperative nausea and vomiting, and potential neuroprotective and immunomodulatory effects. In this review, we compared the pharmacological mechanisms and clinical implications of inhalational anesthesia and TIVA, focusing on myocardial injury after noncardiac surgery and other perioperative outcomes. We summarized evidence from randomized controlled trials, large-scale observational studies, and health system-level analyses across multiple outcome domains: all-cause mortality, cardiovascular complications, pulmonary and renal outcomes, oncological prognosis, and system-level factors, such as cost-effectiveness and environmental impact. While inhalational agents demonstrated advantages in terms of cardioprotection and airway management, TIVA was found to offer potential benefits in select populations, particularly in cancer surgery and neuroanesthesia. No single technique demonstrated consistent superiority across all clinical contexts. Therefore, the selection of anesthetic technique should be personalized based on surgical risk, patient comorbidities, institutional infrastructure, and clinician expertise. Emerging trends in sustainability and precision medicine further underscore the need for individualized evidence-based strategies. By combining mechanistic insights with evidence from clinical practice, this review aimed to provide a balanced framework to guide optimal anesthetic decision-making in noncardiac surgery.

Background: One-lung ventilation (OLV) during thoracoscopic surgery can impair oxygenation due to increased intrapulmonary shunts. Remimazolam has gained attention for its hemodynamic stability and rapid recovery profile; however, its effects on arterial oxygenation during OLV remain unclear. This study aimed to compare the effects of remimazolam and sevoflurane on arterial oxygenation during OLV.

Methods: In this prospective, randomized controlled trial, 58 adult patients undergoing thoracoscopic surgery were assigned to receive either sevoflurane or remimazolam for anesthesia maintenance. Arterial blood gas analysis and hemodynamic parameters were measured at four time points: 10 min after lateral positioning during two-lung ventilation (TLV10) and 15, 30, and 60 min after initiating OLV (OLV15, OLV30, and OLV60). The primary outcome was arterial partial pressure of oxygen (PaO2) at OLV30. Secondary outcomes included time-dependent changes in PaO2, hemodynamic variables, and serum lactate levels.

Results: No significant difference in PaO2 at OLV30 was observed between groups (108.9 ± 37.9 vs. 107.0 ± 37.8 mmHg, 95% CI [-21.8 to 18.0], P = 0.815). In within-group analysis, PaO2 at OLV60 increased significantly from TLV10 in the remimazolam group (95% CI [0.3-36.8], P = 0.044), while no such improvement was observed in the sevoflurane group. Serum lactate levels exhibited a significant time-by-group interaction with a greater reduction in the remimazolam group (P = 0.021).

Conclusions: Remimazolam provided arterial oxygenation and hemodynamic stability comparable to sevoflurane during OLV. The greater reduction in serum lactate levels with remimazolam suggests its potential metabolic or immunomodulatory advantages that warrant further investigation.

Background: The interpectoral and pectoserratus plane (PECs) blocks have been reported to provide favorable postoperative analgesia after mastectomy. However, studies have reported controversial data regarding its effect on the quality of recovery (QoR). We aimed to evaluate the effect of the PECs block in light of baseline psychological factors and pain sensitivity.

Methods: Patients undergoing partial mastectomy were randomly assigned to receive either a PECs block (PECs group, n = 69) or no block (Control group, n = 70). We assessed the preoperative psychosocial factors and pain recognition using the Hospital Anxiety Depression Scale (HADS), Pain Catastrophizing Scale, Breast Cancer Pain Questionnaire, temporal pain summation (TPS), and pressure pain threshold and tolerance; we then conducted the interaction test to evaluate the moderating role of these factors on the efficacy of the PECs block.

Results: The global QoR-15 score 1 day after surgery did not differ between the groups (136.50 [124.00, 144.00] vs. 141.00 [127.00, 148.00], P = 0.061); however, the score was enhanced in patients who were depressed, did not ruminate pain aberrantly, and did not have pre-existing pain. The pain Verbal Numeric Rating Scale 1 day after surgery was not different between the groups; however, the TPS score showed an interaction, indicating that the PECs block could reduce pain intensity in patients with high pain sensitivity.

Conclusions: The PECs block did not enhance the QoR-15 score or pain intensity after mastectomy, but its efficacy was pronounced in patients with several specific emotional traits and pain perception.

Background: Injectate distribution patterns in the pterygopalatine fossa may differ based on the drug administration approach used. This study primarily aimed to assess and compare injectate distribution following the posterior infrazygomatic and transoral approaches. The secondary aim was to evaluate the safety of both approaches.

Methods: Injectate distribution patterns were evaluated in 13 cadaveric head specimens. The vessels were perfused with a gelatin-based solution containing an iodinated contrast agent. The ultrasound-guided posterior infrazygomatic approach and transoral approach were performed on contralateral sides, and needle placement was confirmed using computed tomography (CT). A methylene blue and iodinated contrast agent solution was administered following successful needle placement. Injectate distribution and injuries were assessed via CT and anatomical dissection.

Results: With the posterior infrazygomatic approach, methylene blue consistently stained the maxillary artery and nerve, sphenopalatine ganglion, and lateral pterygoid muscle, whereas with the transoral approach, it most frequently surrounded the maxillary artery and structures within the greater palatine canal. The iodinated contrast agent was distributed predominantly along the needle trajectories for both approaches. Injuries to the maxillary artery and facial nerve were documented following the posterior infrazygomatic approach, whereas injury to the lateral pterygoid plate was observed following the transoral approach.

Conclusions: With the posterior infrazygomatic approach, contrast agent encompassed the entire pterygopalatine fossa, whereas the transoral approach yielded a more localized distribution, primarily within the inferior portion and greater palatine canal. These differences in distribution patterns should guide the selection of the most appropriate approach based on the specific clinical indication.