Korean Journal of Anesthesiology最新文献

Background: The sex-specific association between serum uric acid (SUA) levels and postoperative outcomes in elective non-cardiac surgery remains unclear. This study aimed to identify sex-specific SUA thresholds and their impact on short- and long-term outcomes.

Methods: A retrospective analysis of 295 267 patients (2012-2021) undergoing non-cardiac surgery was conducted. Patients were stratified by preoperative SUA levels: for males (< 4 to ≥ 9 mg/dl) and females (< 3 to ≥ 8 mg/dl), with mid-range levels as reference. Mortality (30-day to overall) and complications were assessed using Cox and logistic regression. Cubic splines evaluated nonlinear trends, with subgroup analyses by age and surgical risk.

Results: SUA levels exhibited a nonlinear, sex-specific association with postoperative outcomes. The estimated lower-risk SUA range was 5.08-7.63 mg/dl in males and 3.34-5.35 mg/dl in females. In Cox and spline analyses, a U-shaped association between SUA and mortality was observed in both sexes, with significant risks at both low (< 4 mg/dl) and high (≥ 9 mg/dl) levels in males, and predominantly at low levels (< 3 mg/dl) in females. The types of complications varied subtly between sexes. Within SUA ranges of 4-6 mg/dl (males) and 3-4 mg/dl (females), composite and specific complication risks were lower than at either extreme, showing a protective effect, with reduced risk of acute kidney injury in males and pneumonia in females. Additionally, extreme SUA levels were significantly associated with increased mortality and complications, particularly in low-risk surgical patients.

Conclusions: Preoperative SUA levels show a nonlinear, sex-specific association with postoperative outcomes, highlighting the need for sex- and risk-based perioperative stratification.

Background: This study aimed to determine the association between frailty, as measured by the five-item modified frailty index (mFI-5), and postoperative pulmonary complications (PPCs) in older patients undergoing major abdominal surgery and to explore the predictive value of frailty beyond traditional PPC risk factors.

Methods: In this retrospective cohort study, we collected baseline and perioperative data of older patients (aged ≥ 65 years) undergoing major abdominal surgery in a tertiary hospital. The association between the mFI-5 score and PPCs was examined using multivariate logistic regression analysis. Additionally, the predictive value of the mFI-5 beyond the four basic PPC risk models was estimated using discrimination (areas under receiver operating characteristic curve [AUROCs]; DeLong's test), calibration (Hosmer-Lemeshow test), goodness of fit (likelihood ratio χ2 test), explained variance (Nagelkerke R2), and reclassification (categorical and continuous net reclassification improvement and integrated discrimination improvement).

Results: A total of 3298 patients were included, of whom 351 (10.6%) developed PPCs. After adjusting for confounding factors, higher mFI-5 scores were independently associated with an increased risk of PPCs compared with a score of 0 (all P < 0.05). Incorporating the mFI-5 score into the basic PPC risk models significantly improved the AUROC, goodness of fit, and risk reclassification (all P < 0.001); enhanced or maintained calibration (all P > 0.05); and increased explained variance.

Conclusions: Frailty, measured using the mFI-5, was independently associated with an increased risk of PPCs and improved the predictive performance of conventional risk factors for PPCs in older patients undergoing major abdominal surgery.

Background: Non-anemic iron deficiency (ID) may be harmful during cardiac surgery with cardiopulmonary bypass. However, its impact on off-pump coronary artery bypass (OPCAB) remains unclear. This study examined the association between non-anemic ID and outcomes following OPCAB.

Methods: This single-center retrospective study included non-anemic patients who underwent OPCAB between November 2016 and May 2023. Patients were classified by preoperative ID status, defined as serum ferritin < 100 μg/L or 100-300 μg/L with C-reactive protein > 5 mg/L or transferrin saturation < 20%. The risk of primary outcome, defined as the composite of acute kidney injury, permanent stroke, deep sternal wound infection, hemostatic reoperation, prolonged mechanical ventilation, delirium, myocardial infarction, and 30-day mortality, was compared using multivariable logistic regression. Mediation analysis was performed to determine the indirect effects of non-anemic ID via perioperative red blood cell (RBC) transfusion.

Results: Of the 433 non-anemic patients, 229 (52.9%) had ID. The incidence of composite outcome was similar between patients with and without ID (30.1% vs. 22.5%, P = 0.075). ID was not significantly associated with the composite outcome, whereas perioperative transfusion (odds ratio: 2.10, 95% CI [1.17-3.78], P = 0.013) showed significant associations. Perioperative RBC transfusion was more common in patients with ID (25.8% vs. 10.8%, P < 0.001). Mediation analysis suggested that RBC transfusion partially mediated the effect of ID on the composite outcome.

Conclusions: Preoperative ID was not associated with adverse outcomes in non-anemic patients who had undergone OPCAB. However, its indirect impact via RBC transfusion warrants further investigation.

The costoclavicular block is a proximal approach for blocking the brachial plexus in the infraclavicular fossa. Whether the costoclavicular block offers advantages over lateral paracoracoid approaches has been debated. However, diaphragm-sparing anesthesia for shoulder surgery has recently reignited interest in the costoclavicular space. In this review, we examine the costoclavicular block as an alternative to the interscalene block for shoulder surgery, focusing on minimizing involvement of the phrenic nerve. We conducted a systematic search of MEDLINE, EMBASE, and Google Scholar databases using the search terms "costoclavicular block" and "shoulder surgery," to identify relevant studies published up to April 2025. Only randomized trials meeting rigorous inclusion criteria, i.e., those that were prospectively registered, used blinded assessment, and provided sample size justification, were included. The findings of these studies suggested that local anesthetic deposition in the costoclavicular space can reliably anesthetize the brachial plexus cords, achieving a high rate of suprascapular nerve blockade, while sparing the diaphragm. The effectiveness of the anesthesia and analgesia provided by this block depends on use of the appropriate local anesthetic volume and concentration. Further research is needed to validate these findings. Nevertheless, the evidence to date indicates that the costoclavicular block is a promising alternative for patients at risk of respiratory insufficiency secondary to hemidiaphragmatic paralysis.

Background: We conducted a multicenter cohort study to evaluate whether preoperative acute hyperglycemia is associated with postoperative adverse cardiac events.

Methods: Data from 10 hospitals were converted to the Observational Medical Outcomes Partnership Common Data Model and analyzed. We extracted the records of 318 119 adult patients who underwent non-cardiac surgery and had available blood glucose measurements less than 24 h before surgery. We defined acute hyperglycemia as at least one fasting blood glucose measurement > 140 mg/dl or random blood glucose level measurement > 180 mg/dl < 24 h before surgery. Risk of adverse cardiac events during the first year after surgery was analyzed.

Results: After 1:2 propensity score matching (PSM), 40 340 patients with acute hyperglycemia and 70 770 patients without hyperglycemia were enrolled. Acute hyperglycemia was associated with an increased risk of adverse cardiac events (hazard ratio [HR], 1.26; 95% CI, 1.16-1.36; P < 0.001). In the subgroup analyses, the young age group (≤ 65 years) had a significantly higher risk (HR, 1.61; 95% CI, 1.40-1.85) than the older age group (HR, 1.13; 95% CI, 1.03-1.25; P for interaction < 0.001). A greater adverse cardiac events risk was observed in patients without hypertension (HR, 1.37; 95% CI, 1.24-1.52) but not in those with hypertension (HR, 1.09; 95% CI, 0.96-1.22; P for interaction = 0.003).

Conclusions: Preoperative acute hyperglycemia was associated with adverse cardiac events during one year of follow up. Further investigation is warranted to determine whether acute glycemic control before non-cardiac surgery could prevent perioperative cardiac complications.

Background: The continuous interscalene brachial plexus block (ISB) is widely used for regional anesthesia in shoulder surgeries. Although the continuous costoclavicular brachial plexus block (CCB) has been proposed, its comparative efficacy and safety remain unclear. This randomized, single-blind trial aimed to determine whether the CCB offers non-inferior postoperative analgesia compared to the ISB while mitigating hemidiaphragmatic paresis (HDP).

Methods: patients underwent rotator cuff repair received continuous ISB or CCB followed by 0.2% ropivacaine infusion postoperatively. The primary outcome was the resting numerical rating scale (NRS) pain score 24 h postoperatively. Secondary outcomes included block-related parameters, dynamic and resting pain scores, HDP incidence, opioid consumption, rescue analgesia requirements, and satisfaction scores.

Results: Resting NRS scores at 24 h demonstrated the non-inferiority of the CCB compared to the ISB (2.41 ± 0.59 vs. 2.00 ± 0.81; mean difference: 0.41; 95% CI: 0.1-0.73). The CCB significantly reduced the incidence of early complete HDP (30 min post-block: 7.3% vs. 41.5%; P < 0.001), with no incidence of complete HDP at 24 h. The CCB had longer block times (19.2 ± 3.7 vs. 17.2 ± 3.6 min; P = 0.013) and sensory onet (24.0 [21.0-24.0] vs. 18.0 [18.0-21.0] min; P < 0.001). Total ropivacaine consumption, rescue analgesia, or satisfaction scores were comparable.

Conclusions: The continuous CCB is non-inferior to the ISB in terms of postoperative analgesia after rotator cuff repair and substantially decreases the risk of HDP. These findings support the CCB as a clinically advantageous alternative for shoulder surgery analgesia.

Background: Sugammadex reverses the effects of steroidal neuromuscular-blocking agents, such as rocuronium, by encapsulating these agents. Its cardiovascular adverse effects include QTc prolongation, hypotension, bradycardia, atrioventricular block, atrial fibrillation, and asystole. Additionally, rocuronium has cardiac side effects, such as bradycardia, hypotension, cardiac arrest, circulatory collapse, and ventricular fibrillation. Herein, we investigated the effects of sugammadex, rocuronium, and combined rocuronium + sugammadex on cardiac electrophysiological parameters.

Methods: In vitro experiments were performed using ventricular myocytes obtained from male Wistar rats. Myocyte contraction and relaxation responses were recorded along with action potential (AP), and L-type calcium (ICaL) and potassium channel currents (Ito, Iss, and IK1).

Results: Sugammadex caused dose-dependent decreases in myocyte contraction and relaxation responses. Rocuronium had no effect in this respect, whereas its co-administration with sugammadex led to decreased contraction responses. Sugammadex prolonged the AP repolarization phase, whereas rocuronium prolonged all AP phases. Co-administration of sugammadex and rocuronium did not significantly affect AP parameters. Sugammadex suppressed the peak ICaL value, while rocuronium caused an even greater decrease. Co-administration of these drugs further decreased the current-voltage characteristics of the ICaL. However, no significant effects were observed on the potassium currents.

Conclusions: Separate or combined administration of sugammadex and rocuronium had various effects on myocyte contractility, AP, and ICaL, which could cause significant changes leading to adverse cardiac events. Further experimental and clinical studies are required to understand the clinical consequences of the modulatory effects of these drugs on cardiac electrophysiological parameters.

Background: Chronic opioid use has become a socioeconomic as well as a medical problem. This study aimed to identify risk factors and develop prediction models for postoperative chronic opioid use (PCOU).

Methods: This retrospective cohort study used data from the Korean National Health Insurance Service (NHIS) between January 2008 and December 2018. Of 2 077 825 patients aged seven years or older who underwent surgery, survived at least one year, and had no additional surgeries, 1 108 119 were randomly selected. Logistic regression (LR) and machine learning models were developed to identify risk factors for PCOU. PCOU was defined as having filled 10 or more prescriptions or receiving more than 120 days' supply between postoperative days 91 and 365. Age, sex, medical comorbidities (systemic diseases, psychological disorders, and substance use disorders), preoperative medications (antidepressants, antipsychotics, anticonvulsants, benzodiazepines, opioids, and nonopioid analgesics), and type of surgery were assessed as potential risk factors.

Results: PCOU occurred in 9308 patients (0.84%). Older age, preoperative history of opioid use, and high in-hospital opioid doses were the three most important predictors. Among the 28 most commonly performed surgical procedures in Korea, lung surgery, general spinal surgery, and total knee arthroplasty were most strongly associated with chronic opioid use.

Conclusions: According to the best-performing gradient boosting model, older age, longer hospital stay, high in-hospital opioid consumption, and preoperative opioid use were the most important risk factors for PCOU.