Korean Journal of Anesthesiology最新文献

Background: Acute exacerbation of interstitial pneumonia (AE-IP) is associated with high mortality rates. Although the risk factors for AE-IP have been extensively studied, given the small sample sizes, only a few risk factors have been established. This study aimed to investigate the postoperative mortality and factors associated with AE-IP.

Methods: This retrospective study included 482 patients with a preoperative diagnosis of IP who underwent noncardiac surgery between December 2012 and April 2020. AE-IP was diagnosed by a radiologist using computed tomography when worsening respiratory symptoms were observed within 1 month postoperatively. The Cox proportional hazards model was used to compare mortality rates. Candidate factors associated with AE-IP were identified through logistic regression analysis using the variable selection method, followed by case-control analysis using propensity score matching to determine possible factors associated with AE-IP.

Results: The multivariable-adjusted hazard ratios for all-cause and IP-related deaths were significantly higher in patients with AE-IP than in those without AE-IP. Multivariable analysis with variable selection suggested that male sex, higher C-reactive protein (CRP) levels, fraction of inspired oxygen (FiO2) ≥ 60%, and non-lung surgery were candidate factors associated with AE-IP. Case-control analysis using propensity score matching demonstrated that patients with AE-IP had higher CRP levels (P = 0.044) and frequency of FiO2 ≥ 60% (P = 0.035) than those without AE-IP. Furthermore, a positive, nearly linear relationship was observed between FiO2 ≥ 60% duration and AE-IP incidence.

Conclusions: Intraoperative management with FiO2 ≥ 60% and high preoperative CRP levels were significantly associated with postoperative AE-IP.

Background: Predicting fatal neurological complications after clipping surgery for unruptured intracranial aneurysms (UIAs) is crucial; however, existing scoring systems are limited by narrow consideration of factors. We aimed to develop and validate a comprehensive risk stratification scoring system that incorporates patient-, aneurysm-, and operation-specific variables for predicting postoperative neurological complications in UIA surgeries.

Methods: This multi-center retrospective cohort study was conducted from September 2018 to October 2023. Patients undergoing clipping surgery for UIAs were divided into development and validation sets based on the treating institution. A predictive score for postoperative neurological complications was developed from a multivariate logistic regression analysis. The score, named NEURO, that incorporates variables like previous neurological disease, categorized aneurysm location and size, categorized operation time, and transfusion was validated externally.

Results: The study included 2847 patients, with 1547 and 1300 in the development and validation sets, based on the institution of surgery, respectively. The incidence of neurological complications was 5.7% (88/1547) and 5.6% (73/1300) in the development and validation sets, respectively. The NEURO score showed good predictive ability with C-statistics of 0.720 (95% CI [0.667-0.776]) in the development set and 0.693 (95% CI [0.631-0.754]) in the validation set, demonstrating good calibration across the predicted probability range.

Conclusions: The NEURO score, integrating multiple perioperative variables, may effectively predict the risk of neurological complications post UIA clipping surgery, aiding in identifying high-risk patients. This tool could enhance clinical decision-making and patient management in neurosurgical practice.

Background: The association between preoperative anemia and postoperative delirium (POD) is unclear. We sought to evaluate the effect of preoperative anemia on the risk of POD in elderly patients after non-cardiac surgery.

Methods: We retrospectively analyzed 62 600 patients aged over 60 years undergoing non-cardiac surgery between January 2011 and June 2019. The patients were divided into two groups according to the presence of preoperative anemia defined as hemoglobin < 13 g/dl for men and < 12 g/dl for women. Anemia was further categorized into mild or moderate-to-severe anemia based on a cutoff of 11 g/dl. The primary outcome was POD within 7 days after surgery. The secondary outcomes included one- and three-year mortality after surgery. The inverse probability of treatment weighting (IPTW) method was used to adjust for confounders between the two groups.

Results: The overall incidence of POD was 3.9% (2447/62 600) within 7 days after surgery. After IPTW, preoperative anemia was significantly associated with increased risk of POD (odds ratio [OR]: 1.42, 95% CI [1.30-1.55], P < 0.001). Also, the risk of POD increased with the severity of anemia (OR: 1.32, 95% CI [1.18-1.47], P < 0.001 for mild anemia; and OR: 1.70, 95% CI [1.50-1.93], P < 0.001 for moderate-to-severe anemia). This association was similar for one- and three-year mortality.

Conclusions: Preoperative anemia was associated with an increased risk of POD in elderly patients after non-cardiac surgery. Further investigations are required to verify whether preoperative anemia is a modifiable risk factor for POD.

Background: As ultrasound imaging technology matured, stellate ganglion blocks (SGBs) have become increasingly precise and safe, and their use in clinical practice has become widespread. However, the 90% minimum effective volume (MEV90) and concentration (MEC90) of lidocaine for ultrasound-guided SGB remain unclear. We aimed to determine the MEV90 and MEC90 of lidocaine used in ultrasound-guided SGBs.

Methods: Patients with indications for an SGB were recruited, without restrictions on sex or disease type. In this two-part study, we first determined the MEV90, and then used these results to determine the MEC90. The MEV90 and MEC90 of lidocaine for each subsequent patient were determined based on the previous patient's response, using a biased-coin design, up-and-down sequential allocation trial. The lidocaine volume and concentration intervals were 0.2 ml and 0.1%, respectively.

Results: In total, 110 patients were enrolled (58 and 52 patients in the MEV90 and MEC90 studies, respectively). The MEV90 for 1% lidocaine was found to be 3.83 ml (95% CI [3.19-3.91]) and the extrapolated MEV99 was 3.97 ml (95% CI [3.95-5.29]). The MEC90 for lidocaine (4.0 ml) was found to be 0.38% (95% CI [0.32-0.41]) and the extrapolated MEC99 was 0.47% (95% CI [0.46-2.55]). Four patients in this study developed hoarseness, but no serious adverse events occurred.

Conclusions: For ultrasound-guided SGB in adults, we have determined the MEV90 of 1% lidocaine as 3.83 ml, and identified the MEC90 of 4 ml of lidocaine as 0.38%.

This narrative review explores multimodal prehabilitation, a patient-centered, evidence-based, and multidisciplinary approach to enhance postoperative recovery. It shifts the focus from traditional intraoperative and postoperative care to a comprehensive process beginning at diagnosis. Multimodal prehabilitation integrates exercise, nutrition, and psychological strategies to improve preoperative functional capacity and physiological reserve, enabling better management of surgical stress. The review examines prehabilitation's clinical efficacy, highlighting enhanced functional capacity as a key outcome. It details prehabilitation components: exercise (aerobic, resistance, and respiratory muscle training), nutritional optimization targeting modifiable risk factors such as malnutrition and sarcopenia, and psychological support to lower anxiety and boost patient motivation and adherence. Individualized approaches are emphasized due to significant patient variability. This review also presents a successful multimodal prehabilitation program implemented at the Montreal General Hospital, which has a strong track record in this area. The program is structured around four key phases: screening, assessment, intervention, and follow-up. It also discusses the barriers to implementation and the roles of stakeholders, including the government, hospitals, healthcare professionals, and patients and their families, within the context of South Korea's unique healthcare system and socio-cultural environment.

Repeated measures analysis of variance (RM-ANOVA) is a specialized form of analysis of variance used for analyzing data involving repeated measurements, such as longitudinal data commonly encountered in anesthesia and pain medicine research. When data are collected at multiple time points across more than one group, RM-ANOVA evaluates the between-subject (group) effect, within-subject (time) effect, and interaction between these two factors. The group-by-time interaction effect indicates whether changes in an outcome variable over the study period differ among groups. Analyzing interaction contrasts between specific time points is particularly useful for identifying intervals where this interaction effect is significant. For instance, if an outcome variable is measured at multiple time points in two groups, the interaction contrast for any two time points represents the difference between the change in the outcome variable over that interval in one group and the corresponding change in the other group. An independent two-sample Student's t-test can then compare these differences to determine the statistical significance of the group-by-time interaction for the selected time points. Thus, incorporating interaction contrast analysis into RM-ANOVA enhances the interpretation of longitudinal data by pinpointing specific time intervals where significant interactions occur.