Korean journal of anesthesiology
-
Korean J Anesthesiol · Dec 2020
ReviewEmergence agitation: current knowledge and unresolved questions.
Emergence agitation (EA), also referred to as emergence delirium, can have clinically significant consequences. The mechanism of EA remains unclear. The proposed risk factors of EA include age, male sex, type of surgery, emergency operation, use of inhalational anesthetics with low blood-gas partition coefficients, long duration of surgery, anticholinergics, premedication with benzodiazepines, voiding urgency, postoperative pain, and the presence of invasive devices. ⋯ However, it is difficult to identify patients at high risk and apply preventive measures in various clinical situations. The risk factors and outcomes of preventive strategies vary with the methodologies of studies and patients assessed. This review discusses important outcomes of research on EA and directions for future research.
-
Korean J Anesthesiol · Dec 2020
ReviewAnesthesia guidelines for COVID-19 patients: a narrative review and appraisal.
The coronavirus disease 2019 (COVID-19) pandemic has challenged health systems globally and prompted the publication of several guidelines. The experiences of our international colleagues should be utilized to protect patients and healthcare workers. The primary aim of this article is to appraise national guidelines for the perioperative anesthetic management of patients with COVID-19 so that they can be enhanced for the management of any resurgence of the epidemic. ⋯ Evidence supporting the recommendations was weak. Early guidelines for the anesthetic management of COVID-19 patients lacked quality and a robust reporting framework. As new evidence emerges, national guidelines should be updated to enhance rigor, clarity, and applicability.
-
Korean J Anesthesiol · Oct 2020
Randomized Controlled Trial Comparative StudyRandomized, controlled trial comparing respiratory and analgesic effects of interscalene, anterior suprascapular, and posterior suprascapular nerve blocks for arthroscopic shoulder surgery.
Interscalene brachial plexus block (ISB) provides excellent analgesia for arthroscopic shoulder surgeries but is associated with adverse effects including hemidiaphragmatic paresis. We aimed to compare the respiratory effects, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) between suprascapular nerve block (SSB) and ISB. ⋯ Anterior SSB preserves lung function and has a comparable analgesic effect as ISB. Thus, it is recommended for arthroscopic shoulder surgeries, especially in patients who have reduced lung function.
-
Korean J Anesthesiol · Oct 2020
Randomized Controlled TrialEvaluation of postoperative pain in patients undergoing modified radical mastectomy with pectoralis or serratus-intercostal fascial plane blocks.
Regional nerve blocks are an integral part of multimodal analgesia and should be chosen based on their efficacy, convenience, and minimal side effects. Here, we compare the use of pectoral (PEC II) and serratus-intercostal fascial plane (SIFP) blocks in breast carcinoma cases undergoing modified radical mastectomy (MRM) in terms of the postoperative analgesic efficacy and shoulder mobility. ⋯ Both SIFP and PEC blocks have comparable dynamic and static pain relief with better shoulder pain scores in patients receiving SIFP.
-
Rebound pain after regional anesthesia can be defined as transient acute postoperative pain that ensues following resolution of sensory blockade, and is clinically significant, either with regard to the intensity of pain or the impact on psychological well-being, quality of recovery, and activities of daily living. Current evidence suggests that it represents an unmasking of the expected nociceptive response in the absence of adequate systemic analgesia, rather than an exaggerated hyperalgesic phenomenon induced by local anesthetic neural blockade. ⋯ Strategies to mitigate the impact of rebound pain include routine prescribing of a systemic multimodal analgesic regimen, as well as patient education on appropriate expectations regarding block offset and expected surgical pain, and timely initiation of analgesic medication. Prolonging the duration of action of regional anesthesia with continuous catheter techniques or local anesthetic adjuncts may also help alleviate rebound pain, although further research is required to confirm this.