Cheolhyeong Lee

Background: The coronavirus disease 2019 (COVID-19) pandemic has profoundly influenced surgical practice and perioperative care, but its impact on postoperative pneumonia incidence remains unclear.Methods: We conducted a retrospective cohort study using the Observational Medical Outcomes Partnership–Common Data Model databases from 17 Korean hospitals. Based on the inpatient surgery date, patients were classified into prepandemic (January 2018–December 2019) and postpandemic groups (January 2020–December 2021). Postoperative pneumonia was identified within 30 days after surgery. Logistic regression analysis assessed the independent effects of the pandemic, age, anesthetic technique, and their interaction.Results: The overall incidence of postoperative pneumonia per 10,000 persons changed slightly from 12.38 prepandemic to 12.99 postpandemic (+4.94%). Younger patients (< 70 years) demonstrated decreased incidence (8.47→7.97, −5.81%), whereas older patients (≥ 70 years) demonstrated increased incidence (28.97→31.97, +10.36%). Considerable interhospital variation was observed, with some hospitals reporting increases exceeding 100%, while others reporting declines exceeding 80%. Overall postoperative pneumonia risk was similar between the pre- and postpandemic periods (odds ratio [OR], 0.893; 95% confidence interval [CI], 0.787–1.015). Older age (≥ 70 years) was strongly associated with higher risk (OR, 2.816; 95% CI, 2.383–3.328), and a significant postpandemic×age interaction indicated that older patients were disproportionately affected (OR, 1.385; 95% CI, 1.145–1.675).Conclusions: The COVID-19 pandemic did not substantially change the overall incidence of postoperative pneumonia, although variations existed across hospitals and age groups. Older age remained the strongest risk factor. Further studies are warranted to clarify the underlying causes and optimize perioperative infection control.

Background and Objectives: Elderly patients frequently receive antiplatelet therapy, creating a clinical dilemma between bleeding risk and cardiovascular protection during surgery. We evaluated the association between preoperative antiplatelet therapy and postoperative bleeding and cardiovascular events using multicenter observational data. Materials and Methods: We conducted a retrospective cohort study using standardized OMOP-CDM databases from 10 tertiary hospitals. Patients aged ≥65 years undergoing surgery were classified by preoperative aspirin or clopidogrel exposure. Propensity score matching was performed within each site. Hazard ratios (HRs) were estimated using Cox regression and pooled using meta-analytic techniques. Results: A total of 1464 exposed patients and 7038 matched comparators were analyzed. Across sites, hazard ratios varied without a statistically significant pooled association. The pooled HR for postoperative events was 1.01 (95% CI 0.57–1.78, p = 0.967). Covariate balance improved substantially after matching. Conclusions: Preoperative antiplatelet therapy was not associated with a consistent increase in postoperative bleeding or cardiovascular events in elderly surgical patients. These findings support individualized perioperative management rather than routine discontinuation.

Background and Objectives: The analgesia/nociception index (ANI) potentially monitors nociceptive status during anesthesia, but its link to preoperative pain sensitivity is unclear. We investigated the relationship between pre-anesthetic ANI scores and propofol injection pain (PIP) in patients receiving remifentanil. Materials and Methods: This study included 124 male patients aged 19–60 undergoing general anesthesia (ASA class I or II). Patients were randomized to group R (n = 62, remifentanil 4 ng/mL) or group C (n = 62, saline). The primary outcome was the association between PIP and ANI. Secondary outcomes included the incidence and severity of PIP or rocuronium-induced withdrawal movement (RIWM) and their association with ANI. Results: PIP and RIWM incidence and severity were lower in group R than in group C. A weak negative correlation between PIP and ANI at pre-induction (r_pb = −0.21, p = 0.02, r_pb = −0.37, p < 0.01) and a moderate negative correlation during propofol injection (r_pb = −0.48, p = 0.02) were observed. A significant negative correlation was found between RIWM and ANI during rocuronium injection (τb = −0.61, p < 0.01). AUC, cut-off value, specificity, and sensitivity in ANI at pre-induction for predicting PIP were 0.67 (p = 0.02), 59, 76%, and 55%, respectively. AUC, cut-off value, specificity, and sensitivity in ANI during propofol injection for PIP were 0.77 (p < 0.01), 65, 81%, and 67%, respectively. Conclusions: ANI scores demonstrated significant differences between groups, suggesting potential predictive value for PIP despite the low pre-induction AUC value. This study highlights the potential of using ANI scores to predict and manage PIP in patients receiving remifentanil.

Cheol-Hyeong Lee, Eun Young Lee, Miyoung Yang, Hyung-Sun Won, and Yeon-Dong Kim. Korean J Pain 2023;36:458-64. https://doi.org/10.3344/kjp.23204

Background and objectives: Anesthesia maintenance agents affect the incidence of postoperative shivering (PS) after general anesthesia. This study compared the effects of remimazolam with sevoflurane on PS in patients undergoing laparoscopic gynecologic surgery under general anesthesia. Materials and methods: Seventy-four patients were allocated into one of two groups. In anesthesia maintenance, group S received sevoflurane and remifentanil, and group R received remimazolam and remifentanil. Results: The incidence and severity of postoperative shivering, mean arterial pressure (MAP), heart rate (HR), core body temperature, and the association of PS with hypothermia, MAP, or HR in the post-anesthesia care unit (PACU) were measured. Group R had significantly lower rates of perioperative hypothermia (58.8 vs. 27.8%, p = 0.009) and postoperative shivering (41.2 vs. 19.4%, p = 0.047). The severity of PS was also lower in group R than in group S (p = 0.034). Core body temperature was significantly higher in group R than in group S from 10 min after induction (p = 0.047) to the PACU (p = 0.009). MAP and HR were significantly higher in group R than in group S from 20 min after induction (p = 0.047) to the PACU (p = 0.009). In group S, the correlation between the severity of PS and the incidence of hypothermia (φc = 0.414, p = 0.121) was moderate but not significant. In group R, the correlation between PS severity and hypothermia (φc = 0.418, p = 0.043) was moderate and significant. Conclusions: Remimazolam showed better results than sevoflurane in anesthesia maintenance regarding hypothermia and PS.

Background and Objectives: Different types of anesthetics affect thermoregulatory mechanisms, such as the redistribution of body temperature, loss of skin heat, or inhibition of thermoregulatory vasoconstriction. Therefore, we compared remimazolam with propofol in terms of core body temperature in patients undergoing robotic-assisted and laparoscopic radical prostatectomy. Materials and methods: Ninety patients were randomly assigned to either the propofol–remifentanil (PR) group or the remimazolam–remifentanil (RR) group. The PR group (n = 45) received effect-site concentrations of 6.0 μg/mL of propofol and 4 ng/mL of remifentanil, followed by 0.9 mg/kg of 1% rocuronium and maintenance with effect-site concentrations of 2–4 μg/mL of propofol and 3 ng/mL of remifentanil. The RR group (n = 45) received remimazolam 6 mg/kg/h by continuous intravenous infusion and the effect-site concentration of 4 ng/mL of remifentanil, followed by 0.9 mg/kg of 1% rocuronium, remimazolam 1–3 mg/kg/h, and remifentanil 3 ng/mL. The primary outcome was core body temperature, and secondary outcomes included vasoconstriction threshold (°C) and time to onset of vasoconstriction (min). Results: The core body temperature in the RR group was significantly higher at 60, 80, 100, 120, 140, 160, and 180 min after induction than in the PR group (p < 0.01). The vasoconstriction threshold was significantly higher in the RR group (35.2 ± 0.4) than in the PR group (34.8 ± 0.3) (p < 0.01). The time to onset of vasoconstriction was significantly less in the RR group (150.5 ± 10.2) than in the PR group (158.5 ± 8.4) (p < 0.01). However, the incidence of intraoperative hypothermia was not significant between two groups. Conclusions: Remimazolam appears to reduce vasoconstriction threshold less than and had a faster onset of vasoconstriction, resulting in superior thermoregulatory control.

Cheol-Hyeong Lee, Ho-Yeon Jang, Hyung-Sun Won, Ja-Sook Kim, and Yeon-Dong Kim. Korean J Pain 2021;34:332-8. https://doi.org/10.3344/kjp.2021.34.3.332