Jeong-Rim Lee

Background: Ex-premature infants have a high risk of postoperative apnea and bradycardia. This study aimed to develop a predictive model for postoperative desaturation and bradycardia in infants who underwent laparoscopic inguinal hernia repair (IHR) under general anesthesia based on identified risk factors.Methods: The retrospective cohort included infants who underwent laparoscopic IHR under general anesthesia at Severance Hospital in Korea between February 2013 and September 2019. Collected data included sex, gestational age (GA), postnatal age and post-conceptual age at surgery, birth weight, body weight at surgery, medical history and comorbidities, urgency of surgery, preoperative hemoglobin, anesthetic agents used, operation time, anesthesia time, intraoperative opioid dose, length of hospital stay, operation to discharge time, and postoperative ward. Feature selection was applied, and a machine learning model was developed to predict postoperative desaturation and bradycardia.Results: Three features for desaturation (cardiac comorbidities, GA, and body weight at surgery) and two features for bradycardia (GA and cardiac comorbidities) were selected for multivariate logistic regression analysis. Cardiac comorbidities were the most significant predictor for desaturation and bradycardia with odds ratios (95% confidence intervals) of 5.112 (1.881–13.888) and 26.597 (3.190–221.850), respectively.Conclusions: Preterm infants with cardiac comorbidities and lower GA may be more susceptible to postoperative desaturation or bradycardia.

Background: Intravenous (IV) administration of dexamethasone has been reported to prolong the analgesic duration of a caudal block. The aim of this study was to compare the analgesic effects of IV low-dose and high-dose dexamethasone in pediatric patients undergoing orchiopexy.Methods: In this randomized controlled trial, 273 children aged 6 months to 6 years who underwent orchiopexy under general anesthesia with a caudal block at Severance Hospital (Seoul, South Korea) were assigned to receive either low-dose dexamethasone (0.15 mg/kg, Group L) or high-dose dexamethasone (0.5 mg/kg, Group H) during general anesthesia. Parents were trained to assess postoperative pain using the Face, Legs, Activity, Cry, Consolability (FLACC) scale and instructed to administer analgesics when the pain score was 4 or higher. The primary outcome was the need for additional analgesics within 48 h postoperatively in both groups. Secondary outcomes included the time to first analgesic administration, postoperative pain scores, incidence of nausea or vomiting, parental assessment of postoperative pain, and overall parental satisfaction.Results: The proportion of patients requiring additional analgesics did not differ significantly between the groups (41.5% in Group H vs. 49.2% in Group L, odds ratio 1.37; 95% confidence interval, 0.83–2.27; P = 0.22). No significant differences were observed in secondary outcomes.Conclusions: Although no significant differences in analgesic effect were observed between low- and high-dose dexamethasone groups, the noninferiority of low-dose could not be conclusively demonstrated.

Burnout is a widespread occupational issue in the medical field, posing significant risks to both physician health and patient care worldwide. While the COVID-19 pandemic highlighted the impact of systemic factors—such as excessive workloads, administrative burdens, and inefficiencies—in exacerbating physician burnout, discussions about well-being remain limited in South Korea. Given the recent challenges faced by healthcare professionals in Korea, addressing burnout has become urgent to prevent further negative outcomes. Although individual efforts toward wellness are important, they are insufficient without systemic support. Distinguishing between burnout and well-being is crucial for developing targeted interventions. Drawing on global examples, comprehensive strategies—including policy reforms, organizational support, mental health resources, and cultural shifts—are recommended to create a sustainable and supportive environment for anesthesiologists in Korea.

Background: General anesthesia is inevitable for pediatric patients undergoing surgery, though volatile anesthetic agents may cause neuroinflammation and neurodevelopmental impairment; however, the underlying pathophysiology remains unclear. We aimed to investigate the neuroinflammation mechanism in developing rat brains associated with sevoflurane exposure time, by identifying the specific damage-associated molecular patterns (DAMPs) pathway and evaluating the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in alleviating neuroinflammation.Methods: A three-step experiment was conducted to investigate neuroinflammation induced by sevoflurane. First, the exposure time required for sevoflurane to cause neuroinflammation was determined. Next, the specific pathways of DAMPs involved in neuroinflammation by sevoflurane were identified. Finally, the effects of NSAIDs on sevoflurane-induced neuroinflammation were investigated. The expression of various molecules in the rat brain were assessed using immunohistochemistry, immunofluorescence, quantitative real-time polymerase chain reaction, western blot analysis, and enzyme-linked immunosorbent assay.Results: In total, 112 rats (aged 7 days) were used, of which six rats expired during the experiment (mortality rate, 5.3%). Expression of CD68, HMGB-1, galectin-3, TLR4, TLR9, and phosphorylated NF-κB was significantly increased upon 6 h of sevoflurane exposure. Conversely, transcriptional levels of TNF-α and IL-6 significantly increased and IFN-γ significantly decreased after 6 h of sevoflurane exposure. Co-administration of NSAIDs with sevoflurane anesthesia significantly attenuated TNF-α and IL-6 levels and restored IFN-γ levels.Conclusions: In conclusion, 6 h of sevoflurane exposure induces neuroinflammation through the DAMPs pathway, HMGB-1, and galectin-3. Co-administration of ibuprofen reduced sevoflurane-induced neuroinflammation.

Background: The administration of intravenous dexamethasone increases the duration of neuraxial block and improves the quality of analgesia. However, little is known about these effects of dexamethasone on peripheral nerve blocks in children.Aims: In this study, we aimed to investigate the benefit of intravenous dexamethasone for enhancing the effect of pudendal block on postoperative analgesia in children who underwent hypospadias surgery.Methods: In total, 46 children aged 6–36 months who underwent hypospadias surgery were randomly allocated to either a control group (normal saline, group C) or dexamethasone group (0.5 mg/kg, group D). Pudendal block was performed before the surgery using 0.3 mL/kg of 0.225% ropivacaine on both sides. Parents were instructed to press the patient‐controlled analgesia bolus button when their children's pain score was >4 points. The primary outcome measure was the time at which the first patient‐controlled analgesia by proxy bolus dose was administered. The secondary outcome measures were pain score, number of patient‐controlled analgesia administration by proxy bolus attempts, number of rescue analgesics required, total amount of fentanyl administered, and overall parental satisfaction.Results: The time of first patient‐controlled analgesia bolus administration by proxy was not different between the control and dexamethasone groups (5.6 [5.2, 8.8] h versus 6.5 [5.4, 8.1] h, hazard ratio 0.8, 95% confidence intervals 0.43 to 1.47, p = .46). There were no statistically significant differences among the secondary outcomes.Conclusions: Administration of intravenous dexamethasone did not enhance the duration of pudendal nerve block in infants and children aged 6–36 months who underwent hypospadias surgery.

The dose of propofol for pediatric sedation during radiologic tests has been proposed as an equation of 0.75 + 0.14 × age (months) + 45.82 × body surface area (m²) based on results in a previous study. We compared this equation and the conventional dosing strategy for sedation in children undergoing radiologic tests. An amount of 180 children scheduled for magnetic resonance imaging (MRI) were randomized to experimental and control groups. The initial induction dose of propofol calculated using the equation was administered in the experimental group. In the control group, children received 1 mg/kg of the initial induction dose of propofol. Then, 0.5 mg/kg of the additional dose was followed to induce sedation in both groups. When awake or moving, a rescue injection of 0.5 mg/kg propofol was given. The total induction dose was more significant in the experimental group. The number of injections for induction in the experimental group was lesser. The dose and number of rescue injections in the experimental group were significantly less. The equation for the induction dose of propofol in a previous study could achieve quick induction of sedation and prevent a rescue injection during sedation. However, caution is needed when using the equation.

In our previous research showed that tramadol having potential anti-tumor effect was associated with enhancement of oncological prognosis in patients with breast cancer surgery. As these effects have not been confirmed by clinical dose-regulated animal or prospective human studies, we investigated the anti-tumor effect of tramadol in vivo. Female nude mice orthotopically inoculated with luciferase-expressing MCF-7 cells, were randomly divided into the control (saline), tramadol group 1 (1.5 mg kg⁻¹ day⁻¹), tramadol group 2 (3 mg kg⁻¹ day⁻¹), and morphine (0.5 mg kg⁻¹ day⁻¹) (n = 5/group). Bioluminescence signals after D-luciferin injection, tumor size, and tumor weight were compared among groups after 4 weeks. Estrogen receptor (ER), progesterone receptor (PR), and transient receptor potential vanilloid (TRPV)-1 expression, natural killer (NK) cell activity, and serum interleukin (IL)-1β, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and interleukin (IL)-6 were then examined. Tumour growth was attenuated in tramadol-treated groups (P < 0.05). NK cell activity was significantly decreased only in the morphine treated group not in sham, control, and tramadol groups. The expression levels of ERα, PRα and β, and TRPV1 were decreased in tramadol group 2 compared with those in the morphine group, but not compared to the control group. Serum levels of IL-6 and TNFα were reduced in both tramadol-treated group 1 and 2 compared to the control group. Overall, clinical dose of tramadol has anti-tumour effects on MCF-7 cell-derived breast cancer in a xenograft mouse model.

Background Although a neuromuscular blocking agent during induction of anesthesia is the standard of care in adults, some pediatric anesthesiologists remain concerned about their use for several reasons. Therefore, propofol and short-acting opioids with a moderate concentration of sevoflurane have been used as alternatives to a neuromuscular blocking agent. Aims This study compared propofol, alfentanil, and rocuronium to determine the optimal anesthetic agent for intubation conditions as well as emergence in a short pediatric procedure. Methods In this prospective, randomized, double-blind study, 114 pediatric patients, aged 1–9 years, were randomly assigned to one of three groups receiving either propofol 2 mg kg⁻¹ (propofol group), alfentanil 14 mcg kg⁻¹ (alfentanil group), or rocuronium 0.3 mg kg⁻¹ (rocuronium group). The primary outcome was intubating conditions, which were evaluated 90 s after test drug administration. Vital signs were recorded during the intubation period. Complications during and after emergence, time to recovery, airway-related complications, and severity of emergence agitation were recorded. Results Compared with the propofol group (60%), significantly more excellent intubating conditions were observed in the alfentanil group (97%, percent difference −37, 95% confidence interval (CI) −54.4-−21.0, p < .001) and the rocuronium group (87%, percent difference −27, 95% CI −46.5-−8.2, p = .041). Hemodynamic responses were different between the rocuronium and alfentanil groups, although the incidence of adverse events was not different among the three groups. The emergence duration was only statistically different between the rocuronium group [9.9 ± 3.2 min] and the propofol group [11.7 ± 2.2 min] (difference 95% CI 0.667-3.583, p = .001), while that of the alfentanil group [10.9 ± 2.4 min] was comparable with the other groups. Conclusions Both 0.3 mg kg⁻¹ rocuronium and 14 µg kg⁻¹ alfentanil are superior adjuncts for tracheal intubation in children undergoing frenulectomy in comparison with 2 mg kg⁻¹ propofol. Hemodynamic adverse events and recovery profiles were comparable among the three groups.