BACKGROUND: This study aimed to identify the directions of research published in the Korean Journal of Anesthesiology (KJA) and identify the main topics and journal network through a bibliometric analysis. The results can be reflected in strategies for the journal's promotion to a top-ranking journal in the anesthesiology category. METHODS: KJA articles from January 1, 2017 to September 11, 2022 were retrieved from the Web of Science Core Collection on September 11, 2022, and analyzed using Biblioshiny. Journal metrics, the document network, the conceptual structure, and social structures were elucidated. RESULTS: Out of 525 articles, fewer than half (48.6%) were from Korean corresponding authors. The impact factor steeply increased from 2.316 in 2019 to 5.167 in 2021. The Hirsch index of KJA was 24. A co-occurrence network of Keywords Plus showed four clusters of central keywords: surgery, management, anesthesia, and mortality. The conceptual structure map of Keywords Plus showed a main cluster of anesthesia and analgesia, while another minor cluster included intubation and induction. The co-citation network demonstrated that KJA was in the same cluster of anesthesiology journals. The collaboration network of the authors' countries showed that Korean authors collaborated mainly with researchers in the United States and Canada. CONCLUSIONS: These results show KJA's developmental process of promotion to a top-tier journal in the anesthesiology category. Furthermore, the following strategies are suggested for journal promotion: recruitment of articles on emerging and highly citable topics; and more active collaboration of society members with researchers worldwide.
BACKGROUND\nKorean Journal of Anesthesiology was published in 1968 and its volume has been increased every year. The purpose of this study was to investigate and to clarify the trend of increasing volumes for 28 years (1968~1996) as quantitative analysis.\nMETHODS\nUsing computerized index of Korean Journal of Anesthesiology ("ART"), the trend, volumes and cumulative records (top ranked 22 frequently cited key words, 16 persons and 10 departments of University) were calculated. Some key words such as "Anesthetic techniques: spinal, Anesthetics, intravenous:, Anesthetics, volatile: halothane, Complications:" was traced every year for grasping the trend of academic concerns.\nRESULTS\n1. Total volumes of articles were about 3,000 (1968~1996). The volumes were increased slowly until 1976 and steeply since 1986. 2. The ratio of clinical case reports has been decreased every year. 3. Key words "Anesthetic techniques", "Surgery" and "Complications" were more frequently cited than the others. 4. Tracing some key words showed their vitality in anesthetic fields. 5. The personal top ranked number of records revealed each author's contribution to Korean Journal of Anesthesiology and the number of records in each department of University could be used as an index of academic activity.\nCONCLUSIONS\nThe extent of the increasing volumes was great especially from 1986 to 1996 and the proportion of original articles has been increased every year. The frequency of the investigated key words showed their own vitality in the field of anesthesiology. The rank according to personal and departmental records suggested the possibility of reflecting a measure of academic concerns and activity.
We evaluated whether there has been an improvement in the quality of randomized controlled trial (RCT) abstracts in the Korean Journal of Anesthesiology (KJA) after the publication of the CONSORT abstract guidelines in 2008. All RCT abstracts published in 2006 and in 2012 were selected as pre-CONSORT and post-CONSORT abstracts, respectively. From the retrieved articles, 102 human RCT abstracts were selected as a pre-CONSORT abstract and 52 were selected as a post-CONSORT abstract. Two reviewers scored every individual item as '0' if the abstract does not adhere to the criteria recommended in the CONSORT abstract statement and scored individual items as '1' if the information suggested by the CONSORT statement was described followed. The k-statistic test demonstrated high agreement between the reviewers (k = 0.914, 95% confidence interval [CI]: 0.878, 0.95]). We compared the frequencies of each item in the abstracts of the pre-CONSORT and post-CONSORT pe-riods using z-tests with Yates correction. More than 90% of the articles from the pre-CONSORT sample group described the five checklist items of intervention (96.1%), objective (95.1%), method-outcome (95.1%), results-outcome (96.1%) and conclusions (100%). With the above-mentioned five checklists, the "randomization" of other sub-items was found in 92.3% of the RCT abstracts in the post-CONSORT sample group, whereas the title, the number of patients analyzed, the harmful effects, and the funding source were noted in less than 20% of the abstracts in both the pre-and post-CONSORT eras. The significant improvement from the pre-era to the post-era samples was related to the trial design, randomization, blinding, and number randomization at a rate increasing from 0 to 53.8% (P < 0.001), from 71.6 to 92.3% (P = 0.006), from 7.8 to 21.2% (P = 0.033) and from 33.3 to 78.8% (P < 0.001), respectively. We calculated the proportion of items which complied with the CONSORT abstract checklist. The mean proportions were 41.7 and 53.0% in the pre-and post-CONSORT period, respectively (P < 0.001, 95% CI for difference: -0.155, -0.071). Absolute points increased significantly at a rate of 11.3% over time (P < 0.001). CONSORT for abstracts aims to improve the reporting accuracy and quality of trial reports and recommends what information should be reported in the constraints when describing a RCT. The results of this article suggest that the reporting quality of RCT abstracts of KJA published in the post-CONSORT period improved, but the quality did not reach the expected level according to the recommendations for reported abstracts. The rate of fulfillment was low, at 41.7%, among pre-CONSORT
BACKGROUND: Trial sequential analysis (TSA) is a recent cumulative meta-analysis method used to weigh type I and II errors and to estimate when the effect is large enough to be unaffected by further studies. The aim of this study was to illustrate possible TSA scenarios and their significance using meta-analyses published in the Korean Journal of Anesthesiology as working material. METHODS: We performed a systematic medical literature search for meta-analyses published in the Korean Journal of Anesthesiology. TSA was performed on each main outcome, estimating the required sample size on the calculated effect size for the intervention, considering a type I error of 5% and a power of 90% or 99%. RESULTS: Six meta-analyses with a total of ten main outcomes were included in the analysis. Seven TSAs confirmed the results of the meta-analyses. However, only three of them reached the required sample size. In the two TSAs, the cumulative z-lines were not statistically significant. One TSA boundary for effect was reached with the 90% analysis, but not with the 99% analysis. CONCLUSIONS: In TSA, a meta-analysis pooled effect may be established to assess if the cumulative sample size is large enough. TSA can be used to add strength to the conclusions of meta-analyses; however, pre-registration of the TSA protocol is of paramount importance. This study could be useful to better understand the use of TSA as an additional statistical tool to improve meta-analysis quality.
Background : Statistical type II error has seemed to be ignored commonly by medical researchers. To control and present a power value could be helpful to reduce this type of error and to improve a quality of scientific decision making. We performed the post-hoc survey of the power of the negative results in Korean Journal of Anesthesiology (KJA). Methods : One Hundred nineteen articles with negative results published in KJA during a year of 1997 were selected. We collected the numbers of the sample size and calculated the power of the given negative result only when applicable. And each author's attitude to negative results was taken by arbitrary criteria. Results : Median sample size of these negative results was 16 12 (median interquartile range). We can calculate the power only in 43 articles of 119 negative results. Median power is 18.0% (interquartile range 26.0). In thirty six articles (83.8% of 43) the powers are proved to be under 80.0%. And 22 articles (51.2% of 43) have the powers even under 20.0%. We couldn't find any author who included either power or effect size in the article, and there was only one article in which its authors considered their inadequate number of sample size. Conclusions : We conclude that authors of KJA tend to ignore statistical type II error. In 119 negative results published in KJA during 1997, the calculated powers were very low and were not reported in the text. (Korean J Anesthesiol 1999; 36: 286∼292)
Malignant hyperthermia (MH) is a disorder of the skeletal muscle manifested as a life threatening hypermetabolic crisis in susceptible individuals following exposure to inhalation anesthetics and depolarizing muscle relaxants. The gold standard for determination of MH susceptibility is the in vitro contracture test (IVCT). However, it is invasive, requiring skeletal muscle biopsy and is not widely available. We attempted to reevaluate the MH in Korea using a Clinical Grading Scale (CGS) developed by Larach and colleagues to assist in clinical diagnosis. We intend to study CGS as a standardized means for estimating the qualitative likelihood of MH and establishing a Korean MH registry system. Methods: We obtained twenty-seven case reports from the Korean Journal of Anesthesiology and applied a CGS developed by Larach and colleagues. The raw score of each case was obtained by scoring rules for the MH clinical grading scale, translated to a MH rank, and ranked by the MH likelihood. Results: The overall mortality rate of reported MH was 44.4%. We described for MH rank and likelihood by CGS of cases. The CGS was missing a process in 13 cases for process II, 5 cases for process III and 4 cases for others. Conclusions: MH CGS is useful to aid the objective definition of this disease and for establishing a national registry system.
The Korean Journal of Anesthesiology (KJA) is beginning EPUB ahead of print (EAOP). EPUB has become a lion in scientific journals. Since the KJA steering committee adopted online publication in 2010, we have published 11 volumes and 3 issues using the traditional "paper publication first, followed by online publication" approach. As an indicator of the low efficiency of that strategy, the publication lag of the KJA has become so long that we have been obliged to consider reform. While the rejection speed is adequate (Table We believe that EAOP will increase the publication speed.
Repeated-measures analysis of variance (RMANOVA) continues to be used widely for the analysis of repeated-measures data in anesthetic research. RMANOVA, like other parametric statistical tests, specifies several assumptions and requires specific description in publications. A recent article in the Korean Journal of Anesthesiology (KJA) provided valid information on RMANOVA [1].
A journal article is a comprehensive account of a theoretical argument or proof of reproducible experimental results and statistical analyses conducted in accordance with the appropriate procedure and form. However, no matter how well written the article is, its value cannot be gauged without a reader (who peruses it), and other subsequent researchers who cite it (to maintain and protract its lifespan).
Back to table of contents Previous article Next article CommentaryFull AccessMental Health Response to the COVID-19 Outbreak in ChinaJunying Zhou, M.D., Ph.D., Liu Liu, M.D., Pei Xue, M.D., Xiaorong Yang, B.N., Xiangdong Tang, M.D., Ph.D.Junying Zhou, M.D., Ph.D., Liu Liu, M.D., Pei Xue, M.D., Xiaorong Yang, B.N., Xiangdong Tang, M.D., Ph.D.Published Online:7 May 2020https://doi.org/10.1176/appi.ajp.2020.20030304AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Transmission of the 2019 novel coronavirus (COVID-19) (1) has now widely and rapidly spread around the world. On March 11, 2020, the World Health Organization announced that COVID-19 is a pandemic (2). The rapid transmission and mortality risk of the COVID-19 infection may increase the risk of mental health problems among healthy individuals in the general public and worsen preexisting psychiatric problems in psychiatric patients, although data are still being gathered. A constellation of difficult feelings and psychological distress, including panic, worries, and depression, could be triggered by the fear of possible infection, being quarantined at hospitals and home, social isolation, and even the shortage of protective gear.A number of mental health surveys associated with the COVID-19 outbreak are being conducted in different vulnerable populations, which include infected patients, medical staff, students, and the general population. Liu et al. have reported results from a multicenter survey conducted among 1,563 medical staff members and found that the prevalence of depression and anxiety was 51% and 45%, respectively (3). So far, data on the mental health repercussions of the COVID-19 pandemic in outpatient populations have not been available. Thus, we conducted a questionnaire survey, from February 25 to March 9, 2020, among outpatients who sought care in the Departments of Psychiatry, Neurology, and Sleep Medicine in West China Hospital of Sichuan University (Chengdu, China). A self-report questionnaire was completed by outpatients, who provided consent, via the WeChat-based survey program Questionnaire Star. A total of 2,065 out of 3,441 patients completed the survey, including 589 new patients and 1,476 existing patients. The prevalence rates of mental health problems related to the COVID-19 outbreak, including anxiety (defined as a total score ≥5 on the Generalized Anxiety Disorder 7-item scale), depression (defined as a total score ≥5 on the Patient Health Questionnaire 9-item scale), and insomnia (defined as a total score ≥8 on the Insomnia Severity Index), were 25.5%, 16.9%, and 26.2%, respectively. Furthermore, 20.9% of patients (N=300) with preexisting psychiatric disorders (N=1,434) reported a deterioration of their mental health condition related to the pandemic. In particular, transportation restrictions, isolation at home, and fear of cross-infection in hospitals have inevitably become major concerns and barriers to treatment for these patients during the outbreak. Our survey also showed that 24.5% of new patients, including those with anxiety (N=46), depression (N=37), insomnia (N=79), and psychosis (N=21), could not receive timely diagnoses and treatment. Similarly, 22.0% of existing patients with diagnosed mental disorders, including depression, bipolar disorders, and schizophrenia (N=315), could not receive routine psychiatric care because of suspended hospital visits. Consequently, 18.1% of patients (N=259) have self-reduced medication dosages, and 17.2% of patients (N=247) stopped taking their medication because they could not gain access to prescriptions from physicians during the outbreak. As the lifetime prevalence of mental disorders is 16.6% among adults in China (4), millions of psychiatric patients may face barriers to help seeking for timely management of their mental health condition. The long-term repercussions of the viral pandemic on the management of psychiatric patients warrant further investigation. Nonetheless, our data reiterate the importance of implementing appropriate mental health care measures in the face of the COVID-19 pandemic.In response to the COVID-19 outbreak, there have been ongoing measures and concerted efforts in China that emphasize the importance of dealing with the potentially concurrent mental health crisis. On January 26, 2020, the National Health Commission of China released principles for emergency psychological crisis intervention for the COVID-19 pandemic (5). Mental health hotlines were quickly established across China and provided the public with counseling and psychological services. The telephone and Internet have been widely used to deliver mental health care services, and social media platforms (e.g., WeChat, Weibo) have been used to share strategies, guidelines, and education programs for managing potential mental distress. In addition, a series of self-help handbooks for psychological care associated with COVID-19 have been published by the China Association for Mental Health, medical institutions, and universities.Furthermore, a number of hospitals in China have initiated telemedicine services for patients in need during the outbreak of COVID-19. On January 26, 2020, West China Hospital of Sichuan University, as one of the leading hospitals in China, opened a free online outpatient service involving more than 100 medical doctors across specialties. This online outpatient service was created mainly to provide prescriptions to existing patients and to offer consultation to new patients. Our hospital collaborated with commercial courier services to deliver medication to patients' homes at no cost. To date, thousands of patients have received health care provided by this online outpatient service. Interestingly, only 7.4% of patients with mental disorders (N=136) in our survey have sought online help for medical care. Thus, there is a need to promote online mental health care services across China to manage mental health problems during the pandemic.The long-term outcomes of the mental health interventions in both community and hospital settings need further evaluation to determine how we can ameliorate the negative effects of viral outbreaks in the general public, especially among vulnerable patients with mental health problems.Sleep Medicine Center (Zhou, Xue, Tang), Department of Anesthesiology, Translational Neuroscience Center (Liu), and Outpatient Department (Yang), West China Hospital, Sichuan University, Chengdu, China.Send correspondence to Dr. Zhou ([email protected]).The authors report no financial relationships with commercial interests.The authors thank the clinic nurses in the Departments of Psychiatry, Neurology, and Sleep Medicine, West China Hospital, Sichuan University.References1 Lu R, Zhao X, Li J, et al.: Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395:565–574Crossref, Medline, Google Scholar2 World Health Organization (WHO): WHO director-general's opening remarks at the media briefing on COVID-19: 11 March 2020 (https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020)Google Scholar3 Liu S, Yang L, Zhang C, et al.: Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry 2020; 7:e17–e18Crossref, Medline, Google Scholar4 Huang Y, Wang Y, Wang H, et al.: Prevalence of mental disorders in China: a cross-sectional epidemiological study. 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Psychiatry, Vol. 11, No. und und February 2021 | der Vol. No. prevalence of depressive and anxiety symptoms and their associations with quality of life among patients with psychiatric disorders during the COVID-19 January 2021 | Translational Psychiatry, Vol. 11, No. COVID-19 pandemic and mental of The Vol. of COVID-19 pandemic on the mental health of May 2021 | Journal of associated with mental health and quality of life during the COVID-19 pandemic in May 2021 | Open, Vol. No. and risk of psychiatric symptoms and diagnoses before and during the COVID-19 pandemic: from the COVID-19 mental health April 2021 | Medicine, Vol. in The impact of protective and on and Medicine in Psychiatry, Vol. COVID-19 the of March 2021 | Current Psychiatry Reports, Vol. 23, No. Medicine in Psychiatry in the COVID-19 era: the impact of the pandemic on mental Medicine in Psychiatry, Vol. and in the age of October 2020 | Psychology & Vol. No. in mental health problems related to COVID-19 in Hospital Psychiatry, Vol. mental health and novel coronavirus: The risk of the Journal of Psychiatry, Vol. for and Mental On the of COVID-19 February 2021 | Frontiers in Vol. of during COVID-19: a an January 2021 | Vol. 44, No. and psychological of students during the early stage of COVID-19 outbreak in China: a cross-sectional February 2021 | BMJ Open, Vol. 11, No. an to Mental Health, and among Youth and February 2021 | International Journal of Research and Public Health, Vol. No. in the and of Mental Health November from July Disorders, and and mental illness: A systematic review and & Health, Vol. and in pandemic: the in mental health October 2020 | International Journal of Vol. No. 1Prevalence and with Insomnia Among the Chinese General Public the 2019 June 2021 | and of Vol. the of December 2021 | and of Vol. Health for to Patients in a of Pandemic: and of Patient July 2021 | Mental Health, Vol. 8, No. impact of COVID-19 pandemic on the of depression among health care cross-sectional May 2021 | Vol. Mental Health the of in the April 2021 | Journal of Education in the Health Vol. No. from November to the Mental Health of by COVID-19 in China: A December 2020 | Frontiers in Psychiatry, Vol. of in 100 Patients Disorder During the COVID-19 Pandemic in December 2020 | Frontiers in Psychiatry, Vol. in of November 2020 | Current Psychiatry Reports, Vol. 22, No. adverse with during COVID-19 Journal of Psychiatry, Vol. of patients with Journal of Psychiatry, Vol. health response for and adolescents during the COVID-19 outbreak in Research, Vol. to COVID-19 to in and from a for Sleep in December 2020 | International Journal of Research and Public Health, Vol. 17, No. awareness of suicide during the October 2020 | Reports, Vol. No. of and health anxiety during COVID pandemic among of a psychiatric an Journal of impact of COVID ‐19 on individuals with disorders: A survey of individuals in the and the July 2020 | International Journal of Disorders, Vol. 53, No. and Distress COVID-19 Among University in the October 2020 | Frontiers in Psychiatry, Vol. pandemic and mental health review of the and Vol. and to the COVID-19 crisis in the of Psychiatric Research, Vol. of COVID-19 on Youth Mental Health, and A of and de la COVID-19 la de et adolescents un et July 2020 | The Journal of Psychiatry, Vol. No. Network Analysis of During the COVID-19 October 2020 | Frontiers in Psychology, Vol. of suicide during and after the COVID ‐19 September 2020 | World Psychiatry, Vol. 19, No. psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public A systematic review and Research, Vol. changes during COVID-19 and the potential A June 2020 | Journal of Health Psychology, Vol. 25, No. and July 2020 | Journal of Psychiatry, Vol. No. COVID-19-Pandemie die und Psychotherapie, Vol. No. 2019 (COVID-19) and Psychiatric in Anxiety and Journal of Medicine, Vol. 2, No. of COVID-19 on Mental Health in the September 2020 | Journal of Internet Research, Vol. 22, No. an Outpatient Psychiatric to During the COVID-19 Pandemic: A October 2020 | Journal of Internet Research, Vol. 22, No. disorders in people infected with the coronavirus September 2020 | Journal of Public Health, Vol. No. 4 July authors thank the clinic nurses in the Departments of Psychiatry, Neurology, and Sleep Medicine, West China Hospital, Sichuan April 2020 online May 2020 in 1 July 2020
BACKGROUND: Sevoflurane is an inhaled volatile anaesthetic that is widely used in paediatric anaesthetic practice. Since its introduction, postoperative behavioural disturbance known as emergence agitation (EA) or emergence delirium (ED) has been recognized as a problem that may occur during recovery from sevoflurane anaesthesia. For the purpose of this systematic review, EA has been used to describe this clinical entity. A child with EA may be restless, may cause self-injury or may disrupt the dressing, surgical site or indwelling devices, leading to the potential for parents to be dissatisfied with their child's anaesthetic. To prevent such outcomes, the child may require pharmacological or physical restraint. Sevoflurane may be a major contributing factor in the development of EA. Therefore, an evidence-based understanding of the risk/benefit profile regarding sevoflurane compared with other general anaesthetic agents and adjuncts would facilitate its rational and optimal use. OBJECTIVES: To compare sevoflurane with other general anaesthetic (GA) agents, with or without pharmacological or non-pharmacological adjuncts, with regard to risk of EA in children during emergence from anaesthesia. The primary outcome was risk of EA; secondary outcome was agitation score. SEARCH METHODS: We searched the following databases from the date of inception to 19 January 2013: CENTRAL, Ovid MEDLINE, Ovid EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost), Evidence-Based Medicine Reviews (EBMR) and the Web of Science, as well as the reference lists of other relevant articles and online trial registers. SELECTION CRITERIA: We included all randomized (or quasi-randomized) controlled trials investigating children < 18 years of age presenting for general anaesthesia with or without surgical intervention. We included any study in which a sevoflurane anaesthetic was compared with any other GA, and any study in which researchers investigated adjuncts (pharmacological or non-pharmacological) to sevoflurane anaesthesia compared with no adjunct or placebo. DATA COLLECTION AND ANALYSIS: Two review authors independently searched the databases, decided on inclusion eligibility of publications, ascertained study quality and extracted data. They then resolved differences between their results by discussion. Data were entered into RevMan 5.2 for analyses and presentation. Comparisons of the risk of EA were presented as risk ratios (RRs) with 95% confidence intervals (CIs). Sevoflurane is treated as the control anaesthesia in this review. Sensitivity analyses were performed as appropriate, to exclude studies with a high risk of bias and to investigate heterogeneity. MAIN RESULTS: We included 158 studies involving 14,045 children. Interventions to prevent EA fell into two broad groups. First, alternative GA compared with sevoflurane anaesthesia (69 studies), and second, use of an adjunct with sevoflurane anaesthesia versus sevoflurane without an adjunct (100 studies). The overall risk of bias in included studies was low. The overall Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) assessment of the quality of the evidence was moderate to high. A wide range of EA scales were used, as were different levels of cutoff, to determine the presence or absence of EA. Some studies involved children receiving potentially inadequate or no analgesia intraoperatively during painful procedures.Halothane (RR 0.51, 95% CI 0.41 to 0.63, 3534 participants, high quality of evidence) and propofol anaesthesia were associated with a lower risk of EA than sevoflurane anaesthesia. Propofol was effective when used throughout anaesthesia (RR 0.35, 95% CI 0.25 to 0.51, 1098 participants, high quality of evidence) and when used only during the maintenance phase of anaesthesia after sevoflurane induction (RR 0.59, 95% CI 0.46 to 0.76, 738 participants, high quality of evidence). No clear evidence was found of an effect on risk of EA of desflurane (RR 1.46, 95% CI 0.92 to 2.31, 408 participants, moderate quality of evidence) or isoflurane (RR 0.76, 95% CI 0.46 to 1.23, 379 participants, moderate quality of evidence) versus sevoflurane.Compared with no adjunct, effective adjuncts for reducing the risk of EA during sevoflurane anaesthesia included dexmedetomidine (RR 0.37, 95% CI 0.29 to 0.47, 851 participants, high quality of evidence), clonidine (RR 0.45, 95% CI 0.31 to 0.66, 739 participants, high quality of evidence), opioids, in particular fentanyl (RR 0.37, 95% CI 0.27 to 0.50, 1247 participants, high quality of evidence) and a bolus of propofol (RR 0.58, 95% CI 0.38 to 0.89, 394 participants, moderate quality of evidence), ketamine (RR 0.30, 95% CI 0.13 to 0.69, 231 participants, moderate quality of evidence) or midazolam (RR 0.57, 95% CI 0.41 to 0.81, 116 participants, moderate quality of evidence) at the end of anaesthesia. Midazolam oral premedication (RR 0.81, 95% CI 0.59 to 1.12, 370 participants, moderate quality of evidence) and parental presence at emergence (RR 0.91, 95% CI 0.51 to 1.60, 180 participants, moderate quality of evidence) did not reduce the risk of EA.One or more factors designated as high risk of bias were noted in less than 10% of the included studies. Sensitivity analyses of these studies showed no clinically relevant changes in the risk of EA. Heterogeneity was significant with respect to these comparisons: halothane; clonidine; fentanyl; midazolam premedication; propofol 1 mg/kg bolus at end; and ketamine 0.25 mg/kg bolus at end of anaesthesia. With investigation of heterogeneity, the only clinically relevant changes to findings were seen in the context of potential pain, namely, the setting of adenoidectomy/adenotonsillectomy (propofol bolus; midazolam premedication) and the absence of a regional block (clonidine). AUTHORS' CONCLUSIONS: Propofol, halothane, alpha-2 agonists (dexmedetomidine, clonidine), opioids (e.g. fentanyl) and ketamine reduce the risk of EA compared with sevoflurane anaesthesia, whereas no clear evidence shows an effect for desflurane, isoflurane, midazolam premedication and parental presence at emergence. Therefore anaesthetists can consider several effective strategies to reduce the risk of EA in their clinical practice. Future studies should ensure adequate analgesia in the control group, for which pain may be a contributing or confounding factor in the diagnosis of EA. Regardless of the EA scale used, it would be helpful for study authors to report the risk of EA, so that this might be included in future meta-analyses. Researchers should also consider combining effective interventions as a multi-modal approach to further reduce the risk of EA.
Surgical InfectionsVol. 21, No. 3 Letter to the EditorAnesthesia Procedure of Emergency Operation for Patients with Suspected or Confirmed COVID-19Xianjie Wen and Yiqun LiXianjie WenDepartment of Pain Management, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.Department of Anesthesiology, the Second People's Hospital of Foshan City, Foshan, Guangdong Province, China.Search for more papers by this author and Yiqun LiAddress correspondence to: Dr. Yiqun Li, Department of Orthopaedics, The Second People's Hospital of Foshan City, Foshan, Guangdong Province, China E-mail Address: [email protected]Department of Orthopaedics, the Second People's Hospital of Foshan City, Foshan, Guangdong Province, China.Search for more papers by this authorPublished Online:19 Mar 2020https://doi.org/10.1089/sur.2020.040AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View article"Anesthesia Procedure of Emergency Operation for Patients with Suspected or Confirmed COVID-19." Surgical Infections, 21(3), p. 299FiguresReferencesRelatedDetailsCited byRecent COVID-19 infection is associated with increased mortality in the ambulatory surgery populationJournal of Clinical Anesthesia, Vol. 89Optimal Decision of Dynamic Bed Allocation and Patient Admission with Buffer Wards during an Epidemic29 January 2023 | Mathematics, Vol. 11, No. 3How Should Anesthesiologists Face Coronavirus Disease 2019?27 May 2022 | Frontiers in Cardiovascular Medicine, Vol. 9The impact of COVID-19 on cleft services in Great Britain & Northern IrelandJournal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 75, No. 5Anesthesia and intensive care for patients with COVID-19. 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Russian Federation of anesthesiologists and reanimatologists guidelines26 February 2021 | Annals of Critical Care, No. 1-SCOVID-19 Detection via Wavelet Entropy and Biogeography-Based Optimization12 December 2020A Protocol for Performing Reconstructive Microsurgery on Patients With COVID-19Plastic Surgical Nursing, Vol. 41, No. 1Diagnostics, Vol. 11, No. 9Peri-operative and anesthesia considerations for patient recovered from COVID-19 scheduled for radical cancer surgeryBali Journal of Anesthesiology, Vol. 5, No. 2PERIOPERATIVE NURSING CARE IN CASES REQUIRING EMERGENCY SURGERY IN COVID-19 INFECTED PATIENTS25 December 2020 | International Journal of Health Services Research and Policy, Vol. 5, No. 3Introducing the “Corona Curtain”: an innovative technique to prevent airborne COVID-19 exposure during emergent intubations13 May 2020 | Patient Safety in Surgery, Vol. 14, No. 1The COVID-19 Pandemic and Plastic Surgery: Literature Review, Ethical Analysis, and Proposed Guidelines7 February 2020 | Plastic & Reconstructive Surgery, Vol. 146, No. 4Developing a holistic contingency plan: Challenges and dilemmas for cancer patients during the COVID‐1920 July 2020 | Cancer Medicine, Vol. 9, No. 17Anesthesia and intensive care for patients with COVID-19. 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At the outbreak of World War II (WWII), anesthesiology was struggling to establish itself as a medical specialty. The battlefield abruptly exposed this young specialty to the formidable challenge of mass casualties, with an urgent need to provide proper fluid resuscitation, airway management, mechanical ventilation, and analgesia to thousands. But while Europe was suffering under the Nazi boot, anesthesia was preparing to rise to the challenge posed by the impending war. While war brings death and destruction, it also opens the way to medical advances. The aim of this study is to measure the evolution of anesthesia owing to WWII. We conducted a retrospective observational bibliometric study involving a quantitative and statistical analysis of publications. The following 7 journals were selected to cover European and North American anesthesia-related publications: Anesthesia & Analgesia, the British Journal of Anaesthesia, Anesthesiology, Schmerz-Narkose-Anaesthesie, Surgery, La Presse Médicale, and The Military Surgeon (later Military Medicine). Attention was focused on journal volumes published between 1920 and 1965. After reviewing the literature, we selected 12 keywords representing important advances in anesthesiology since 1920: "anesthesia," "balanced anesthesia," "barbiturates," "d-tubocurarine," "endotracheal intubation," "ether," "lidocaine," "morphine," "spinal anesthesia," "thiopental," "transfusion," and "trichloroethylene." Titles of original articles from all selected journals editions between 1920 and 1965 were screened for the occurrence of 1 of the 12 keywords. A total of 26,132 original article titles were screened for the occurrence of the keywords. A total of 1815 keywords were found. Whereas Anesthesia & Analgesia had the highest keyword occurrence (493 citations), Schmerz-Narkose-Anaesthesie had the lowest (38 citations). The number of publications of the 12 keywords was significantly higher in the postwar than in the prewar period (65% and 35%, respectively; P < .001). Not surprisingly, the anesthesiology journals have a higher occurrence of keywords than those journals covering other specialties. The overall occurrence of keywords also showed peaks during other major conflicts, namely the Spanish Civil War (1936-1939), the Korean War (1950-1953), and the Vietnam War (1955-1975). For the first time, this study demonstrates statistically the impact of WWII on the progress of anesthesiology. It also offers an objective record of the chronology of the major advances in anesthesiology before and after the conflict. While the war arguably helped to enhance anesthesiology as a specialty, in return anesthesiology helped to heal the wounds of war.
BACKGROUND: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS: Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING: Bill & Melinda Gates Foundation.
Corresponding author: Kye-Min Kim, M.D., Ph.D., Department of Anesthesia and Pain Medicine, Inje University College of Medicine, Sanggye Paik Hospital, 761-1, Sanggye 7-dong, Nowon-gu, Seoul 139-707, Korea. Tel: 82-2-950-1173, Fax: 82-2-950-1323, E-mail: kyemin@paik.ac.kr Copyright c Korean Society of Anesthesiologists, 2009 cc This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Difficult airway is a major factor threatening the safety of anesthesia. According to the database of the American society of Anesthesiologists Closed Claims Project [1], difficult tracheal intubation is the second most common cause of adverse events bringing about anesthesia-related malpractice claims. To avoid the unanticipated difficult intubation and the catastrophic outcomes, preoperative airway assessment and recognition of difficult intubation are necessary. Several factors such as Mallampati classification, thyromental distance, sternomental distance have been related to difficult intubation [2]. Predictive abilities for difficult intubation of these factors or composite indexes have been tested [2,3]. Postburn sternomental contractures with limited head and neck mobility are considered to increase the incidence of difficult airway. A recent case report on a child with an advanced neck contracture after burn shows us how serious it can be [4]. Therefore, very careful approach to the airway management is required in these patients. In this issue of Korean Journal of Anesthesiology, Jeong et al. [5] compared the predictive abilities for difficult intubation in those patients among three tests: modified Mallampati classification, modified Onah’s classification, El-Ganzouri and Colleagues Multivariate Risk Index (EGRI) [6]. In the study, Jeong et al. introduced Onah’s classification [7] which is originally for guiding surgical options. They modified it by removing elements of surgical consideration and used the simplified form for predicting difficult intubation. In their study, sensitivity and specificity of Mallampati classification for predicting difficult intubation were 97.7% and 19.7%, respectively. On the other hand, sensitivity and specificity of modified Onah’s classification were 86.0% and 84.9%, respectively, which are remarkably improved. Even though the diagnostic performance of EGRI were slightly lower than those of modified Onah’s, they seem to be acceptable also (sensitivity and specificity of EGRI were 83.7% and 75.8%, respectively). On the basis of these results, modified Onah’s classification was more accurate test for difficult intubation than the others in patients with sternomental contractures (Accuracy of modified Onah’s classification, EGRI and modified Mallampati classification were 85.3%, 78.9% and 50.5%, respectively). For safety issue, we must reduce the incidence of unanticipated difficult intubation as far as we can. To do so, we need to use more accurate test for the prediction of difficult intubation in case of postburn sternomental contractures. From this point of view, Jeong et al.’s study has clinical implication. However, we should also keep in mind that there is some probability of false negative prediction even with the most accurate test. So, it is recommended to be careful in the airway management regardless of the results of predictive tests. Furthermore, we should be fully aware of ‘practice Guidelines for Management of the Difficult Airway’ [8] and be familiar with several alternative techniques to laryngoscopic intubation.
Postoperative nausea and vomiting (PONV) is a common complication after surgery.It is associated with poor patient satisfaction, delayed recovery, and high healthcare costs [1].PONV has several risk factors, including female sex, non-smoking status, history of PONV or motion sickness, postoperative opioid analgesia, and the use of volatile anesthetics [2].Although some of these factors are not modifiable, choosing appropriate anesthetics to reduce PONV is highly feasible.This issue of the Korean Journal of Anesthesiology includes a study conducted by Yoo et al.[3] that compares the incidence of PONV after general anesthesia between remimazolam and sevoflurane.Forty patients undergoing laparoscopic cholecystectomy or hemicolectomy were randomized to receive either total intravenous anesthesia (TIVA) with remimazolam/remifentanil or balanced anesthesia with sevoflurane/remifentanil.Patients anesthetized with remimazolam showed a significantly lower incidence of PONV and a reduced rescue antiemetic requirement within the first 24 h postoperatively.The reduction in PONV was most notable in the immediate postoperative period.According to the Quality of Recovery-15 questionnaire results, patients who received remimazolam scored higher on PONV but had significantly lower scores on "a feeling of general well-being" than those who received sevoflurane.The authors attributed this to worse pain in the post-anesthesia care unit and a higher rescue analgesic requirement during the first 24 h postoperatively in patients who received remimazolam anesthesia.Midazolam, a relatively short-acting benzodiazepine, is a common anxiolytic agent used in the perioperative period.The antiemetic properties of midazolam, possibly mediated by decreased dopaminergic activity and 5-hydroxytryptamine release, were first reported in the 1990s [4,5].Multiple studies have demonstrated that intravenous midazolam, administered as premedication, at the induction of anesthesia, or prior to the end of surgery, reduces PONV [6,7].Midazolam has also been shown to effectively treat acute refractory emesis after chemotherapy [8].Additionally, the efficacy of midazolam for the treatment of PONV has be shown to be comparable to that of ondansetron [9].Despite accumulating evidence, midazolam is currently not recommended solely for the prophylaxis or treatment of PONV because of its potent sedative effect.Additionally, propofol, which possesses antiemetic properties and more favorable pharmacokinetic characteristics, has become popular as a hypnotic agent for monitored anesthesia care or general anesthesia.Remimazolam is a novel ultra-short-acting benzodiazepine.Owing to its rapid metabolism by nonspecific esterases, it has a fast onset and offset, a short context-sensitive halflife even after prolonged infusion, and highly predictable and titratable effects [10].Remi-
Purpose: This study aimed to investigate the distribution of research fields and diseases in the North Korean internal medicine journal by using a content analysis and a frequency analysis method. Methods: All 2,092 articles published in Internal Medicine [Naegwa], a North Korean medical journal, from the first issue of 2006 to the last of 2015, were searched and classified by subspecialty of internal medicines, diseases, and classification codes of the Korean Standard Classification of Diseases version 6. Results: In total, 1,392 out of the 2,092 articles were classified into the internal medicine field, with the remaining 700 classified as basic medicine, family medicine, or anesthesiology. Among the articles on internal medicine, most concerned the digestive system, followed by circulatory, respiratory, renal, and endocrine systems. Among the 700 articles in other fields, articles on gynecology were most common. According to the analysis of diseases, the most commonly studied in internal medicine were gastrointestinal diseases, hypertension, respiratory infectious diseases, glomerular diseases, and diabetes. Meanwhile, cerebrovascular diseases, herpes zoster, mental and behavioral disorders, and urinary tumors were most covered in the other fields. In the distribution by classification code of the Korean Standard Classification of Diseases version 6, circulatory and digestive diseases accounted for 42.4% of articles.
Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly.
PURPOSE: The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). METHODS: A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by 7 expert peer reviewers and by the members of the Stroke Council Leadership and Manuscript Oversight Committees. It is intended that this guideline be fully updated every 3 years. RESULTS: Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. CONCLUSIONS: aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care. The guidelines offer a framework for goal-directed treatment of the patient with aSAH.
The Korean Journal of Anesthesiology, the official journal of the Korean Society of Anesthesiologists, recently introduced the Statistical Round as a new publishing category for the year 2015. The Aims and Scope section of the journal explains that the Statistical Round category provides educational material to help the reader understand the designs of experimental and statistical analyses used in anesthesiology investigations. A Statistical Round is a narrative review of the application of various topics ranging from contemporary quantitative sciences to issues of concern to anesthesia researchers. A Statistical Round provides a focused discussion of one or more unique or interesting statistical analysis methods that were previously published in this journal or express the general policies or opinions of the Statistical Round Board. Statistical Round articles are provided by members of the Statistical Round Board or are invited from authors and then are reviewed by the Statistical Editor. All of the Statistical Round articles are published in both English and Korean for the convenience of Korean readers; the Korean version is present only on the journal's web page.