Background: Remimazolam is a novel short-acting benzodiazepine. This study compared the effects of remimazolam and propofol on cognitive function in adult patients after surgery or other procedures.Methods: We searched electronic databases, including PubMed, Embase, CENTRAL, Web of Science, and Scopus, for relevant studies. The primary outcome was the proportion of participants who experienced delirium or impaired cognitive function postoperatively. Secondary outcomes included the incidence of hypotension, bradycardia, and postoperative nausea and vomiting. We estimated the odds ratios (OR) and mean differences (MD) with 95% CIs using a random-effects model.Results: In total, 1295 patients from 11 randomized controlled trials were included. The incidence of postoperative delirium was 8.0% in the remimazolam group and 10.4% in the propofol group that was not significantly different (OR: 0.74, 95% CI [0.39–1.42], P = 0.369, I2 = 32%). More favorable cognitive function, as assessed using the Mini-Mental State Examination, was observed in the remimazolam group compared to the propofol group (MD: 1.06, 95% CI [0.32–1.80], P = 0.005, I2 = 89%). Remimazolam lowered the incidence of hypotension (OR: 0.28, 95% CI [0.21–0.37], P = 0.000, I2 = 0%) compared to propofol.Conclusions: Remimazolam did not increase the risk of postoperative delirium and maintained cognitive function well, providing hemodynamic stability during surgery compared to propofol.

Quadratus lumborum block (QLB) has been shown to be effective for pain relief after hip surgery. This study evaluated the efficacy of ultrasound-guided anterior QLB in pain control after total replacement hip arthroplasty (TRHA). A total of 115 patients receiving anterior QLB were propensity score-matched with 115 patients who did not receive the block. The primary outcome was opioid consumption at 24, 24–48, and 48 postoperative hours. Secondary outcomes included pain scores at the post-anesthesia care unit (PACU), 8, 16, 24, 32, 40, and 48 h length of hospital stay, time to first ambulation, and the incidence of opioid-related side effects. Postoperative opioid consumption 48 h after surgery was significantly lower in the QLB group. Resting, mean, worst, and the difference of resting pain scores compared with preoperative values were significantly lower in the QLB group during the 48 postoperative hours. The length of hospital stay was shorter in the QLB group. The incidence of postoperative nausea and vomiting was significantly lower in the QLB group during the 48 postoperative hours, except at the PACU. This study suggests that anterior QLB provides effective postoperative analgesia for patients undergoing THRA performed using the posterolateral approach.

Background: Remimazolam is a novel short-acting benzodiazepine that has recently been used for general anesthesia. This study compared the safety and efficacy of remimazolam-based total intravenous anesthesia (TIVA) and volatile agent-based anesthesia in adults undergoing general anesthesia.Methods: We searched electronic databases including PubMed, Embase, CENTRAL, and Scopus for relevant studies. The primary outcome was the proportion of patients who experienced hypotension during surgery. Secondary outcomes included incidence of bradycardia, extubation time, duration in the post-anesthesia care unit hospital stay, and incidence of postoperative nausea and/or vomiting (PONV). We estimated the relative risk (RR) and mean difference with 95% CIs using a random-effects model.Results: A total of 969 patients from 12 randomized controlled trials were included. The incidence of hypotension was 14% and 34% in the remimazolam and volatile agent groups, respectively. Remimazolam significantly lowered the incidence of hypotension (RR: 0.43, 95% CI [0.29–0.63], P = 0.0000, I2 = 26%). The remimazolam group had a PONV incidence of 13%, compared to 28% in the volatile agent group, indicating a significant difference (RR: 0.51, 95% CI [0.37–0.72], P = 0.0001, I2 = 15%). No significant differences were observed in the other outcomes.Conclusions: Remimazolam-based TIVA demonstrated favorable hemodynamic effects, with a lower incidence of hypotension and similar bradycardia rates, compared to volatile agent-based anesthesia. Furthermore, the reduction in PONV supports the use of remimazolam-based TIVA as a valuable method for general anesthesia.

Background: As an anesthesia induced during cesarean section, spinal anesthesia is preferred over general and epidural anesthesia. This study aimed to review the trend of anesthetic methods for cesarean section based on data obtained from the Korean Health Insurance Review and Assessment Service from 2013 to 2018.Methods: The anesthetic methods were analyzed in 753,285 parturients who underwent a cesarean section in Korea from 2013 to 2018. We determined the association between each anesthetic method and hospital type and maternal and fetal factors. We also evaluated whether the anesthetic method was associated with the parturients’ length of hospital stay.Results: General anesthesia, spinal anesthesia, and epidural anesthesia were induced in 28.8%, 47.7%, and 23.6% of parturients from 2013 to 2018, respectively. Trend analyses showed that spinal anesthesia increased from 40.0% in 2013 to 53.7% in 2018. The opposite trend applied to general anesthesia, decreasing from 37.1% in 2013 to 22.2% in 2018. The factors that were significantly associated with the anesthetic method were parturient’s parity, emergency condition, gestational age, and fetal weight. The type of hospital, parturient’s age, and multiple birth were also associated with the anesthetic methods. There was a strong association between general anesthesia and hospital stay longer than 7 days.Conclusions: Spinal anesthesia is currently the main anesthetic method used for cesarean delivery, and the rate of spinal anesthesia is gradually increasing in Korea.

Background and Objectives: Patients with hip fractures have a high mortality rate, highlighting the need for a reliable prognostic tool. Although the prognostic nutritional index (PNI) is a well-established predictor in patients with cancer, its utility has not been thoroughly investigated in patients with hip fractures. Therefore, this study aims to evaluate the association between PNI and mortality in patients undergoing hip fracture surgery. Materials and Methods: A retrospective review was conducted on all patients aged ≥65 years who underwent surgery for hip fracture between January 2014 and February 2018. Quartile stratification was chosen because no universally accepted clinical cut-off exists for PNI; this approach enables comparison of equally sized groups and exploration of potential non-linear risk patterns. The primary endpoints were 1-year and overall mortality in older adults undergoing hip fracture surgery. Multivariable Cox proportional-hazards models adjusted for age, sex, ASA class and comorbidities. Results: A total of 815 patients were analyzed. One-year and overall mortality rates were highest in the Q1 group (26.6%, 14.2%, 6.9%, 6.4% [p < 0.001] and 56.7%, 36.3%, 27.0%, 15.2% [p < 0.001], respectively). In Cox regression analysis, a lower preoperative PNI was significantly associated with an increased risk of overall mortality (Q1: HR 3.25, 95% confidence interval [CI] 2.11–5.01, p < 0.001; Q2: HR 1.85, 95% CI 1.19–2.86, p = 0.006; Q3: HR 1.52, 95% CI 0.97–2.38, p = 0.065; Q4 as reference), indicating a stepwise, dose–response increase in mortality risk as PNI decreases. Conclusions: The findings demonstrate that a lower preoperative PNI is significantly associated with higher 1-year and overall mortality in older adults undergoing hip fracture surgery. Although further prospective validation is needed, preoperative PNI may help predict mortality in frail patients undergoing hip fracture surgery and identify those who could benefit from nutritional assessment and optimization before surgery.

Background and Objectives: Spinal anesthesia is widely used in various types of surgery. However, several complications can occur afterward. This study aimed to identify differences in the incidence of anesthesia-related complications according to the approach methods (midline versus paramedian) for landmark-based spinal anesthesia. Materials and Methods: We searched electronic databases, including PubMed, EMBASE, CENTRAL, Scopus, and Web of Science, for eligible randomized controlled trials. The primary outcome was post-dural puncture headache (PDPH) incidence, and secondary outcomes were low back pain (LBP) incidence and success rate in the first trial of spinal anesthesia. We estimated the odds ratio (OR) with 95% confidence intervals (CI) using a random-effects model. Results: In total, 2280 patients from 13 randomized controlled trials were included in the final analysis. The incidence rates of PDPH were 5.9% and 10.4% in the paramedian and midline approach groups, respectively. The pooled effect size revealed that the incidence of PDPH (OR: 0.43, 95% CI [0.22–0.83]; p = 0.01; I² = 53%) and LBP (OR: 0.27, 95% CI [0.16–0.44]; p < 0.001; I² = 16%) decreased, and the success rate in the first attempt was higher (OR: 2.30, 95% CI [1.36–3.87]; p = 0.002; I² = 35%) with the paramedian than with the midline approach. Conclusions: Paramedian spinal anesthesia reduced PDPH and LBP and increased the success rate of the first attempt.