Background: Emergence delirium (ED) is common in pediatric patients undergoing general anesthesia with sevoflurane. Preoperative sleep quality is associated with the risk factors for ED. However, research on the relationship between sleep quality and ED is limited. We aimed to investigate the relationship between ED and preoperative sleep quality in pediatric patients undergoing strabismus surgery.Methods: This clinical trial included pediatric patients aged 4–12 years who underwent elective strabismus surgery. The patients and their parents were questioned about the patients’ preoperative sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. For anesthesia induction, thiopental (5 mg/kg) and rocuronium (0.6 mg/kg) were used, and anesthesia was maintained with sevoflurane (minimum alveolar concentration, 1–1.5). After administration of a reversal drug, extubation was performed, and the patients were transferred to a post-anesthesia recovery unit. At 10 min after extubation, the degree of ED was measured using the pediatric anesthesia emergence delirium (PAED) and Watcha scale scores.Results: Of the 62 enrolled patients, three pediatric patients were excluded. The overall incidence of ED was 22%. A total of 59 patients were divided into the two groups. The ED group and the non-ED group comprised 13 and 46 patients. Age, height and weight were significantly lower in the ED group than in the non-ED group. Preoperative PSQI and Watcha scale score were significantly higher in the ED group than in the non-ED group. Multivariate analysis showed that age (adjusted OR [95% CI]: 0.490 [0.290–0.828],p = 0.008) and preoperative PSQI score (adjusted OR [95% CI]: 2.149[1.224–3.771],p = 0.008) was associated with ED. In sub-group analysis, PAED scale and Watcha scale scores showed a moderate correlation with preoperative sleep quality in preschool-age patients.Conclusion: In conclusion, the incidence of ED tended to be higher in younger age and poorer preoperative sleep quality in pediatric patients. In particular, the poorer sleep quality score was associated with higher incidence of ED in the preschool-age. Large-scale clinical studies and long-term follow-up studies on ED and sleep quality are required.Trial registration: This study was registered with Clinicaltrials.gov (NCT03332407) at November 5th 2017.

Boo-Young Hwang, Eunsoo Kim, Jae-young Kwon, Ji-youn Lee, Dowon Lee, Eun Ji Park, and Taewoo Kang. Korean J Pain 2020;33:378-85. https://doi.org/10.3344/kjp.2020.33.4.378

Background: Assessing and managing patient anxiety is essential to reduce postoperative complications in elderly patients. However, monitoring patient anxiety objectively is impossible. This study aimed to investigate the correlation between the level of fNIRS signals and anxiety in patients aged 65 and older undergoing artificial joint replacement surgery.

Epidural blood patch (EBP)-the most effective treatment for intracranial hypotension (IH)-can be performed using the blind technique in the lateral position or under fluoroscopic guidance in the prone position. This study aimed to compare the effectiveness of EBP in patients with spontaneous intracranial hypotension (sIH) and iatrogenic intracranial hypotension (iIH) when performed with the blind technique in the lateral decubitus position or fluoroscopic guidance in the prone position. We reviewed IH patients who underwent EBP between January 2015 and September 2019 in a single hospital and divided them into two groups according to the type of IH. Of the 84 included patients, 36 had sIH and 48 had iIH. We compared the effectiveness of EBP using the two methods in each group. There was no significant difference in the effect of EBP between the patients with iIH (p > 0.05). For patients with sIH, fluoroscopic guidance in the prone position technique showed better improvement than the blind technique in the lateral decubitus position (p < 0.05). We observed similar outcomes after blind EBP versus fluoroscopic guidance EBP in patients with iIH. However, procedure-dependent differences were observed in patients with sIH. For patients with sIH, it would be effective to consider fluoroscopic EBP first. Further study is needed to investigate interactions between method of EBP and other factors that affect the effectiveness of EBP.

Monitoring heart rate (HR) and peripheral oxygen saturation (SpO₂) in underwater environments has gained increasing importance due to the expanding popularity of diving activities such as SCUBA diving, freediving, and professional underwater operations. These physiological parameters are critical indicators for detecting adaptive responses and early signs of physiological distress caused by environmental stressors like elevated ambient pressure, hypoxia, cold temperatures, and psychological stress. Although recent advances in wearable sensor technologies offer new opportunities for real-time physiological monitoring underwater, significant limitations persist due to issues such as signal interference, cold-induced vasoconstriction, sensor durability, and the complexity of reliably measuring these parameters in dynamic underwater conditions. Evidence shows HR can fall by more than 50% in freedivers and SpO₂ may decline to below 50% during repeated dives, with proposed depth-specific thresholds (e.g., <98.5% at 30 m) serving as early warning levels. This review synthesizes current knowledge on the cardiovascular and oxygenation responses observed during diving, explores the technological challenges associated with underwater HR and SpO₂ monitoring, and discusses future directions, including the integration of multisensor platforms and predictive analytics to enhance diver safety and physiological monitoring capabilities. Addressing these technological and methodological gaps holds the potential to substantially improve safety standards and expand the clinical applicability of underwater physiological monitoring systems.