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This document is a letter to the editor of the Journal of Anesthesia, commenting on a study that compared different intercostal nerve block modalities for postoperative analgesia in patients undergoing thoracoscopic pulmonary resection. The authors of the letter raise several concerns about the study, including the use of high concentration ropivacaine, the lack of incisional local anesthetic infiltration in the control group, the assessment of postoperative pain levels, the clinical significance of the opioid-sparing effect, and the inconsistent use of non-opioid basic analgesics. The authors also note that the results of the multivariable logistic regression analysis were not provided. It is important for library patrons to consider these limitations and potential biases when interpreting the findings of the original study. [Extracted from the article]

A comment was made on a small-sample randomized controlled trial that evaluated the postoperative analgesic efficacy of a combination of continuous paravertebral block (PVB) and multilevel single-shot intercostal nerve block (ICNB) compared to PVB alone for patients who underwent thoracotomy. The comment raises several issues that need clarification, such as the lack of information on the thoracotomy approaches and surgical types, the difference in the administration of the blocks, and the clinical significance of opioid sparing with the combination of PVB and ICNB. The comment suggests that adding ICNB to an erector spinae plane block may be worth considering for pain control after thoracotomy. [Extracted from the article]

Third, in this study, intravenous tramadol (1 mg/kg) was administered as rescue analgesia, if the NRS pain score was 4 or more and the proportion of patients needing rescue analgesia was significantly reduced in the M-TAPA group. As opioid sparing is one of the main objectives of postoperative multimodal analgesia protocols including a nerve or fascial plane block [[3]], the authors should provide whether morphine milligram equivalent of tramadol for rescue analgesia was significantly different between groups. Keywords: Laparoscopic cholecystectomy; Postoperative analgesia; Thoracoabdominal nerves block through perichondrial approach; Local infiltration EN Laparoscopic cholecystectomy Postoperative analgesia Thoracoabdominal nerves block through perichondrial approach Local infiltration 495 496 2 06/01/23 20230601 NES 230601 This comment refers to the article available online at https://doi.org/10.1007/s00540-022-03158-0. [Extracted from the article]

A letter to the editor is presented in response to the article "The effect of dexmedetomidine pretreatment on the median effective bolus dose of propofol for facilitating laryngeal mask airway insertion" written by Gui‑Zhen Yang.

A letter to the editor is presented in response to the article "A comparison of single-handed chin lift and two-handed jaw thrust for tracheal intubation using a lightwand" written by S.M. Yang, which includes techniques for anesthesia patients.

A letter to the editor is presented in response to the article "Nasotracheal intubation of a patient with restricted mouth opening using a McGrath MAC X-Blade and Magill forceps," by Z. İ. Arslan and colleagues.

A letter to the editor is presented in response to the article "Face-to-face tracheal intubation in adult patients: A comparison of the Airtraq, Glidescope and Fastrach devices," by Z.I. by Arslan et al., published in a previous issue of the journal.

The available evidence indicates that preoperative pain is common among patients undergoing arthroscopic shoulder surgery and both preoperative pain severity and opioid use are the strongest independent risk factors of postoperative pain [[2]]. Keywords: Remifentanil; Shoulder arthroplasty; Postoperative analgesia; Analgesic consumption EN Remifentanil Shoulder arthroplasty Postoperative analgesia Analgesic consumption 665 666 2 09/30/22 20221001 NES 221001 This comment refers to the article available online at https://doi.org/10.1007/s00540-022-03085-0. [Extracted from the article]

As adequate movement pain control is very important for postoperative functional recovery in patients undergoing AKT, we were very interested in knowing why designed goal of postoperative pain control was not achieved in some time points, especially for patients receiving ACB alone. Keywords: iPACK; Adductor canal block; Periarticular block; Postoperative analgesia; Total knee arthroplasty EN iPACK Adductor canal block Periarticular block Postoperative analgesia Total knee arthroplasty 447 448 2 06/03/22 20220601 NES 220601 This comment refers to the article available online at https://doi.org/10.1007/s00540-022-03047-6. Adductor canal block, Postoperative analgesia, Total knee arthroplasty, iPACK, Periarticular block. [Extracted from the article]

Within the airway management field, simulation has been used as a tool of training for over 40 years. Simulation training offers a chance of active involvement for the trainees. It can effectively enhance and upgrade the knowledge and skills of the trainees in airway management, and subsequently decrease medical errors and improve patients' outcomes and safety through a variety of airway management training modalities, such as common airway skills, difficult airway management strategies, and crisis management skills. To perform simulation-based airway management training effectively, not only are task trainers and high-fidelity simulators required but also instructors with rich experience in airway management simulation training and optimal curriculum design are essential. [ABSTRACT FROM AUTHOR]

Background: The combination of various interventions to obtain enhanced cardioprotection is always an important area of research focus. This randomized experiment was designed to assess whether combined fentanyl and limb remote ischemic postconditioning produced enhanced protection against myocardial ischemia/reperfusion injury in an in vivo rat model, and to determine if κ-opioid receptors were implicated in the cardioprotection of these interventions. Methods: Seventy-two rats were exposed to a 30-min myocardial ischemia followed by a 180-min reperfusion. Half of the rats (36) were randomized into four different groups receiving control treatment, fentanyl postconditioning, limb remote ischemic postconditioning, and combined fentanyl and limb remote ischemic postconditioning. The remaining 36 rats were also randomized into four groups receiving the same interventions as the above groups following the intravenous administration of a κ-opioid receptor antagonist, nor-binaltorphimine, before myocardial ischemia. At the end of reperfusion, both serum cardiac troponin I and infarct size were determined. Results: Both fentanyl postconditioning and limb remote ischemic postconditioning significantly decreased the infarct size and serum cardiac troponin I level, and combined fentanyl and limb remote ischemic postconditioning produced enhanced cardioprotection on the infarct size-sparing effect. The use of nor-binaltorphimin to block κ-opioid receptors eliminated cardioprotection by fentanyl postconditioning and enhanced cardioprotection by combined fentanyl and limb remote ischemic postconditioning, but did not change cardioprotection by limb remote ischemic postconditioning. Conclusions: Combined fentanyl and limb remote ischemic postconditioning produced enhanced protection against myocardial ischemia/reperfusion injury. κ-Opioid receptors are essential for cardioprotection by fentanyl postconditioning and enhanced cardioprotection by combined fentanyl and limb remote ischemic postconditioning; however, they do not play a pivotal role in cardioprotection by limb remote ischemic postconditioning. [ABSTRACT FROM AUTHOR]

Reference 1 Panghal R, Mitra S, Singh J, Sarna R, Goel B. Oral acetaminophen as an adjunct to continuous epidural infusion and patient-controlled epidural analgesia in laboring parturients: a randomized controlled trial. Given that labor pain is an acute pain and oral acetaminophen has a slow onset time, we argue that appropriate time of oral acetaminophen administration should be an important part of study design for achieving best effect of combined PCELA. Keywords: Acetaminophen; Patient-controlled epidural analgesia; Labor pain EN Acetaminophen Patient-controlled epidural analgesia Labor pain 328 328 1 04/01/22 20220401 NES 220401 This comment refers to the article available online at https://doi.org/10.1007/s00540-021-02975-z. [Extracted from the article]

Anesthetic strategy for obese patients during gastroscopy: deep sedation or conscious sedation? To the Editor: In recent article of Kang et al. [[1]] comparing deep sedation versus conscious sedation for gastroscopy in obese patients, patients' positions during gastroscopy were not provided. Keywords: Sedation; Gastroscopy; Obese patients EN Sedation Gastroscopy Obese patients 327 327 1 04/01/22 20220401 NES 220401 This comment refers to the article available online at https://doi.org/10.1007/s00540-021-02951-7. [Extracted from the article]

Comparison of single minimum dose administration of dexmedetomidine and midazolam for prevention of emergence delirium in children: a randomized controlled trial. Keywords: Emergence delirium; Emergence agitation; Children EN Emergence delirium Emergence agitation Children 156 156 1 02/02/22 20220201 NES 220201 Cho EA, et al. As postoperative pain is a known precipitating factor for ED in children, we were concerned that unbalanced postoperative pain treatments would have biased their findings. [Extracted from the article]

Keywords: Prediction; Risk factors; Difficult intubation EN Prediction Risk factors Difficult intubation 630 630 1 07/25/20 20200801 NES 200801 This comment refers to the article available at 10.1007/s00540-019-02721-6. In multivariate analysis, odds ratios of LNE for difficult laryngoscopy and intubation were significantly greater than those of low thyromental height test and high modified Mallampati test, but LNE was not identified as a risk factor. Second, difficult laryngoscopy is a main determinant of successful intubation with direct laryngoscopy, but incidence of difficult laryngoscopy (12%) in this study was lower than incidence of difficult intubation was 17%. [Extracted from the article]

Purpose: To evaluate the role of the phosphatidylinositol 3 kinase (PI3K)/protein kinase B (Akt)/hypoxia-inducible factor 1α (HIF-1α) signaling pathway in the protection by dexmedetomidine against lung ischemia-reperfusion injury (IRI) in rats. Methods: Forty-eight male Sprague-Dawley rats weighing 250-350 g were randomly divided into six groups ( n = 8 each group): sham group, IRI group, low-dose dexmedetomidine group (LD group), high-dose dexmedetomidine group (HD group), combined low-dose dexmedetomidine and LY294002 group (LDL group), and combined high-dose dexmedetomidine and LY294002 group (HDL group). A 30-min ischemia was induced by occluding the hilum of the left lung, followed by a 120-min reperfusion by removing occlusion of the hilum. After the left lung was removed, the wet/dry weight ratio (W/D) of the lung tissues was determined. Pathological changes of lung tissues were evaluated by light and electron microscopes and the expression of p-Akt and HIF-1α in the lung tissues was determined by western blotting. Results: Compared with the sham group, both the W/D ratio and lung injury were significantly increased, the p-Akt expression was down-regulated and HIF-1α expression was up-regulated in the five experimental groups. Compared with the LD and LDL groups, both the W/D ratio and lung injury were decreased, but the expression of p-Akt and HIF-1α was increased in the HD and HDL groups. Conclusions: Administration of dexmedetomidine before ischemia can provide a protection against lung IRI by re-installing the PI3K/Akt/HIF-1α signaling pathway. [ABSTRACT FROM AUTHOR]