Background: Extremely premature neonates can have neonatal respiratory distress syndrome. Anesthetic challenges can result, especially during rigid bronchoscopy requiring maintenance of spontaneous ventilation.Case: 1-day old 560 g female, 23-weeks and 6 days gestation was born with labored breathing and intubated at birth. Four attempts, including one with video-laryngoscopy and visualization of the endotracheal tube going through the vocal cords failed to detect end tidal carbon dioxide (EtCO2). She was extubated onto bilevel positive pressure and transferred for urgent rigid bronchoscopy under anesthesia to rule out tracheoesophageal fistula. Intraoperatively, lack of EtCO2 for over 1 min after 2.5 mm ETT placement over a rigid bronchoscope was noted and overcome using sustained high peak inspiratory pressures. Conclusions Lack of preoperative surfactant administration in extremely premature neonates may lead to significant atelectasis with inability to detect EtCO2 after intubation.

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.

Pain management in lung cancer resection has undergone a paradigm shift from opioid-centric approaches to multimodal analgesia, and more recently, personalized strategies that integrate the principles of precision medicine. Historically, opioids have been the mainstay of perioperative analgesia. However, concerns regarding opioid-related adverse effects, including respiratory depression, immunosuppression, and potential oncologic implications, have driven the adoption of opioid-sparing techniques. Current strategies emphasize multimodal analgesia, combining nonsteroidal antiinflammatory drugs, acetaminophen, regional anesthesia, and adjunctive agents to enhance pain control while minimizing opioid exposure. However, growing evidence suggests that perioperative analgesics may differentially influence tumor biology depending on molecular and genetic factors, necessitating a more tailored approach. This has led to the emergence of precision oncoanesthesia, which aims to integrate tumor-specific genomic insights into perioperative pain management. Although promising, the clinical implementation of precision oncoanesthesia remains in its early stages, with key challenges including the lack of large-scale prospective studies, limited real- time genomic profiling in anesthetic planning, and variability in patient responses to analgesics. Future research should focus on identifying biomarkers that predict individual responses to perioperative analgesia and establishing evidence-based guidelines for precision- based pain management. By evolving beyond traditional opioid reliance and standard analgesic protocols, perioperative pain management in lung cancer surgery can align with emerging precision medicine approaches, ensuring effective pain control and optimized oncologic outcomes.

Enhanced recovery after surgery (ERAS) is an innovative perioperative management approach designed to shorten the recovery time, improve patient safety and quality of care, and enhance overall satisfaction. Successful implementation of ERAS requires active collaboration between healthcare providers and patients to facilitate a timely return to daily activities. The ERAS protocol, originally developed for colorectal surgery, has gradually been expanded and adapted to other major surgeries, and more recently, to Cesarean deliveries. Enhanced recovery after Cesarean delivery (ERAC) presents unique challenges due to its distinct patient population, comprising relatively young women. Its dual focus on maternal recovery and neonatal well-being sets it apart from conventional ERAS protocols. Several components of the ERAC protocol have been adapted from the ERAS recommendations; however, supporting evidence remains limited. This review examines the current ERAC protocol and considers the types of research needed to establish an evidence-based ERAC protocol in the future.

Permissive strategies in the intensive care unit (PSICU) intentionally allow certain physiological parameters to deviate from traditionally strict control limits to mitigate the risks associated with overly aggressive interventions. These strategies have emerged in response to evidence that rigid adherence to normal physiological ranges may cause harm to critically ill patients, leading to iatrogenic complications or exacerbation of underlying conditions. This review discusses several permissive strategies, including those related to hypotension, hypercapnia, hypoxemia, and lower urinary output thresholds. The key principles of these strategies require careful balancing and close monitoring to ensure that the benefits outweigh the risks for each patient. This approach emphasizes individualized care, thoughtful decision- making, and flexible application of guidelines. The use of a PSICU may help minimize the side effects of treatment while addressing the primary condition of the patient and allowing for a more holistic view of critically ill patients.

Continuous peripheral nerve blocks using perineural catheters are increasingly used because they are the only well-established techniques that can provide prolonged analgesia. Although the novel indications and benefits of each type of continuous peripheral nerve block have been well described in several review articles, there is a lack of recent publications focusing on the use of perineural catheters. Numerous clinical challenges are associated with the use of catheters for pain management. This narrative review discusses the currently available perineural catheter designs, catheter fixation methods, perineural catheter-related complications, and management strategies.

Monitored anesthesia care is a feasible option for anesthetic management during awake craniotomy. Patients selected for surgery are thoroughly evaluated by anesthesiologists, primarily focusing on their risk for airway emergencies, such as respiratory depression and obstruction, throughout the procedure. For patients with relative contraindications, a tailored approach is used to assess their suitability. Neuropsychiatric counseling is also helpful for enhancing the patient’s ability to participate in and perform the necessary tasks during brain mapping. Building good rapport with the patient is essential for the success of awake craniotomy, as it helps foster trust and cooperation. Analgesia during awake craniotomy is primarily achieved through scalp nerve blocks or infiltration. Among the six scalp nerve blocks, I have described the zygotemporal nerve block in detail. Proper positioning is crucial for both the surgical approach and the safety and comfort of the patient. Even when local anesthetics are effectively administered, many patients may still experience mild to moderate pain during the procedure. This pain is common and transient, typically occurring around the temporal region. In some cases, sedatives or additional analgesics may be necessary. Serious adverse events can arise, including those that require urgent life-saving interventions or those that interfere with brain mapping and the patient's ability to perform tasks. However, MAC in neurosurgery offers the potential for an improved quality of life for individuals with brain tumors or epileptic seizures, as well as for those with disabilities, such as the deaf or visually impaired, in the future.

Background: Serotonin syndrome results from the use of serotonergic agents that elevate intrasynaptic serotonin level or excessively activate serotonin postsynaptic receptors. Common serotonergic agents used for pain management include opioids, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants.Case: A 24-year old woman diagnosed with complex regional pain syndrome underwent multidrug therapy for pain management over approximately five years. During this period, changes in diaphoresis severity were noted following adjustments to pain medications. The concurrent use of multiple serotonergic agents, exacerbation of diaphoresis after the addition or dose escalation of opioids, and resolution of symptoms upon discontinuation of duloxetine (Cymbalta®, Lily S.A.) strongly suggest the development of serotonin syndrome. Conclusions Diagnosing serotonin syndrome without neuromuscular symptoms can be challenging. Careful monitoring of changes in symptoms and signs following medication use is essential in such cases.