Purpose: : This study sought to investigate novice nurses’ communication education needs in the intensive care unit (ICU) using Importance-Performance Analysis (IPA) and Borich’s need assessment model. This study identified communication challenges in clinical settings to develop a simulation program that enhances communication competencies based on educational requirements. Methods: : A descriptive research design and a self-report questionnaire were used. The latter was developed and administered to 121 novice nurses with less than one year of experience in the ICU at various university hospitals in Korea. Data were collected via the online open chatroom from June 24th to July 28th, 2023. The communication education needs were identified using descriptive statistics, t-tests, IPA, and Borich’s needs assessment model. Text analysis was used to categorize the participants’ communication experience. Results: : The results revealed that “communication with physicians,” “communication with patients,” and “communication with nurse on another shift” domains contained the most substantial educational needs for novice nurses working in the intensive care units. Conclusion : The results provide fundamental data for developing and enhancing customized communication education programs for novice ICU nurses. This valuable information could help ICU nurses and educators improve new nurses’ communication skills, which would ultimately contribute to the advancement of nursing education and clinical practice.

Decisions about stopping or continuing medications perioperatively should be based on withdrawal potential, the potential for disease progression if therapy is interrupted, and the potential for drug interactions with anesthesia. In general, most medications are tolerated well through surgery and do not interfere with anesthetic administration. Therefore, most drugs should be continued through the morning of surgery. However, some medications are known to influence surgical risk or surgical decisions (e.g., antiplatelet agents, anticoagulants, some hormonal therapies, and herbal remedies), so it is important to obtain a complete medication list from the patient and to advise adjusting doses or discontinuing certain potentially complicating medications in advance of surgery. This article reviews general recommendations for perioperative management of a number of common medication classes.
Anesthesia* ; Anticoagulants ; Disease Progression ; Drug Interactions ; Humans ; Medication Therapy Management ; Perioperative Care ; Platelet Aggregation Inhibitors ; Preanesthetic Medication

Thoracic surgery often causes severe postoperative pain, even when minimally invasive techniques are employed. Effective pain management is essential for optimizing recovery and improving patients’ quality of life. Traditional opioid-based strategies effectively alleviate pain, but often lead to significant adverse effects. Multimodal analgesia (MMA) is a comprehensive approach combining pharmacologic and non-pharmacologic methods. This strategy aims to minimize opioid use, target multiple pain pathways, and improve recovery outcomes.Current Concepts: MMA covers the entire perioperative period and utilizes non-opioid agents such as acetaminophen, non-steroidal anti-inflammatory drugs, gabapentinoids, dexmedetomidine, lidocaine, and ketamine—used either individually or in combination. Regional anesthesia techniques, such as thoracic epidural anesthesia, paravertebral blocks, and fascial plane blocks (including erector spinae and serratus anterior plane blocks), have been shown to effectively reduce pain scores, opioid use, and complications. Enhanced recovery after surgery (ERAS) protocols support these multimodal strategies, highlighting the importance of regimens tailored to each patient’s characteristics and the specific surgical procedure. Integrating MMA into ERAS programs has been associated with enhanced recovery, reduced length of hospital stays, and improved quality of life.Discussion and Conclusion: MMA provides comprehensive pain control by targeting both nociceptive and neuropathic pain mechanisms, thereby reducing opioid-related side effects. Nevertheless, evidence gaps remain concerning the best therapeutic combinations and long-term outcomes. Large-scale clinical trials should be conducted to confirm the efficacy of advanced nerve blocks and tailored analgesic strategies. Evidence-based, patient-specific pain management protocols are needed to improve surgical outcomes, accelerate recovery, and enhance patient satisfaction in thoracic surgery.

Thoracic surgery often causes severe postoperative pain, even when minimally invasive techniques are employed. Effective pain management is essential for optimizing recovery and improving patients’ quality of life. Traditional opioid-based strategies effectively alleviate pain, but often lead to significant adverse effects. Multimodal analgesia (MMA) is a comprehensive approach combining pharmacologic and non-pharmacologic methods. This strategy aims to minimize opioid use, target multiple pain pathways, and improve recovery outcomes.Current Concepts: MMA covers the entire perioperative period and utilizes non-opioid agents such as acetaminophen, non-steroidal anti-inflammatory drugs, gabapentinoids, dexmedetomidine, lidocaine, and ketamine—used either individually or in combination. Regional anesthesia techniques, such as thoracic epidural anesthesia, paravertebral blocks, and fascial plane blocks (including erector spinae and serratus anterior plane blocks), have been shown to effectively reduce pain scores, opioid use, and complications. Enhanced recovery after surgery (ERAS) protocols support these multimodal strategies, highlighting the importance of regimens tailored to each patient’s characteristics and the specific surgical procedure. Integrating MMA into ERAS programs has been associated with enhanced recovery, reduced length of hospital stays, and improved quality of life.Discussion and Conclusion: MMA provides comprehensive pain control by targeting both nociceptive and neuropathic pain mechanisms, thereby reducing opioid-related side effects. Nevertheless, evidence gaps remain concerning the best therapeutic combinations and long-term outcomes. Large-scale clinical trials should be conducted to confirm the efficacy of advanced nerve blocks and tailored analgesic strategies. Evidence-based, patient-specific pain management protocols are needed to improve surgical outcomes, accelerate recovery, and enhance patient satisfaction in thoracic surgery.

Thoracic surgery often causes severe postoperative pain, even when minimally invasive techniques are employed. Effective pain management is essential for optimizing recovery and improving patients’ quality of life. Traditional opioid-based strategies effectively alleviate pain, but often lead to significant adverse effects. Multimodal analgesia (MMA) is a comprehensive approach combining pharmacologic and non-pharmacologic methods. This strategy aims to minimize opioid use, target multiple pain pathways, and improve recovery outcomes.Current Concepts: MMA covers the entire perioperative period and utilizes non-opioid agents such as acetaminophen, non-steroidal anti-inflammatory drugs, gabapentinoids, dexmedetomidine, lidocaine, and ketamine—used either individually or in combination. Regional anesthesia techniques, such as thoracic epidural anesthesia, paravertebral blocks, and fascial plane blocks (including erector spinae and serratus anterior plane blocks), have been shown to effectively reduce pain scores, opioid use, and complications. Enhanced recovery after surgery (ERAS) protocols support these multimodal strategies, highlighting the importance of regimens tailored to each patient’s characteristics and the specific surgical procedure. Integrating MMA into ERAS programs has been associated with enhanced recovery, reduced length of hospital stays, and improved quality of life.Discussion and Conclusion: MMA provides comprehensive pain control by targeting both nociceptive and neuropathic pain mechanisms, thereby reducing opioid-related side effects. Nevertheless, evidence gaps remain concerning the best therapeutic combinations and long-term outcomes. Large-scale clinical trials should be conducted to confirm the efficacy of advanced nerve blocks and tailored analgesic strategies. Evidence-based, patient-specific pain management protocols are needed to improve surgical outcomes, accelerate recovery, and enhance patient satisfaction in thoracic surgery.

No abstract available.
Meconium*

Thyroid storm is a critical complication of molar pregnancy. However, early diagnosis of it is difficult because it is a rare complication and usually presents nonspecific findings. In this case report, we present a woman with molar pregnancy who had persistent tachycardia and hypertension. She was diagnosed initially with preeclampsia and sepsis as complications of molar pregnancy. During dilation and curettage under general anesthesia with sevoflurane and remifentanil, tachycardia and hypertension remained even with continuous infusion of labetalol. The patient was subsequently diagnosed with thyroid storm associated with molar pregnancy. She was restored to a clinically euthyroid state 1 day after the operation, and her thyroid function test and beta-hCG values were normal 3 months later. The anesthesiologists should bear in mind the possibility of thyroid storm in patients with molar pregnancies who show persistent tachycardia and hypertension.
Anesthesia, General ; Curettage ; Early Diagnosis ; Female ; Humans ; Hydatidiform Mole* ; Hypertension* ; Labetalol ; Pre-Eclampsia ; Pregnancy ; Sepsis ; Tachycardia* ; Thyroid Crisis* ; Thyroid Function Tests

Background: Propofol-based total intravenous anesthesia (TIVA) improves long-term outcomes after cancer surgery compared with inhalation anesthesia. However, its effect on patients undergoing non-small cell lung cancer (NSCLC) surgery remains unclear. We aimed to compare the oncological outcomes of TIVA and inhalation anesthesia after curative resection of early-stage NSCLC. Methods: We analyzed the medical records of patients diagnosed with stage I or II NSCLC who underwent curative resection at a tertiary university hospital between January 2010 and December 2017. The primary outcomes were recurrence-free survival (RFS) and overall survival (OS) according to anesthesia type. Results: We included 1,508 patients with stage I/II NSCLC. The patients were divided into the TIVA (n = 980) and Inhalation (n = 528) groups. The two groups were well-balanced in terms of baseline clinical characteristics. The TIVA group demonstrated significantly improved RFS (7.7 years, 95% CI [7.37, 8.02]) compared with the Inhalation group (6.8 years, 95% CI [6.30, 7.22], P = 0.003). Similarly, TIVA was superior to inhalation agents with respect to OS (median OS; 8.4 years, 95% CI [8.08, 8.69] vs. 7.3 years, 95% CI [6.81, 7.71]; P < 0.001). Multivariable Cox regression analysis revealed that TIVA was an independent prognostic factor related to recurrence (hazard ratio [HR]: 1.24, 95% CI [1.04, 1.47], P = 0.014) and OS (HR: 1.39, 95% CI [1.12, 1.72], P = 0.002). Conclusions Propofol-based TIVA was associated with better RFS and OS than inhalation anesthesia in patients with stage I/II NSCLC who underwent curative resection.

Background: Unexpected conversion to thoracotomy during planned video-assisted thoracoscopic surgery (VATS) can lead to poor outcomes and comparatively high morbidity. This study was conducted to assess preoperative risk factors associated with unexpected thoracotomy conversion and to develop a risk scoring model for preoperative use, aimed at identifying patients with an elevated risk of conversion. Methods: A retrospective analysis was conducted of 1,506 patients who underwent surgical resection for non-small cell lung cancer. To evaluate the risk factors, univariate analysis and logistic regression were performed. A risk scoring model was established to predict unexpected thoracotomy conversion during VATS of the lung, based on preoperative factors. To validate the model, an additional cohort of 878 patients was analyzed. Results: Among the potentially significant clinical variables, male sex, previous ipsilateral lung surgery, preoperative detection of calcified lymph nodes, and clinical T stage were identified as independent risk factors for unplanned conversion to thoracotomy. A 6-point risk scoring model was developed to predict conversion based on the assessed risk, with patients categorized into 4 groups. The results indicated an area under the receiver operating characteristic curve of 0.747, with a sensitivity of 80.5%, specificity of 56.4%, positive predictive value of 1.8%, and negative predictive value of 91.0%. When applied to the validation cohort, the model exhibited good predictive accuracy. Conclusion We successfully developed and validated a risk scoring model for preoperative use that can predict the likelihood of unplanned conversion to thoracotomy during VATS of the lung.