Background: The global use of computed tomography (CT) scans in emergency settings is rapidly increasing; however, nationwide data from South Korean Emergency Medical Centers (EMCs) remain limited. Methods: We conducted a retrospective cross-sectional analysis using nationwide data from the National Emergency Department Information System, which collects real-time emergency medical information from EMCs across South Korea. Approximately 11 million emergency department (ED) visits involving CT scans at EMCs between 2014 and 2021 were analyzed to evaluate annual trends in CT utilization, as well as trends by EMC level, age group, Korean Triage and Acuity Scale (KTAS), CT scan region, and scan type. Results: From 2014 to 2021, the total number of CT scans performed at EMCs increased by 96.97%. The proportion of ED visits involving CT scans (CT utilization proportion) increased from 10.23% in 2014 to 25.67% in 2021 (p < 0.001). Subgroups with high CT utilization included patients aged ≥80 years, Level I EMC patients, and KTAS Level I cases. The largest increases were observed in patients aged ≥80 years (160.34%), Level III EMCs (246.61%), and KTAS Level I cases (98.59%). Among patients aged ≤9 years, CT utilization increased by 133.42%. The most common CT scan types were non-contrast brain CT, contrast-enhanced abdominal CT, and non-contrast chest CT, with non-contrast chest CT increasing sharply after 2020. Discrepancies between scanned regions and presenting symptoms have also increased, particularly in chest and abdominal CT scans. Conclusions: CT utilization has substantially increased in South Korean EMCs, particularly among subgroups with high-utilization and those vulnerable to radiation exposure. Medical and ethical considerations regarding unnecessary radiation exposure and potential low-value diagnostic imaging (LVDI) should be carefully evaluated. We propose that continuous monitoring and systematic evaluation are essential to ensure appropriate imaging practices and minimize unnecessary radiation exposure.
Metabolic phenotyping during the perioperative period, defined as the patient-specific characterization of metabolic activities across the pre-, intra-, and postoperative phases, is increasingly recognized as a promising component of emerging precision perioperative medicine, although it has not yet become an established pillar. It differs from conventional approaches based on static baseline assessments by capturing dynamic metabolic responses to surgical stress and anesthesia, which may enable more informative risk stratification than conventional assessment tools. Advances in metabolomics, pharmacometabolomics, and multiomics methodologies have enabled the identification of metabolic signatures associated with perioperative risk, medication responses, organ dysfunction, and recovery. This narrative review uses a structured search strategy in major databases (2015–2026) to synthesize current evidence regarding the utility, methodologies, and future potential of perioperative metabolic phenotyping in adults undergoing surgery. The review describes how studies were selected and critically evaluates the available evidence, emphasizing that most primary research consists of single-center observational cohort studies that require external validation. The review summarizes historical developments, mass spectrometry and nuclear magnetic resonance (NMR)-based techniques, and how these technologies are combined with artificial intelligence and pharmacogenomics to study anesthesia and intensive care outcomes. In addition, it collates clinical studies examining the associations between metabolic phenotypes and delirium, emergence agitation (EA), acute kidney injury, stress hyperglycemia, and organ dysfunction, and discusses pharmacometabolomic approaches to anesthetic drug selection and dosing. Finally, the review outlines key challenges to clinical adoption, including methodological heterogeneity, lack of external and interventional validation, economic and point-of-care barriers, and ethical and regulatory considerations, and highlights research priorities that must be addressed before perioperative metabolic phenotyping can evolve from exploratory research into a clinically robust decision support tool.
Background: Crouzon syndrome and ankylosing spondylitis are independently associated with difficult airway management because of craniofacial abnormalities and severe restriction of cervical spine mobility. Lingual tonsillar hypertrophy is an underrecognized supraglottic pathology that may cause unexpected failure of tracheal intubation. Case: A 54-year-old man with Crouzon syndrome and ankylosing spondylitis underwent thoracic spinal surgery. Preoperative airway assessment revealed markedly limited neck extension and a Mallampati class III airway; videolaryngoscopy was selected for tracheal intubation. However, no laryngeal structures were visualized (Cormack-Lehane grade IV), and further attempts were abandoned. After reversal of neuromuscular blockade with sugammadex, the patient was awakened and underwent awake fiberoptic intubation. Fiberoptic examination revealed severe lingual tonsillar hypertrophy with atypical supraglottic soft tissue structures obscuring the epiglottis and laryngeal inlet. Despite technical difficulties with airway blocks, incremental topical anesthesia enabled successful awake fiberoptic intubation while maintaining spontaneous ventilation. The surgery and extubation over an airway exchange catheter were completed uneventfully. Conclusion: Videolaryngoscopy may fail in patients with combined craniofacial abnormalities and severe cervical spine rigidity, particularly in the presence of occult supraglottic pathology such as lingual tonsillar hypertrophy. Early recognition of failed intubation, timely transition to awake fiberoptic intubation, and careful extubation planning are essential for safe airway management.
To date, surgery remains the only curative treatment for many pathological conditions, and the number of surgical procedures is expected to increase in the coming years. Continuous advances in medical care now allow invasive procedures to be planned even for elderly and frail patients who were previously considered unsuitable for surgery. Combined with the general aging of the population, this has resulted in an increase in the number of frail patients undergoing surgery, who are more prone to postoperative complications and significant functional decline. It is, therefore, crucial to utilize the entire preoperative period not only to stratify preoperative risk but, shifting from a reactive to a proactive approach, also to optimize patients’ functional capacity through multimodal prehabilitation programs. After an initial assessment, surgical patients should receive a personalized, multidisciplinary optimization program aimed at improving their physical, nutritional, and psychological status. Clinical and scientific interest in prehabilitation has grown substantially in recent years. However, several unmet needs about prehabilitation still remain. In this narrative review we examine and discuss the current state of the art in prehabilitation, focusing specifically on unanswered questions and possible future developments.
