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Background Patients who undergo urinary catheterization may experience postoperative catheter-related bladder discomfort (CRBD). Previous studies have indicated that drugs with antimuscarinic effects could reduce the incidence and severity of CRBD. Accordingly, this study was carried out to investigate whether nefopam, a centrally acting analgesic with concomitant antimuscarinic effect, reduces the incidence and severity of CRBD. Methods Sixty patients with American Society of Anesthesiologists physical status I and II and aged 18–70 years who were scheduled to undergo elective ureteroscopic litholapaxy participated in this double-blinded study. Patients were divided into control and nefopam groups, comprising 30 patients each. In the nefopam group, 40 mg nefopam in 100 ml of 0.9% saline was administered intravenously. In the control group, only 100 ml of 0.9% saline was administered. All patients had a urethral catheter and ureter stent inserted during surgery. The incidence and severity of CRBD, numerical rating scale (NRS) score of postoperative pain, rescue pethidine dose, and side effects were recorded in the post-anesthesia care unit after surgery. Results The incidence (P = 0.020) and severity (P < 0.001) of CRBD were significantly different between the control group and the nefopam group. The NRS score of postoperative pain (P = 0.006) and rescue dose of pethidine (P < 0.001) were significantly higher in the control group than in the nefopam group. Conclusions Intravenous administration of nefopam in patients scheduled to undergo ureteroscopic litholapaxy reduced the incidence and severity of CRBD, NRS score of postoperative pain and analgesic requirements.

Background: Nefopam is a non-opioid, non-steroidal analgesic drug with fewer adverse effects than narcotic analgesics and nonsteroidal anti-inflammatory drugs, and is widely used for postoperative pain control. Because nefopam sometimes causes side effects such as nausea, vomiting, somnolence, hyperhidrosis and injection-related pain, manufacturers are advised to infuse it slowly, over a duration of 15 minutes. Nevertheless, pain at the injection site is very common. Therefore, we investigated the effect of warmed carrier fluid on nefopam injection-induced pain. Methods: A total of 48 patients were randomly selected and allocated to either a control or a warming group. Warming was performed by diluting 40 mg of nefopam in 100 ml of normal saline heated to 31-32°C using two fluid warmers. The control group was administered 40 mg of nefopam dissolved in 100 ml of normal saline stored at room temperature (21-22°C) through the fluid warmers, but the fluid warmers were not activated. Results: The pain intensity was lower in the warming group than in the control group (P ＜ 0.001). The pain severity and tolerance measurements also showed statistically significant differences between groups (P ＜ 0.001). In the analysis of vital signs before and after the injection, the mean blood pressure after the injection differed significantly between the groups (P = 0.005), but the heart rate did not. The incidence of hypertension also showed a significant difference between groups (P = 0.017). Conclusions: Use of warmed carrier fluid for nefopam injection decreased injection-induced pain compared to mildly cool carrier fluid. (Korean J Pain 2018; 31: 102-8)

Background The stroke volume variation (SVV), based on lung-heart interaction during mechanical ventilation, is a useful dynamic parameter for fluid responsiveness. However, it is affected by many factors. The aim of this study was to evaluate the effects of SVV on Trendelenburg (T) and reverse Trendelenburg (RT) position and to further elaborate on the patterns of the SVV with position. Methods Forty-two patients undergoing elective surgery were enrolled in this study. Fifteen minutes after standardized induction of anesthesia with propofol, fentanyl, and rocuronium with volume controlled ventilation (tidal volume of 8 ml/kg of ideal body weight, inspiration : expiration ratio of 1 : 2, and respiratory rate of 10-13 breaths/min), the patients underwent posture changes as follows: supine, T position at slopes of operating table of -5°, -10°, and -15°, and RT position at slopes of operating table of 5°, 10°, and 15°. At each point, SVV, cardiac output (CO), peak airway pressure (PAP), mean blood pressure, and heart rate (HR) were recorded. Results The SVV was significant decreased with decreased slopes of operating table in T position, and increased with increased slopes of operating table in RT position (P = 0.000). Schematically, it was increased by 1% when the slope of operating table was increased by 5°. But, the CO and PAP were significant increased with decreased slopes of operating table in T position, and decreased with increased slopes of operating table in RT position (P = 0.045, 0.027). Conclusions SVV is subjected to the posture, and we should take these findings into account on reading SVV for fluid therapy.

Background: Although a brachial plexus block can be used to provide anesthesia and analgesia for upper extremity surgery, its effects using MgSO4 on postoperative pain management have not been reported. The aim of this study was to evaluate brachial plexus block using MgSO4 on postoperative analgesia. Methods: Thirty-eight patients who were scheduled to undergo upper extremity surgery were randomly allocated into two groups: patients receiving axillary brachial plexus block with 0.2% ropivacaine 20 ml and normal saline 2 ml (group S) or 0.2% ropivacaine 20 ml and MgSO4 200 mg (group M). Before extubation, the blocks were done and patient controlled analgesia was started, and then, the patients were transported to a postanesthetic care unit. The postoperative visual analogue scale (VAS), opioid consumption, and side effects were recorded. Results: The two groups were similar regarding the demographic variables and the duration of the surgery. No differences in VAS scores were observed between the two groups. There was no statistically significant difference in opioid consumption between the two groups. Nausea was observed in three patients for each group. Conclusions: Axillary brachial plexus block using MgSO4 did not reduce the level of postoperative pain and opioid consumption. (Korean J Pain 2011; 24: 158-163)

Background During coronary anastomosis in off-pump coronary artery bypass surgery (OPCAB), hemodynamic alternations can be induced by impaired diastolic function of the right ventricle. This study was designed to examine the effect of milrinone on right ventricular function and early outcomes in patients undergoing OPCAB. Methods Forty patients undergoing OPCAB were randomly assigned in a double-blind manner to receive either milrinone (milrinone group, n = 20) or normal saline (control group, n = 20). Hemodynamic variables were measured after pericardiotomy (T1), 5 min after stabilizer application for anastomosis of the left anterior descending coronary artery (LAD, T2), the obtuse marginalis branch (OM, T3), the right coronary artery (RCA, T4), 5 min after sternal closure (T5), and after ICU arrival. The right ventricular ejection fraction (RVEF) and right ventricular volumetric parameters were also measured using the thermodilution technique. For evaluation of early outcomes, the 30-day operative mortality and morbidity risk models were used. Results There was no significant difference in hemodynamic variables, including mean arterial pressure, between the 2 groups, except for the cardiac index and RVEF. The cardiac index and RVEF were significantly greater at T3 in the milrinone group than in the control group. Conclusions Continuous infusion of milrinone demonstrated a beneficial effect on cardiac output and right ventricular function in patients undergoing OPCAB, especially during anastomosis of the graft to the OM artery, and it had no adverse effect on early outcomes.

We report a 66-yr-old male patient who developed tricuspid regurgitation secondary to internal cardiac massage. After uneventful off-pump coronary artery bypass surgery, the subject experienced cardiac arrest in the intensive care unit. External cardiac massage was initiated and internal cardiac massage was performed eventually. A transesophageal echocardiography revealed avulsion of the anterior papillary muscle and chordae to the anterior leaflet after successful cardiopulmonary resuscitation. Emergency repair of the papillary muscle was performed under cardiopulmonary bypass.

With the growing popularity of the Internet, Korea has been successful in providing broadband Internet services to the level of universal service. More than 70 percent of households have high-speed Internet connection, and their lives have been changed dramatically. The cutting edge technology of broadband Internet has a profound impact on many aspects of the economy, education, entertainment, and social culture. This article addresses the experiences and future perspectives of KT (formerly Korea Telecom) in providing the broadband network and services in Korea. We present our experiences in the deployment of the world's largest ADSL network, and our ongoing deployment of VDSL and WLAN. Based on the accomplishment in broadband access, we also provide a forecast on the next generation of broadband services and the corresponding technologies required to support these services.

Background: Emergence agitation is associated with increased morbidity and hospital costs. However, there have been few reports in the medical literature on the occurrence of emergence agitation in adults. The aim of this study was to compare emergence agitation between sevoflurane and propofol anesthesia in adults after closed reduction of nasal bone fracture. Methods: Forty adults (ASA I-II, 20-60 yr) undergoing closed reduction of nasal bone fracture were randomly assigned to either sevoflurane or propofol group and anesthesia was maintained with sevoflurane or propofol. The bispectral index (BIS) was monitored and maintained within 40-60. At the end of surgery, patients were transported to the post anesthetic care unit (PACU) and agitation state scale was checked by Aono's four-point scale (AFPS). Emergence agitation was defined as and AFPS score of 3 or 4. Pain score were measured by numeric rating scale (NRS) on arrival and peak value at PACU. Results: Nine (45.0%) patients in the sevoflurane group and 2 (10.0%) patients in the propofol group developed emergence agitation in the PACU (P = 0.031). There was no correlation between peak NRS and Aono's four-point scale. Conclusions: Propofol may decrease incidence of emergence agitation compared to sevoflurane in adults under going closed reduction of nasal bone fracture. (Korean J Anesthesiol 2012; 63: 48-53)

We have studied the mechanism of Bragg diffraction in electrooptic thin-film lightguides and examined in effectiveness of interaction between the electric field and optical field. Expressions for the full detail the deflection voltage and the power per bandwidth are obtained and applied to various modulator structures using out-diffused, metal-diffused, epitaxial, and sputtered-film (electrooptic substrate) waveguides. An expression for minimum interaction length to ensure better than 30-dB extinction ratio is derived. The theoretical results are checked with experimental observations from an electrooptic substrate modulator we fabricated, and good agreement is obtained.

Background: Inhalation induction with desflurane can cause airway irritability and sympathetic stimulation. The aim of this study was to investigate whether lidocaine and fentanyl could reduce these unwanted reactions. Methods: Seventy-five patients who had premedication with midazolam were randomly allocated to one of three groups to receive intravenous saline (S group), lidocaine 1.5 mg/kg (L group), fentanyl 1 μg/kg (F group), respectively, before tidal volume induction with desflurane in oxygen and nitrous oxide. We recorded airway irritability such as cough, apnea, laryngospasm and excitatory movement and hemodynamic changes. Results: Airway irritability was not significantly different between the groups. In F group, mean blood pressure at LOC ver and LOC BIS and heart rate at LOC ver, LOC BIS and just before intubation were lower than those of S group (P ＜ 0.05). Other results were not significantly different. Conclusions: The results of the study showed that intravenous fentanyl and lidocaine had no beneficial effects to reduce airway irritability, but intravenous fentanyl could significantly reduce hemodynamic stimulation during inhalation induction with desflurane in the patients who were premedicated with midazolam. (Korean J Anesthesiol 2009; 57: 693∼7)

Background: Many studies have suggested that propofol in combination with remifentanil may provide adequate conditions for tracheal intubation without the use of muscle relaxants. Other hypnotic drugs have not been thoroughly investigated in this regard. The goal of our study was to evaluate the effect of thiopental, propofol or etomidate on tracheal intubating conditions and hemodynamic changes using remifentanil in the absence of muscle relaxants. Methods: A total of 45 healthy adults were divided randomly into three groups. After iv lidocaine 1.5 mg/kg, thiopental 5 mg/kg (thiopental group) or propofol 2.5 mg/kg (propofol group), or etomidate 0.4 mg/kg (etomidate group) were injected. After the injection of study drugs, remifentanil 2 mcg/kg was administered. Ninety seconds after the administration of remifentanil, laryngoscopy and intubation were attempted. Intubating conditions were assessed and the mean arterial pressure and the heart rate was measured. Results: There were no significant differences in intubating conditions between patients in the three groups. The heart rate was significantly lower in the propofol and etomidate group patients when compared to the thiopental group patients after anesthetic induction. The mean arterial pressure was significantly lower in the propofol group patients when compared to the thiopental and etomidate group patients. Both heart rate and mean arterial pressure after tracheal intubation were significantly elevated in etomidate group patinets when compared to their preintubation value. Conclusions: The use of thiopental 5 mg/kg, propofol 2.5 mg/kg, and etomidate 0.4 mg/kg did not differ in effect under intubating conditions for tracheal intubation using remifentanil in the absence of muscle relaxants. Thiopental provided the best

Spontaneous intracranial hypotension due to spinal cerebrospinal fluid leakage is uncommon, relatively benign and usually self-limiting. However it is being increasingly recognized as a cause of postural headaches. The treatment options range from conservative supportive measures to an pidural blood patch. We report a 40-year-old woman who developed intracranial hypotention without any preceding events such as lumbar puncture, back trauma, surgical procedures or medical illnesses. The site of the cerebrospinal fluid leakage was identified at between the C1 to C2 level using computerized tomographic myelography. Consequently, the patient underwent a CT-guided autologous epidural blood patch at the C3-C4 level. Her symptoms were relieved immediately without recurrence.

Background: Angiotensin-converting enzyme inhibitors (ACE-I) have been widely used for cardiac patients. This study investigated the effect of omitting ACE-I medication on hemodynamics during induction of anaesthesia and operation in patients chronically treated with ACE-I undergoing off pump coronary artery bypass graft surgery (OPCAB). Methods: Sixty patients scheduled for OPCAB were included in this study. Patients not treated with ACE-I were included in control group (Group 1, n = 20). And then, patients treated with ACE-I more than 4 weeks were randomly divided into two groups: continuing group including patients who continued ACE-I medication until the morning of surgery (Group 2, n = 20) and discontinuing group including patients who discontinued ACE-I one day before the surgery (Group 3, n = 20). Norepinephrine (8μg/ml) was infused when systolic blood pressure decreased below 90 mmHg during induction and operation. Amount of norepinephrine infused and hemodynamic data were recorded. Results: Significantly larger amount of norepinephrine was infused in Group 2 than in other two groups during obtuse marginal artery anastomosis. Total amount of norepinephrine infused during the all coronary anatsomosis was significantly larger in Group 2 than those values in other two groups. Conclusions: Continuing ACE-I treatment until the morning of surgery significantly increased the use of norepinephrine during the anastomosis. In contrast, there was no significant difference in the use of norepinephrine between Group 1 and Group 3. Discontinuing ACE-I before the surgery may helpful to maintain hemodynamics stable during coronary anastomosis in OPCAB. (Korean J Anesthesiol 2007; 52: 34～41)

In this case, a successful mitral valve repair was confirmed by transesophageal echocardiography (TEE) at the end of a cardiopulmonary bypass. The left ventricular vent was placed through the mitral valve to remove the air after the TEE examination, and on its way out, the left ventricular vent damaged the anterior mitral leaflet (AML). Re-examination of the valve with TEE detected the new mitral valve insufficiency. The CPB was reinstituted, and tearing of the lateral third part of the anterior mitral leaflet was found. This case emphasizes the importance of TEE in the operating room as a continuous monitor, not only to evaluate the result of the cardiac surgery, but also to detect any unpredictable events during the surgery.

Background: Although controlled ventilation can shorten the induction time during vital capacity inhalation induction (VCII) with sevoflurane, it may associated with decrease in blood pressure and hyperventilation-related hyperdynamic responses such as hypertension and tachycardia. This study was designed to compare the clinical effects between controlled ventilation (CV) within acceptable ranges of PET and spontaneous breathing (SB) during VCII. Methods: 100 patients were randomly allocated to the one of two groups. After the loss of consciousness during VCII with sevoflurane, controlled ventilation was applied in CV group within acceptable ranges of PET and spontaneous breathing was maintained in SB group. Alfentanil 4 mcg/kg was given i.v. 2 minutes prior to intubation. PET, mean arterial pressure (MAP), heart rate (HR), , and BIS were measured at 1, 2 and 3 minute after the loss of consciousness (LOC). Clinical side effects were evaluated. Results: MAP and HR were significantly decreased and increased in CV group compare to the baseline values at 1 minute after LOC. There were statistical differences of MAP and HR between two groups at 1 and 2 minutes after LOC. 46 of 50 (92%) showed delayed expiration with holding their breath >20 s in SB group. No differences of other clinical side effects except hypotension between two groups. Conclusions: We conclude that spontaneous breathing provides a stable hemodynamic status and relatively acceptable ventilation profile compare to controlled ventilation during VCII.

Background: Modified ultrafiltration (MUF) has been demonstrated to have beneficial effects in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). In adults, the hemodynamic effects of MUF are little known. The purpose of this investigation is to evaluate the hemodynamic effects of MUF in adult patients undergoing valvular heart surgery. Methods: 30 patients scheduled for elective mitral valvular surgery were randomized into either Ultrafiltration (U) or Control (C) group. In the U group, MUF was performed just after termination of CPB for 20 minutes, and not in the C group. Measurements of hemodynamic variables including right ventricular ejection fraction (RVEF) measured by thermodilution technique and hematocrit were performed before induction, just after termination of CPB, after completion of MUF and after sternal closure. Measurement after MUF in the C group was performed at 20 minutes after the termination of CPB. After transfer to ICU, same measurements were performed at postoperative 6 and 12 hrs. Results: After MUF, RVEF (P

Background: Postoperative nausea and vomiting (PONV) continues to be a common complication of surgery and patients report that avoidance of PONV is of greater concern than avoidance of postoperative pain. The overall incidence of postoperative nausea and vomiting has been reported to be in the 20-30%. The incidence of PONV in the recovery room was 9-10% but it was increased 30% during the first 24 hours after surgery. This retrospective study was designed to find the incidence of PONV in immediate postanesthetic period as well as the difference in incidence of PONV due to gender, age, duration of surgery, different inhalation agents and method of patient controlled analgesia. Methods: The anesthesia and postanesthesia records for 12,895 patients receiving surgery under general and regional anesthesia between September 2001 and August 2002 one year were retrospectively reviewed. Results: The overall incidence of nausea, vomiting and nausea/vomiting (either nausea, vomiting or both) in immediate postanesthetic period was 1.5%, 2.0% and 2.9% of patients, respectively. The incidence of nausea, vomiting and nausea/vomiting in immediate postanesthetic period was significantly higher in female than in male, general anesthesia with enflurane than with sevoflurane or isoflurane, and patients receiving patient controlled analgesia (PCA) via intravenous route than via epidural route. The incidence of nausea, vomiting and nausea/vomiting in immediate postanesthetic period was significantly lower in surgery duration less than 60 minutes. Conclusions: Patients with female gender, intravenous PCA and under enflurane anesthesia had significantly higher incidence of nausea, vomiting and nausea/vomiting in immediate postanesthetic period.

Infection of pacemaker electrode is one of the most frequent causes for the removal of the permanent cardiac pacemaker electrode and it is dangerous to remove the infected electrode by external traction method because the electrode is adhered to the myocardium. In this case, surgeon tried to remove infected cardiac pacing electrode using continuous external traction method. Myocardial rupture and consequent cardiac tamponade suddenly developed because the electrode was pulled by force. Emergent cardiopulmonary bypass was initiated and then, ruptured myocardium was repaired and the remaining electrode was removed without remarkable complications. This case emphasizes the risk of the myocardial rupture and the importance of preparing for emergent situation which can occur during the removal of the permanent pacemaker electrode, especially when the reason for the removal is the infection.

Background: This study examined the effect of chronic preoperative ACEI treatment on hemodynamics and the amount of vasoconstrictor used to maintain mean arterial pressure (MAP) during off-pump coronary artery bypass surgery (OPCAB) Methods: Sixty patients undergoing OPCAB were divided into two groups: ACEI group, in which patients were treated with ACEI preoperatively (n = 30) and control group, in which patients were not treated with ACEI preoperatively (n = 30). Norepinephrine was infused when MAP decreased below 70 mmHg during operation. Hemodynamic variables and amount of norepinephrine infused were obtained during pericardiotomy and during the anastomosis of each coronary artery including left anterior descending artery (LAD), obtuse marginal artery (OM) of left circumflex coronary artery, and posterior descending artery (PDA) of right coronary artery. Results: During LAD, OM, and PDA anastomosis, cardiac index and mixed venous oxygen saturation were decreased and central venous pressure and systemic vascular resistance index were increased significantly in both group. There was no significant difference in hemodynamic variables, including MAP, between two groups during all study period. During OM anastomosis, amount of norepinephrine infused to maintain MAP was significantly greater in ACEI group than in control group Conclusions: Preoperative treatment with ACEI significantly increased amount of vasoconstrictor used to maintain target MAP during OM anastomosis, which has been known as hemodynamically unstable period during OPCAB, and cautious management is required to maintain MAP.

Background: Myofascial pain syndrome is characterized by the presence of hypersensitive points, called 'trigger points'. Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. Numerous therapeutic approaches have been used to treat myofascial pain syndrome. An acupotomy has been applied for various pain conditions in China since the 1980's. This investigation evaluated the efficacy of an acupotomy in myofascial pain syndrome. Methods: Twenty females, with myofascial pain syndrome on trapezius muscle, were treated with an acupotomy. The pretreatment resting and pressing on pain site visual analog scores (VAS) were compared with those 7 days post-treatment. At the same time, the effects of the acupotomy were graded as almost complete pain relief, good relief, slight relief, no change or aggravation at 7 and 14 days post-treatment. Results: The pre-treatment resting and pressing on the pain site mean VAS were 7.2 and 9.2, respectively. The post-treatment resting and pressing on pain site mean VAS decreased significantly to 1.0 and 2.8, respectively (P

Experimental demonstration of electrooptic polarization conversion from a guided TE wave to an unguided TM wave in a thin-film light guide is reported. In the specific device we fabricated utilizing Ta 2 O 5 film and LiTaO 3 substrate, we have observed a 40-percent modulation when 500 V were applied across two electrodes spaced 50 μm apart. We present here a ray-optics analysis of the conversion process. With the inclusion of the Goos-Haenchen shifts, the analysis agrees well with the experiment.

A technique is reported which allows formation of a light‐guiding Ta2O5 film onto an electro‐optic LiTaO3 crystal. We find it necessary to have an isolation layer (a 144‐A SiO2 layer in our case) between the Ta film and the substrate in order to prevent interactions between them during thermal oxidation of the Ta film. Possible applications of the structure to thin‐film electro‐optic and acousto‐optic devices are examined.