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BACKGROUND Relative to interscalene block, superior trunk block (STB) provides comparable analgesia and a reduced risk of hemidiaphragmatic paralysis. However, the incidence of hemidiaphragmatic paralysis remains high when a standard volume (15 mL) of local anesthetic is used. This study aimed to evaluate the effects of local anesthetic volume of STB on the incidence of phrenic nerve palsy, as well as its analgesic efficacy following arthroscopic shoulder surgery. METHODS Patients scheduled for elective arthroscopic shoulder surgery were randomized to receive ultrasound-guided STB using either 5- or 15-mL 0.5% ropivacaine before general anesthesia. The primary outcome was the incidence of hemidiaphragmatic paralysis at 30 minutes after block. The secondary outcomes were pulmonary function, grade of sensory and motor blockade, pain score, opioid consumption, adverse effects, and satisfaction. RESULTS Relative to standard-volume STB, low-volume STB was associated with a lower incidence of hemidiaphragmatic paralysis after block (14.3 [4.8%-30.3%] vs 65.7 [46.8%-80.9%]; difference 51.4% [95% confidence intervals {CIs}, 29.0%-67.1%]; P < .0001) and at the postanesthesia care unit (9.4% vs 50.0%; difference 40.6 [95% CI, 18.9%-57.7%]; P = .0004). Pulmonary function was also better preserved in the low-volume group than in the standard-volume group. The extent of the sensory and motor blocks was significantly different between the groups. Pain-related outcomes, satisfaction, and any adverse events were not significantly different between the groups. CONCLUSIONS Low-volume STB provided a lower incidence of hemidiaphragmatic paralysis with no significant difference in analgesic efficacy relative to standard-volume STB for arthroscopic shoulder surgery.

Background In contrast to interscalene block, there was little information regarding the analgesic efficacy of supraclavicular block for shoulder surgery. This study aimed to compare the analgesic efficacy and side effects of interscalene and supraclavicular blocks for shoulder surgery. Methods Patients scheduled for shoulder surgery were assigned to receive either ultrasound-guided interscalene (n = 25) or supraclavicular block (n = 24) with 20 ml of 0.375% ropivacaine. We assessed the duration of post-operative analgesia as a primary outcome and pain scores, supplemental analgesia, diaphragmatic excursion, motor block, fingertip numbness, side effects, and patient satisfaction as secondary outcomes. Results The duration of post-operative analgesia was not statistically different between groups: 868 (800–1440) min for supraclavicular block vs. 800 (731–922) min for interscalene block (median difference −85 min, 95% CI, −283 to 3 min, P = 0.095). The incidence of diaphragmatic paresis was significantly lower in the supraclavicular block group compared with that in the interscalene block group, both at 30 min after the block (66.7% vs. 92%, P = 0.021) and in the post-anaesthesia care unit (62.5% vs. 92%, P = 0.024). Motor block was higher in the supraclavicular block group in the post-anaesthesia care unit, however, not at 24 h. Other secondary outcomes were similar for both groups. Conclusions This study showed no statistically significant difference in the duration of post-operative analgesia between the supraclavicular and interscalene blocks. However, the supraclavicular block was associated with a lower incidence of diaphragmatic paresis compared with that of the interscalene block after shoulder surgery.

Detrusor overactivity (DO) persists after prostatectomy in 20% to 25% of patients with benign disease. Assuming that nonvoiding contractions (NVCs) can be used as a surrogate for DO in humans, the rat model of obstruction/deobstruction may allow us to study the pathophysiology of persistent DO after deobstruction. We investigated bladder function, with a special focus on NVCs, in rats by use of a new, modified method of obstruction and deobstruction and compared these results with those obtained by use of the conventional method. Seventy female Sprague-Dawley rats underwent 1) sham operation ( n = 10), 2) obstruction by a modified method (Modif-Obs; n = 12), 3) obstruction/deobstruction by the conventional method (Conv-Obs/Deobs; n = 13), or 4) obstruction/deobstruction by the modified method (Modif-Obs/Deobs; n = 35). The Modif-Obs/Deobs animals were divided into subgroups with (DO+) and without (DO−) NVCs. Two weeks after partial urethral obstruction, the animals were deobstructed, and 1 wk later cystometry was performed with recording of intravesical and intra-abdominal pressures. NVCs were shown in all groups: Modif-Obs (80%), Conv-Obs/Deobs (100%), and Modif-Obs/Deobs (40%). In the Modif-Obs/Deobs group, bladder weight and the muscle-to-collagen ratio were higher in DO+ than in DO− rats. The Modif-Obs/Deobs group showed no mortality compared with 25% mortality in the Conv-Obs/Deobs group. The modified method may be more adequate for studying persistent DO after deobstruction, because it resulted in pressure/volume- and DO-related parameters similar to those found in the clinical situation. The persistence of DO after deobstruction may partly be due to irreversible changes in the bladder caused during the period of obstruction.

Study Objective To determine the most suitable effect-site concentration of remifentanil during lightwand intubation when administered with a target-controlled infusion (TCI) of propofol at 4.0 μ g/mL without neuromuscular blockade. Design Prospective study using a modified Dixon's up-and-down method. Setting Operating room of an academic hospital. Patients 28 ASA physical status 1 and 2 patients, aged 18-65 years, scheduled for minor elective surgery. Interventions Anesthesia was induced by TCI propofol effect-site concentration to 4.0 μ g/mL, and the dose of remifentanil given to each patient was determined by the response of the previously tested patient using 0.2 ng/mL as a step size. The first patient was tested at a target effect-site concentration of 4.0 ng/mL of remifentanil. If intubation was successful, the remifentanil dose was decreased by 0.2 ng/mL; if it failed, the remifentanil dose was increased by 0.2 ng/mL. Successful intubation was defined as excellent or good intubating conditions. Measurements and Main Results The remifentanil effect-site concentration was measured. The optimal effect-site concentration of remifentanil for lightwand tracheal intubation during propofol induction using 2% propofol target effect-site concentration to 4 μ g/mL was 2.16 ± 0.19 ng/mL. From probit analysis, the effect-site concentration of remifentanil required for successful lightwand intubation in 50% (EC50) and 95% (EC95) of adults was 2.11 ng/mL (95% CI 1.16-2.37 ng/mL) and 2.44 ng/mL (95% CI 2.20-3.79 ng/mL), respectively. Conclusion A remifentanil effect-site concentration of 2.16 ± 0.19 ng/mL given before a propofol effect-site concentration of 4 μ g/mL allowed lightwand intubation without muscle relaxant.

Introduction Correction of the congenital concealed penis is a difficult surgical challenge. Many techniques have been described for its treatment that differ according to the incision lines and covering techniques, but the results have generally been disappointing. We report a novel surgical technique for unfurling the inner prepuce and outer penile skin and thus obtaining sufficient penile skin coverage. Technical considerations Surgical techniques for correcting the concealed penis are aimed at freeing the penis from any tethering or webbing, providing adequate penile skin coverage and fixing the proximal penile skin to the underlying fascia to prevent the body of the penis from retracting and detaching from its overlying skin. The unfurling method we describe here consists of dividing the outer penile skin to the penile base bilaterally, with ventral and dorsal incisions of the inner prepuce in the midline, perpendicular to the incision of the outer skin. Conclusions This method is simple and provides a good blood supply to the flap. It appears to show good subjective and objective results, and no serious complications have developed.

Cerebellar hemorrhage occurs mainly due to hypertension. Postoperative cerebellar hemorrhage is known to be associated frequently with frontotemporal craniotomy, but quite rare with spine operation. A 56-year-old female received spinal fixation due to continuous leg tingling sensation for since two years ago. Twenty-one hours after operation, she was disoriented and unresponsive to voice. Performed computed tomography showed both cerebellar hemorrhage. An emergency decompressive craniotomy was carried out to remove the hematoma. On the basis of this case, we reported this complications and reviewed related literature.

This case report involves tracheal intubation using i-gel® in combination with a lightwand in a patient with a difficult airway, classified as Cormack-Lehane grade 3. I-gel® was used during anesthesia induction to properly maintain ventilation. The authors have previously reported successful tracheal intubation on a patient with a difficult airway through the use of i-gel® and a fiberoptic bronchoscope. However, if the use of a fiberoptic bronchoscope is not immediately available in a patient with a difficult airway, tracheal intubation may be performed by using i-gel® and a lightwand in a patient with difficult airway, allowing the safe induction of anesthesia.

We studied how hillock in Al film increases the contact resistance (RC) between bottom-side metal stacked (Al-Ti-TiN) and upper-side W-via-plugs in the backend-structure of the semiconductor. The general structure is the via-etch-stop-on-TiN (VEST), otherwise the via-etch-stop-on-Al (VESA) was observed on the hillocks. After metal etching, the sputtering as well as the deposition (DEPO) is conducted for IMD gap-filling in the FSG process. The sputtering makes the TiN surface with the hillock cliffy and the TiN cannot take a role of the Al capping layer from via etching. We found that the oxidation of Al below recessed TiN is the main cause of the high RC. To prevent the hillock, the metal DEPO temperature is increased and the temperature of metal-etch-mask-oxide is decreased. Furthermore, the thickness of TiN increased for relieving clipping from the FSG process. Thanks to those actions, we could completely overcome the high RC issue caused by the hillock.

Different from the conventional study to improve the pad reliability against the peel-off, this study focuses on the probability that the peel-off could be originated from the perpendicular pushing down mechanical stress (PPMS) during the ball mounting process. Suggested in this paper are a new model which causes the peel-off and a new pad structure that overcomes the pad peel-off without any special procedures or changes in material or dimension. Three sets of layout patterns have been designed and fabricated in a 0.13 µm CMOS process. To assess the wire bonding quality, wire pulling tests (WPT) and evaluation of bonding power dependencies by means of wedge wire bonding are conducted. Additionally, FAMMOS simulator is adopted to verify the newly proposed pad structure.

PURPOSE The urodynamic effects of intravesical PGE2 instillation on bladder function and detrusor overactivity (DO) during the filling phase were investigated in rats by measuring intraabdominal and intravesical pressures simultaneously. MATERIALS AND METHODS Continuous cystometry was performed inconscious, female and male Sprague- Dawley rats. We investigated pressure-, volume-, and DO-related parameters. RESULTS Intravesical instillation of PGE2 increased all pressure-related parameters and decreased volume-related ones, compared to the control cystometric ones. However, among the total number of intravesical pressure rises (IVPRs) above 2 cmH(2)O during the filling phase, only 33% in female rats and 38% in male rats after PGE2 instillation were identified as true DO during the filling phase. CONCLUSIONS Our findings suggest that the rat model with intravesical PGE2 is inappropriate for observing the effects of some drugs or mechanisms on DO, because only approximately 30% of IVPRs were confirmed as true DO. However, this model of intravesical PGE2 instillation has some advantages for the observation of changes in pressure and volume parameters rather than in DO-related ones.

PVC (Passive Voltage Contrast) fault isolation method by using a SEM (Scanning Electron Microscope) has been widely used for isolating the defective mc (metal contact) in the CMOS logic SRAM bit cell array. The low power (LP) processed sram cells are easy to charging under PVC test and it helps isolating defective contacts in the cell. However, some device such as a high speed (HS) sram cell is hard to charging in PVC test by unknown reason. It makes difficulties for isolating defective contacts in the sram cell array. In this paper, our group analyzed the electrical current of each contact in sram cell using a nanoprobing technique and correlated it with PVC charged contact images, respectively. Also, the difference of PVC charging status between LP and HS SRAM are characterized electrically by using a nanoprober. The nanoprobing result indicates that a slight increasing a leakage current of about 10pA can abruptly change the charging brightness from dark to grey. Finally, we can found some clues for making grey contacts of HS SRAM using not only a nanoprobing but also a HRTEM (High Resolution Transmission Electron Microscope) image.

Central vein catheterization is a common procedure for monitoring the central venous pressure, securing vascular access, administrating vasoactive drugs and removing air embolisms. However, many complications can occur, such as vessel injury, pneumothorax, hydrothorax, nerve injury, arrhythmia and infection at the insertion site. We encountered an unusual complication of a localized right hydrothorax that was initially misinterpreted as an atelectasis after left internal jugular vein catheterization and right lateral positioning for a left lower lobectomy.

We have firstly demonstrated a hybrid flash including both NOR and NAND cell in a single chip using 90 nm logic technology for S-SIM (Super-Subscriber Identity Module) application. The memory sizes are 16 MB NAND and 768 kB NOR flash, respectively. The flash memory cells exhibited over 10 k-cycle endurance and 10-year retention for the successful smart card application.

We have suggested 2T-Flash cell design methodology to achieve high performance even at sub-90 nm technology nodes for embedded SOC applications (eNVM) and demonstrated by 8x8 array cells. By adopting two different transistors' channel width and boosted gate biasing and new tunnel oxide, current performance increase more than 20%. The fabricated devices also meet 500K endurance and 10 years retention characteristics for smart card application.

Although heparin is better known as an anticoagulant, it also has several anti-inflammatory effects. Heparin is known to inhibit neutrophil adhesion, chemotaxis and oxygen free radical production. In addition, heparin is also known to act as an oxygen radical scavenger. Our hypothesis was that heparin would attenuate renal ischemia reperfusion injury. In this study, we investigated whether heparin had a protective effect on renal ischemia reperfusion injury. Sheep (n = 12) were prepared for the chronic study with venous, arterial and urinary catheters inserted. In addition, pneumatic occluders and ultrasonic flow probes were placed on renal arteries. After a 5-day recovery period, the sheep were randomized to either a heparin treatment group (400 IU/kg i.v. bolus 10 minutes before renal artery occlusion, followed by a continuous effusion 25,000 IU in 250 ml of 0.9% NaCl at 10 ml/hr, n = 6) or a control group (n = 6), which received an equivalent volume of 0.9% NaCl. All the sheep then underwent 90 minutes of bilateral renal ischemia followed by 24 hours of reperfusion. Blood urea nitrogen (BUN), serum creatinine (Scr), and creatinine clearance (CrCl) were determined at various intervals during both the ischemic and reperfusion periods. Kidney tissue samples were obtained at autopsy for histologic examination. As a result, there were significant differences in the degree of inflammation (1.50 +/- 1.24 Vs 0.50 +/- 0.79, P < 0.05) between the control and heparin treatment groups, but not in the degree of injury (2.83 +/- 0.44 Vs 2.33 +/- 0.28). In this study, heparin significantly attenuated polymorphonuclear leukocytes (PMNs) infiltration within the interstitium, but it did not affect the degree of renal damage as measured by urinary chemistries or renal tubular damage as assessed by histopathologic evaluation.

The spine surgery performed in the prone position could cause severe complications such as visual acuity impairment, spinal infarct and rhabdomyolysis. When treating rhabdomyolysis, it is important to prevent acute renal failure from accompanying rhabdomyolysis due to the poor prognosis. We have experienced two cases of rhabdomyolysis after spine surgery where dark urine was present during spine surgery under general anesthesia. Anesthesiologists should pay attention for early diagnosis and treatment of the rhabdomyolysis developing during the spine surgery.

Background: We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.5% levobupivacaine and 0.5% ropivacaine for upper limb surgery. Methods: We included 60 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.5% levobupivacaine or 0.5% ropivacaine. We observed which nerve type was stimulated and scored the sensory and motor block. The quality of block was assessed intraoperatively. The duration of sensory and motor block and complications were assessed. Results: There were no significant differences in frequencies of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant difference in duration of sensory block, but duration of motor block was prolonged after 0.5% levobupivacaine. There were no complications. Conclusions: Both 0.5% levobupivacaine and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block. (Korean J Anesthesiol 2009; 56: 162~8)

Various methods of infraclavicular brachial plexus block have been introduced in the past, of which Wilson's coracoid infraclavicular brachial plexus block, a more lateral approach, consequently thought to be easier and safer. While only a few cases of transient ipsilateral phrenic nerve palsy after infraclavicular brachial plexus block have been reported, we describe a rare case of phrenic nerve palsy after Wilson's coracoid infraclavicular brachial plexus block.

Right internal jugular vein catheterization is performed frequently as central venous catheterization by the landmark method. This procedure, however, might prove difficulty due to anatomic variations or thrombosis of internal jugular vein. We failed to catheterize right internal jugular vein by the landmark method in 70-year-old female patient. And then, we detected right internal jugular vein thrombosis by ultrasound scan. Left internal jugular vein catheterization was performed by the ultrasound guided technique. Central venous catheterization has possibility to fail despite several attempts by the landmark method. Then, ultrasound guided approach is a good choice to aid central venous catheterization when difficulties or complications have been encountered.

Anaphylaxis is one of major causes of morbidity and mortality during anesthesia. Muscle relaxants are the most common cause of anaphylaxis during anesthesia. A 54-year-old woman was scheduled for thyroidectomy. She had no history of allergy and had never previously undergone general anesthesia, Lidocaine, propofol and vecuronium were injected sequentially to induce general anesthesia. Two minutes after the vecuronium injection, severe hypotension, tachycardia and bronchospasm developed, and delayed skin rashes appeared. The patient recovered without any significant complications after immedi ate proper intensive care. The operation was delayed and a skin test was performed on the 7 th day after discharge. She revealed a positive skin test for vecuronium. The anesthesia was re-induced without muscle relaxant and maintained with propofol and remifentanil infusion. Surgery was completed uneventfully, and the patient recovered without any adverse reaction. (Korean J Anesthesiol 2008; 55: 613～7)

Iatrogenic vertebro-vertebral arteriovenous fistula (AVF) is an uncommon complication resulting from various procedures such as central venous catheter insertion. The incidence may be underestimated since the diagnosis is not easy because of its rarity. A central venous catheterization via the internal jugular vein was attempted in a 43-year-old female who presented for intracranial aneurysmal clipping under general anesthesia. Inadvertent arterial puncture was recognized as pulsatile arterial blood flow through the needle. The needle was removed and local compression was applied to the puncture site. The catheter was inserted via the right femoral vein. After surgery, the patient recovered from anesthesia without any complications. On postoperative day 5, thrill and bruit on the right side of the neck were noted on physical examination. Angiography confirmed vertebro-vertebral AVF, which was successfully obliterated with a stent 3 months later.

Background: The effect of a single nucleotide polymorphism (SNP) of the μ-opioid receptor gene at nucleotide position 118 (OPRM1:118A ＞ G) and the MDR1 gene (exon 26: C3435T) have an influence on the interindividual variability of clinical opioid pain therapy. This study aims to evaluate the correlation among pain control and side effects of epidural morphine and these pharmacogenetic modulators. Methods: 194 patients who were undergoing abdominal surgery were included in the study. Patients received a morphine 2 mg bolus and 2 mg/day via epidural route. The VAS score and opioid side effects were checked at postoperative 6, 24 and 48 hr. Patients were genotyped for the known SNPs of the OPRM1 and MDR1. Results: For the SNP of OPRM1, the mutated genotype frequency (homo-wild, heterozygous, and homo-mutants) were 36.8, 47.9 and 15.3%, respectively, and the mutated genotype frequencies for the MDR1 SNP were 46.7, 40.2 and 13.1%, respectively. There were no significant differences in the VAS scores and side effects among the three groups of OPRM1 and MDR1. Yet carriers of the mutated allele 3435 TT, CT of the MDR1 gene showed marginally greater significant sedation effects than did non-carriers (CC) (P = 0.065, the OR was 1.78, 95% CI 0.98-3.24, P = 0.059) and also a lower incidence of analgesic usage (P =0.058). Conclusions: In our data there was a large difference in OPRM1 SNP allele frequency for the Korean population compared to other populations. The SNP of OPRM1 and MDR1 genes did not have significant altered clinical morphine analgesia and side effects via the epidural route. But the SNP of MDR1 gene is more sensitive genetic predictor of the clinical side effects (especially for sedation) and analgesic effects by opioid. (Korean J Anesthesiol 2007; 52: 16~22)

Background: A correlation between a T-type voltage activated calcium channel (VACC) and pain mechanism has not yet been established. The purpose of this study is to find out the effect of ethosuximide and mibefradil, representative selective T-type VACC blockers on postoperative pain using an incisional pain model of rats. Methods: After performing a plantar incision, rats were stabilized on pl astic mesh for 2 hours. Then, the rats were injected with ethosuximide or mibefradil, intraperitoneally and intrathecally. The level of withdrawal threshold to the von Frey filament near the incision site was determined and the dose response curves were obtained. Results: After an intraperitoneal ethosuximide or mibefradil injection, the dose-response curve showed a dose-dependent increase of the threshold in a withdrawal reaction. After an intrathecal injection of ethosuximide, the threshold of a withdrawal reaction to mechanical stimulation increased and the increase was dose-dependent. After an intrathecal injection of mibefradil, no change occurre d in either the threshold of a withdrawal reaction to mechanical stimulation or a dose-response curve. Conclusions: The T-type VACC blockers in a rat model of postoperative pain showed the antihyperalgesic effect. This effect might be due to blockade of T-type VACC, which was distributed in the peripheral nociceptors or at the supraspinal level. Further studies of the effect of T-type VACC on a pain transmission mechanism at the spinal cord level would be needed. (Korean J Pain 2007; 20: 92�� 99)

Combination of propofol and remifentanil is an ideal regimen for total intravenous anesthesia, and the bispectral index (BIS) has been used as an indicator of the sedative state during anesthesia. This study examined the effect of remifentanil on the mean arterial pressure (MAP), heart rate (HR) and BIS to laryngoscopy and tracheal intubation with 4μg/ml of fixed target effect-site concentration infusion of propofol. Methods: In this double-blind study, fifty-one ASA physical status I-II patients, aged 20−60 yr undergoing elective surgery were randomly assigned to one of four groups according to the target effect-site concentration of remifentanil (0, 2, 3, 4 ng/ml). The target-controlled infusion (TCI) of remifentanil was initiated after the effect-site concentration of propofol was maintained with 4μg/ml. After target effect-site concentration of remifentanil was reached, a neuromuscular blockade was produced by rocuronium 1 mg/kg and tracheal intubation was performed after 90 seconds. MAP, HR and BIS were measured at pre-induction, after reaching target effect-site concentration of propofol and remifentanil, before and after tracheal intubation. Results: The changes of MAP, HR and BIS after tracheal intubation were negatively correlated with remifentanil effect-site concentration. Conclusions: Remifentanil attenuated the hemodynamic responses due to tracheal intubation and decreased BIS after tracheal intubation in a comparable dose-dependent fashion.

The electrical properties of a split-gate-type flash cell are investigated and optimized by junction engineering to obtain a high reliability. Phosphorus implantation is conducted to form a cell source junction, and the following three different anneal conditions change voltage coupling ratio between the source and the floating gate. As the ratio increases, it is observed that program characteristic is improved and endurance property is degraded, which matches well with simulation result. Therefore, cells in the pure N2 group are considered to be optimized cells. Optimized cells guarantee 105 cycle endurance, and show excellent program disturbance and bake retention properties.

Stellate ganglion block, due to its wide range of indications, is the most widely practiced procedure in pain clinics. We experienced the case of a 44-year-old female patient who developed prolonged Horner’s syndrome after the use of stellate ganglion block. The patient recovered spontaneously from the Horner’s syndrome after 12 months. If Horner’s syndrome should occur, its etiology will need to be assessed. It is also important to assure the patient they will recover from the complication within a year.

Background: BIS monitoring has been found to decrease the requirements for volatile anesthetics and to improve recovery. We wanted to assess the effect of BIS monitoring on intraoperative sevoflurane consumption, early recovery profile, and on postoperative nausea and vomiting. Methods: Forty ASA class 1 or 2 female patients undergoing mastectomy or thyroidectomy were studied. General anesthesia was induced with propofol (2.0 mg/kg) and fentanyl (/kg), and maintained with 50% nitrous oxide-oxygen and sevoflurane inhalation. In the control group, sevoflurane was administered according to standard clinical practice. In the BIS group, sevoflurane was titrated to maintain a BIS value between 40 and 60 during surgery and of more than 65 during the last 15 minutes prior to the end of surgery. Sevoflurane consumption was measured. Time to response, time to self respiration, time to extubation, and time to orientation were recorded. Postoperative nausea and vomiting were evaluated by incidence and by using a visual analogue scale (VAS). Results: Sevoflurane consumption in the BIS group was 30.4% lower than in the control group (P ＜ 0.05). All recovery times were significantly shorter in the BIS group than in the control group (P ＜ 0.05), but, no differences in postoperative nausea and vomiting were observed between the groups. Conclusions: BIS monitoring decreased and sevoflurane consumption and promoted early recovery. But BIS monitoring did not decrease postoperative nausea and vomiting.

Background: Laryngoscopy and tracheal intubation often provoke an undesirable increase in blood pressure and heart rate. This study was done to determine median effective dose (ED50) of nicardipine for prevention of hemodynamic response to tracheal intubation during induction of anesthesia with thiopental, propofol, or etomidate. Methods: Fourty-five ASA physical status 1 adult patients were allocated into three group; thiopental group (n = 15), propofol group (n = 15), and etomidate group (n = 15). The first patient of each groups received 10/kg of nicardipine 1 minute before induction. Subsequent dose was determined by the hemodynamic response of the previous patient to tracheal intubation based on Dixon's up and down sequential allocation. The test dosing interval was set at 3/kg. If mean arterial pressure increased more than 20% after tracheal intubation, dose of the subsequent patient was increased by 3/kg. If not, it was decreased by 3/kg. Blood pressure was measured after arrival at the operating room, before tracheal intubation, and 1, 2, 3, 4, and 5 minutes following intubation by non invasive method. Results: ED50 of nicardipine for attenuation of hypertensive response after tracheal intubation were 18.0/kg (95% Confidence Limit [CL], 14.8-22.0/kg), 6.2/kg (CL, 2.6-9.5/kg), and 16.7/kg (CL, 13.6-20.7/kg) in thiopental group, propofol group and etomidate group, respectively. Conclusions: We concluded that less nicardipine dose in propofol group was needed to prevent hypertensive response after tracheal intubation (P

Background: Postoperative nausea and vomiting remain a common problem following gynecologic surgery. This study was designed to compare antiemetic effects and to establish optimal doses for dexamethasone and ondansetron for the prevention of postoperative nausea and vomiting (PONV) during intravenous patient-controlled analgesia after gynecologic surgery. Methods: One hundred and fifty ASA 1-2 patients undergoing elective gynecologic surgery were included. Patients were randomly divided into six groups and received a placebo (group C), dexamethasone 4 mg (group D4), dexamethasone 8 mg (group D8), ondansetron 4 mg (group O4), ondansetron 8 mg (group O8) or dexamethasone 4 mg plus ondansetron 4 mg (group D4O4) after induction. Postoperatively, nausea, vomiting, VAS pain score, headache and itching were recorded in the recovery room (2 h after operation) and in the hospitalization area (12, 24 and 48 h after operation). Results: Group C showed a significantly higher incidence of nausea (56%) and vomiting (32%) than group D4 (nausea: 20%, vomiting: 4%), D8 (nausea: 20%, vomiting: 4%), O4 (nausea: 12%, vomiting: 4%), O8 (nausea: 12%, vomiting: 0%) and D4O4 (nausea: 20%, vomiting: 4%). No differences in the incidence of nausea and vomiting were observed between groups D4, D8, O4, O8 and D4O4. Pain score, total analgesic consumption, duration, and side effects were similar in the groups. Conclusions: Dexamethasone 4 mg, dexamethasone 8 mg, ondansetron 4 mg, ondansetron 8 mg, and dexamethasone 4 mg plus ondansetron 4 mg were found to be equally effective at preventing PONV following gynecological surgery. Dexamethasone was as effective as ondansetron for the prevention of PONV after gynecologic surgery.

Background: It is well known that the level of lactate increases in wounds, which is not necessarily caused by a limitation of oxygen delivery, so may not primarily indicate ischemia. In this study, we measured the time course of the changes in the concentrations of lactate produced by incisions at 3 different sites (hind paw, gastrocnemius muscle and paraspinal area) in order to find factors that may activate and sensitize the nociceptors at the incision sites. Methods: Incisions were made in either one side of plantar aspect of hind paw, paraspinal area or gastrocnemius muscle. The other side of each rat received a sham incision. Microdialysis fibers were inserted into the incisional area and sham incisional side of each rat on postoperative days 0, 1, 2, 4, 7 (8), 10 and 14. The concentrations of tissue lactates were then measured and compared. Results: In the hind paw, the concentration of tissue lactate increased on the day of incision and on postoperative days 1 through 7, but was no different to that of the control paw on days 10 and 14. In the gastrocnemius muscle, the lactate concentration increased on postoperative days 1 through 4, and the paraspinal lactate also increased on the day of incision and on postoperative days 1 through 8, but had normalized by postoperative day 14. Conclusions: These data suggest that tissue lactate level increases after incisions, and is in part, parallel to the pH and pain behaviors caused by the incisions. Together, high lactate and low pH may contribute to incisional pain.

Background: There is a suggestion that tissue acidosis may contribute to the induction of pain in inflammation and ischemia. High local proton concentrations have been found in painful inflammatory and ischemic conditions. We assessed tissue pH and pain behavior in a rat model for postoperative pain. Methods: An incision of skin, fascia, and muscle was performed in the right foot. Pain behaviors to von Frey, blunt probe stimulation, and resting pain were evaluated on the incised feet. Then tissue pH was measured in each of the five rats at 4 hours, 1, 2, 4, and 7 days after incision. Results: The withdrawal threshold to von Frey was decreased, the response frequency to blunt probe and pain scores were elevated from 4 hours to 1-2 days after the incision. The deep tissue pH decreased from pH 7.16 in sham to pH 6.95, 6.90, 6.89, and 6.95 at 4 h and 1, 2, and 4 days after incision respectively. Conclusions: In this study, the tissue pH of the wound decreased after surgery. However, the change of tissue pH was not always consistent with pain behaviors. Our results suggest that tissue acidosis may relate partially to the induction of pain after tissue injury.

There are a few case reports describing conversion to normal sinus rhythm after a propofol injection in tachyarrhythmic patients. We managed two cases of 52 year old males complaining of chest pain and dyspnea. We diagnosed them with atrial flutter and idiopathic ventricular tachycardia respectively. Initially they were treated with antiarrhythmic drugs but conversion to normal sinus rhythm was not achieved. Therefore, we decided to use electrical cardioversion. For sedation during electrical cardioversion, we injected propofol 2 mg/kg and 2% lidocaine I mg/kg. A few seconds later, conversion to normal sinus rhythm was achieved without electrical cardioversion in both cases. Thereafter normal sinus rhythm continued on the ECG and they were discharged.

Background: Urinary retention is the most common and distressing complication in the postoperative period after an epidural morphine administration. In this prospective placebo-controlled study, the efficacy of doxazosin on preventing urinary retention after epidural morphine was investigated. Methods: A total of 75 males who underwent elective arthroscopic knee surgery were randomized into three groups. Patients in group I received a placebo orally before surgery. Group II patients received 4 mg of doxazosin, and group III patients received 8 mg of doxazosin. In all patients, 2 mg of epidural morphine in 6 ml normal saline was administrated by the epidural route in the L3-4 interspace. General anesthesia was induced in all patients. The volumes of the first two postoperative urine voidings, the time intervals between the end of surgery and the first micturition and the need for bladder catheterization were recorded. Results: There were statistically no significant differences among the groups in the first two postoperative voidings (Group I 449 ml/445 ml, Group II 343 ml/388 ml, Group III 376 ml/380 ml). No significant differences were noted among the three groups in the mean time between the end of the surgery and the first micturition (Group I 467 minutes, Group II 440 minutes, Group III 366 minutes). Also, with urinary catheterization, there were no differences among the groups (G I6/25, G II 5/25, G III 7/25). Conclusions: Prophylactic use of doxazosin does not prevent postoperative urinary retention after epidural morphine.

Background : Bradycardia frequently occur in intravenous anesthesia with propofol. Patients with sinus bradycardia have increased vagal tone at rest. The purpose of this study is to evaluate the effect of propofol on blood pressure and heart rate during induction of anesthesia in patients with sinus brads-cardia. Methods : Sixteen adult patients were studied. No anticholinergics were used before induction. Anesthesia was induced intravenously with midazolam 0.03 mg/kg, propofol 2 mgfkg, lidocaine 1 mg/kg and vecuronium 0.12 mg/kg. Anesthesia was maintained with continuous iufusion of propofol 150 ug/kg/min and 100% O2. Hemodynamic data were recorded 3 minutes after nidazolam injection, imme- diately aftar propofol injection, 1 and 2 minutes after propofol continuous infusion, and immediately, 1, 3 and 5 minutes after intubation. Results : Heart rate significantly increased after intravenous injection of propofol (P < 0.05) and was maintained during the study. There was no incidence of bradycardia. Conclusions : Anesthesia induction and maintenance with propofol could be a suitable and safe ansethetic method for patients with sinus bradycardia. (Korean J Anesthesiol 2000: 38: 14∼19)

Background: We examined whether increases of intra-abdominal pressure would decrease compliance (C) of both lung and chest wall. Methods: We measured airway and esophageal pressure in 10 anesthetized/paralyzed tracheally intubated patients during mechanical ventilation at the respiratory rate of 10 freq/min and the tidal volume of 10 ml/kg undergoing laparoscopic cholecystectomy. Measurements were made at 0 mmHg intra- abdominal pressure the (Pab) in supine position and at 15 mmHg Pab in 10 head-up (reverse Trendelenburg) position at 0, 5, 10 and 15 min. after CO2 insufflation. Results: We found that abdominal carbon dioxide insufflation caused a marked increase in peak airway pressure, plateau pressure and esophageal pressure (p＜0.05); a reduction in compliance of respiratory system and chest wall (p＜0.05). Conclusion: These changes should be considered in patients such as those with pulmonary disease, undergoing laparoscopic cholecystectomy where increase in impendance may be critical. (Korean J Anesthesiol 1999; 37: 13∼18)