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Distal radius fractures (DRFs) are very common injuries associated with aging, and the number of fractures is increasing with the increase in the elderly population. General anesthesia or brachial plexus block (BPB) is required for fracture fixation, and acute postoperative pain control is necessary after operation. Early pain control can improve patient satisfaction and functional outcomes. In this study, we report the clinical differences in postoperative pain, according to the method of anesthesia (general anesthesia versus brachial plexus block). Volar plating was used to treat 72 patients older than 60 years who had comminuted DRF. Patients were randomized to either group A (36 patients), who underwent general anesthesia, or group B (36 patients), who underwent BPB. We compared these two groups prospectively for acute postoperative pain using a visual analog scale (VAS) at 2, 4, 6, 12, and 24 h after surgery. The VAS scores of each group were: 6.8 ± 2.5 in general anesthesia and 0.5 ± 2.3 in BPB at 2 h, postoperatively; 6.5 ± 2.4 in general anesthesia and 0.5 ± 2.4 in BPB anesthesia at 4 h, postoperatively; 5.2 ± 2.4 in general anesthesia and 1.5 ± 2.4 in BPB anesthesia at 6 h, postoperatively; 4.5 ± 2.5 in general anesthesia and 3.4 ± 2.7 in BPB anesthesia at 12 h, postoperatively; and 3.5 ± 2.5 in general anesthesia and 3.2 ± 2.7 in BPB anesthesia at 24 h, postoperatively. DRF patients with BPB anesthesia showed a lower VAS score than those subjected to general anesthesia in early postoperative period. As a result, the effect of BPB anesthesia on acute pain management after surgery was excellent, which resulted in a lower pain score compared with general anesthesia in DRF patients undergoing volar plating.

Background: Long-chain triglyceride/medium-chain triglyceride (LCT/MCT) propofol is less painful than standard long chain triglyceride (LCT) propofol; however, there is still a need to reduce severe pain. 5-Hydroxytryptamine type 3 (5-HT3) receptor antagonists have an analgesic effect during the injection of standard LCT propofol. This study compared the incidence of moderate-to-severe injection pain with LCT/MCT propofol using pretreatment with palonosetron versus pretreatment with saline or lidocaine. Methods: This prospective, randomized double-blind study divided 98 patients scheduled for general anesthesia into three groups: control (n = 33), palonosetron (n = 32), and lidocaine (n = 33) groups. An 18-gauge intravenous catheter was inserted into the peripheral vein at the dorsum of the hand. The patient’s vein was occluded by a rubber tourniquet at mid-forearm, and we then administered 2 ml of the pretreatment drug. One minute after venous occlusion, we released the tourniquet and administered LCT/MCT propofol 2 mg/kg for 10 –15 seconds. The degree of pain on propofol injection was evaluated using a 4-point scale. Results: The incidence of moderate-to-severe pain in the control, palonosetron, and lidocaine groups was 9.1, 15.6, and 12.1%, respectively. The incidence of overall pain was lower in the lidocaine group than in the control or palonosetron group. Conclusions: Palonosetron and lidocaine pretreatment does not reduce moderate-to-severe pain on injection of 1% LCT/MCT propofol. Lidocaine pretreatment reduced the overall incidence of injection pain. (Anesth Pain Med 2016; 11: 249-254)

The conventional educational robots, which are commonly industrial robots or toy robots, use text-based programming to teach the students. Therefore, students have difficulty in studying robotics due to the difficulties of text based language. The developed robot in this study have a camera, which have the color tracking function, and it has various sensors and actuators. It supports the open hardware and uses graphic language based programming. The developed educational robot is programmed by Scratch, which uses graphic modular language. We also present a curriculum, which is based upon the developed robot and Scratch. We applied the robot and curriculum to the primary school students. We obtained satisfactory results comparing it with the conventional robot education. Furthermore, the imagination and execution ability of students showed enhancement in learning robotics. Thus, this fact means the validity and effectiveness of the proposed approach.

Cervical epidural anesthesia (CEA) is used for pain control and surgical procedures of the head and neck or upper arm areas. However, the failure rate of CEA is reported to be high, is the failure rate being quite higher than other sites, because of the anatomical differences of the cervical spine. We hypothesized that the loss of resistance (LOR) method combined with the drip infusion method for confirmation of the cervical epidural space can reduce the failure rate. This study investigated the usefulness of the drip infusion method.One hundred chronic renal failure patients undergoing arteriovenous bridge graft for hemodialysis at the upper arm under cervical epidural anesthesia were recruited for this study. In the cervical epidural puncture, we identified the cervical epidural space using a combination of the LOR method with the drip infusion method. After confirmation of the epidural space with LOR method, we decided it was the true epidural space when fluid dripping to the space was present. Otherwise, if fluid dripping was not present, we designated it was pseudo LOR, and we found the true epidural space using the drip infusion method only.In all cases, the combined LOR with drip infusion method, identify the epidural space.Combined LOR with drip infusion method is an efficacious method for the confirmation of the cervical epidural space.

Objective: The aim of this study was to investigate the effects of intravenous magnesium sulfate on the prevention of pain during the injection of microemulsion propofol. Magnesium is a known calcium channel blocker and a physiological N-methyl-D-aspartate receptor antagonist. Methods: American Society of Anesthesiologists I and II adults (n= 114) undergoing general anesthesia for surgery were randomly assigned into two groups (n= 57 per group). This study was designed in prospective and double-blind manner. Patients in the LM group (n= 57) received pretreatment with 2% lidocaine (40 mg) and magnesium sulfate 10 mg/kg, while patients in group L (n= 57) received pretreatment with 2% lidocaine (40 mg) and normal saline (2 mL) accompanied by venous occlusion. Induction with microemulsion propofol (Aquafol) 2 mg/kg was accomplished following the release of venous occlusion. Pain intensity was assessed on a four-point scale according to patient movement (grade 0, no movement; grade 1, movement in wrist only; grade 2, movement in the upper arm & shoulder of injected arm; grade 3, generalized movement). Systolic blood pressure, diastolic blood pressure, and heart rate were evaluated. Results: A significant difference in pain intensity following injection of microemulsion propofol between the groups was found (P< 0.05). In addition, the incidence of hypertension after injection was lower in the LM group than in the L group (P< 0.05). Conclusion: The combination of magnesium and lidocaine are effective in attenuating the pain induced by microemulsion propofol injection when compared with lidocaine alone.

In this paper, we survey the auction on the art and the art price index in the international and Korea art market. The auction plays a role on the art market from art creators to art collectors. The auction will grow because it utilizes the open art market. The art price index which is developed to give a guide in art investment. However, the history of art index is short and the developed art index is not well widely used. Since, the art price is opened in the auction, so it provides the necessary condition to develop art price index. In this study, we compare the foreign art price index with the domestic one and we examine the properties and utilization of the art price index in Korea.

Background The purpose of this study was to evaluate the effect of palonosetron combined with dexamethasone for the prevention of PONV compared to dexamethasone alone in women who received intravenous patient-controlled analgesia (IV-PCA) using fentanyl. Methods In this randomized, double-blinded, placebo-controlled study, 204 healthy female patients who were scheduled to undergo elective surgery under general anesthesia followed by IV-PCA for postoperative pain control were enrolled. Patients were divided into two groups: the PD group (palonosetron 0.075 mg and dexamethasone 5 mg IV; n = 102) and the D group (dexamethasone 5 mg IV; n = 102). The treatments were given after the induction of anesthesia. The incidence of nausea, vomiting, severity of nausea, and the use of rescue anti-emetics during the first 48 hours after surgery were evaluated. Results The incidence of PONV was significantly lower in the PD group compared with the D group during the 0-24 hours (43 vs. 59%) and 0-48 hours after surgery (45 vs. 63%) (P < 0.05). The severity of nausea during the 6-24 hours after surgery was significantly less in the PD group compared with the D group (P < 0.05). The incidence of rescue antiemetic used was significantly lower in the PD group than in the D group during the 0-6 hours after surgery (13.1 vs. 24.5%) (P < 0.05). Conclusions Palonosetron combined with dexamethasone was more effective in preventing PONV compared to dexamethasone alone in women receiving IV-PCA using fentanyl.

Background/Aims Distinction is vague between severe constipation and postoperative ileus (POI) in terms of pathogenesis, clinical features, and treatment options. However, no data are available regarding their associations. Methods After retrospective review of data from patients who underwent orthopedic surgery during the first 6 months of 2011, a total of 612 patients were included. Severe constipation was defined as symptoms of constipation requiring treatment using at least 2 laxatives from different classes for at least 6 months. POI was defined as paralytic ileus lasting more than 3 days post-surgery and associated with 2 or more of the following: (1) nausea/vomiting, (2) inability to tolerate an oral diet over a 24-hour period, and (3) absence of flatus over a 24-hour period. The subjects were divided into non-POI and POI groups, and we compared patient-, surgery-, and pharmaceutical-related factors. Results Thirteen (2.1%) out of 612 experienced POI. In comparisons between the non-POI and POI groups, univariate analysis showed significant differences in the mean age (51.4 vs 71.6 years), mean body mass index (24.1 vs 21.8 kg/m2), severe constipation (5.8% vs 76.9%), co-morbidities (33.2% vs 84.6%), type of orthopedic surgery (spine/hip/limb: 19.4/11.0/65.6% vs 23.1/61.5/15.4%), and estimated blood loss (50 vs 300 mL). Multivariate logistic regression analysis, after adjustment for age, body mass index, co-morbidities, type of orthopedic surgery, and estimated blood loss, showed that severe constipation was an independent risk factor for POI (OR, 35.23; 95% CI, 7.72–160.82; P < 0.001). Conclusions Severe constipation is associated with POI after orthopedic surgery.

Background: The opioid sparing effect of low dose ketamine is influenced by bolus dose, infusion rate, duration of infusion, and differences in the intensity of postoperative pain. In this study, we investigated the opioid sparing effect of low dose ketamine in patients with intravenous patient-controlled analgesia (PCA) using fentanyl after lumbar spinal fusion surgery, which can cause severe postoperative pain. Methods: Sixty patients scheduled for elective lumbar spinal fusion surgery were randomly assigned to receive one of three study medications (K1 group: ketamine infusion of 1 μg/kg/min following bolus 0.5 mg/kg, K2 group: ketamine infusion of 2 μg/kg/min following bolus 0.5 mg/kg, Control group: saline infusion following bolus of saline). Continuous infusion of ketamine began before skin incision intraoperatively, and continued until 48 h postoperatively. For postoperative pain control, patients were administered fentanyl using IV-PCA (bolus dose 15 μg of fentanyl, lockout interval of 5 min, no basal infusion). For 48 h postoperatively, the total amount of fentanyl consumption, postoperative pain score, adverse effects and patients’ satisfaction were evaluated. Results: The total amount of fentanyl consumption was significantly lower in the K2 group (474 μg) compared to the control group (826 μg) and the K1 group (756 μg) during the 48 h after surgery. Pain scores at rest or with movement, the incidence of adverse events and patient satisfaction were not significantly different among the groups. Conclusions: Low-dose ketamine at 2 μg/kg/min following bolus 0.5 mg/kg significantly reduced the total amount of fentanyl consumption during the 48 h after lumbar spinal fusion surgery without increasing adverse effects. (Korean J Anesthesiol 2013; 64: 524-528)

Background: This study was performed to ultrasonographically demonstrate the changes in relationship between the right internal jugular vein (IJV) and an anatomical landmark in two different head positions: neutral and rotated. Methods: This was a randomized clinical trial. One hundred patients scheduled for elective surgery under general anesthesia with endotracheal intubation were enrolled in this study. The patients were placed in the supine position with a neutral head position and without a pillow. The apex of the triangle formed by the sternal and clavicular heads of the sternocleidomastoid muscle and clavicle was marked (AL point : anatomical landmark point). Ultrasonography of the neck anatomy was performed and the skin was marked at the central point of the IJV (US point: ultrasonography point). The other investigator measured the distance from the AL point to the US point (ALUS distance). The patient’s head was then turned 30 o to the left; the same procedure was repeated and the AL-US distance was again measured. The changes in AL-US distance were calculated. Results: The AL-US distance increased significantly after 30 o head rotation compared with that in a head neutral position. The mean ± SD of the AL-US distance was 0.28 ± 0.78 cm in the neutral head position and 0.83 ± 1.03 cm in the head rotated position. Conclusions: The anatomical landmark point becomes more distant from the actual right IJV point and moves more medially after head rotation. We suggest minimizing the angle of head rotation and taking this distance into consideration when using the landmark-guided method. (Korean J Anesthesiol 2011; 61: 107-111)

Objective: Topical steroids are a good option for preventing postoperative sore throat (POST). This study examined whether triamcinolone paste applied as lubricant reduces the severity of POST following laryngeal mask airway (LMA) insertion. Methods: This was a prospective, randomized, double-blind, placebo-controlled clinical trial. The study enrolled 50 American Society of Anesthesiologists (ASA) I-II patients who were between 20 and 70 years of age and scheduled for elective surgery under general anesthesia. The patients were divided randomly into two groups. Patients in the chlorhexidine group (the placebo group) were inserted with a LMA lubricated with chlorhexidine gluconate jelly, whereas patients in the triamcinolone group were inserted with a LMA lubricated with 0.1% triamcinolone acetonide paste. The patients were interviewed 1, 6, and 24 hours after the operation. The incidence and severity of POST and the incidence of cough and hoarseness were recorded. Results: The difference of the POST incidence during the 24 hours after the operation was not significant (34.8% in triamcinolone group vs. 45.5% in chlorhexidine group, P = 0.381). The severity score in the triamcinolone group was significantly lower than the chlorhexidine group at 1 hour after the operation (P < 0.001). No significant differences were found in the incidence of cough, hoarse ness, dysphagia, nausea, or dry throat between the two groups. Conclusion: Triamcinolone paste applied as lubricant reduces the severity of POST following LMA insertion.

This study was performed to examine whether applying triamcinolone acetonide paste as a lubricant to endotracheal tubes (ETTs) reduces the incidence and severity of postoperative sore throat (POST) more effectively than applying chlorhexidine gluconate jelly.This was a randomized controlled clinical trial. Patients enrolled in the study were ages 20 to 70 yr, American Society of Anesthesiologists' physical status I and II, and scheduled for elective laparoscopic cholecystectomy. The patients were divided randomly into two groups, the chlorhexidine group and the triamcinolone group. Prior to endotracheal intubation, ETTs in the chlorhexidine group were lubricated with 0.1% chlorhexidine gluconate jelly, whereas the ETTs in the triamcinolone group were lubricated with 0.1% triamcinolone acetonide paste 0.5 mg. During the 24 hr after the operation, we recorded the incidence and severity of POST and the incidence of cough, hoarseness, dysphagia, nausea, and dry throat.Of the 150 patients initially enrolled, 143 patients were included in the study. The incidence of POST was significantly lower in the triamcinolone group compared with the chlorhexidine group (difference = 52.4%; 95% confidence interval, 36.8% to 64.2%; P0.001). The severity score for the triamcinolone group was significantly lower than that for the chlorhexidine group. The frequencies of coughing, hoarseness, dysphagia, nausea, and dry throat were similar in the two groups for the first 24 hr after surgery.Triamcinolone acetonide paste applied along the length of the ETT resulted in clinically important and statistically significant decreases in the incidence and severity of POST compared with the application of chlorhexidine jelly. (ClinicalTrials.gov number, NCT00908817).

Spontaneous intracranial hypotension is a syndrome caused by cerebrospinal fluid (CSF) leakage from the spinal dural sac. The most common symptom is a postural headache and other clinical symptoms may include nausea, vomiting, photophobia, diplopia, dizziness, and tinnitus. Usually, conservative treatments like hydration, bed rest, and administration of caffeine are recommended first, but epidural blood patch is regarded as the mainstay of treatment in the patients who do not respond to conservative therapy. Epidural blood patch was known that it provides the tamponade and seal of dural sac when performed at the leak site. Our patient was suspected the CSF leakage at cervicothoracic junction, but epidural blood patch was performed in lumbar level and the headache of patient was managed successfully for at least 1 year.

Background: This study was performed to evaluate the effectiveness of intravenous low dose ketamine for reducing the incidence and severity of postoperative sore throat (POST). Methods: This was a prospective, randomized, double-blind clinical trial. The study population consisted of 70 patients between 20 and 70 years old who were classified as American Society of Anesthesiologists I-II and were scheduled for elective laparoscopic cholecystectomy. The patients were divided randomly into two groups. Patients in the ketamine group received an intravenous injection of 0.5 mg/kg of ketamine just before induction, followed by 10 μg/kg/min throughout the operation. Patients in the control group received intravenous saline instead of ketamine. The patients were interviewed 1, 6, and 24 h after the operation. The incidence and severity of POST were recorded. Results: No significant differences in the incidence and severity of POST during the 24 h after the operation were found between the two groups (21/31 in the ketamine group vs. 26/34 in the control group, P = 0.398). Conclusions: Intravenous injection of low dose ketamine was not effective for reducing POST. (Korean J Anesthesiol 2010; 59: 22-26)

To get abundant germplasm for developing new waxy corn varieties, pericarp thickness was measured and other factors were evaluated with a total of 142 Korean local waxy corn lines collected from various parts of Busan City and Gyungnam Province. The average pericarp thickness of Korean local waxy corn lines collected was and the rate of thin pericarp under was 70.4%. The pericarp thickness compared by the regions collected showed non significant difference, but which compared by the ear row number per ear showed significant difference $(MS

The aim of this study was to evaluate the effects of Welsh onion administration on -induced hepatic injury in rats. The increasing rate of the body and organ weight was not significantly different by the ad-ministration of the Welsh onion. Welsh onion (2, 4, w/w) was given for 4 weeks with the injections of . Total serum lipid was significantly decreased in all treatment groups compared to only treatment group (p (w/w) showed significantly hepatoprotective activity which was comparable to that -induced hepatic damage. Histological evaluation showed that Welsh onion partially prevented -induced inflammation, necrosis and vacuolation. Pretreatment of Welsh onion reduced extent of the necrosis found 24 hr after the intraperitoneal administration of . The present study shows the liver protective action of the Welsh onion against experimentally induced liver damage in rats. This suggests that the Welsh onion may be used as an effective hepatoprotective agent.

Introduction: We herein present 2 cases involving the combination of rocuronium and sugammadex in patients with motor neuron disease. The patients were a 54-year-old man with progressive muscular atrophy who underwent removal of internal fixators in the arm and leg, and a 66-year-old woman with amyotrophic lateral sclerosis who underwent skin grafting in the left lower leg. General anesthesia was induced with propofol, rocuronium, and remifentanil and maintained with desflurane and remifentanil. At the end of the surgical procedure, we administered sugammadex. Three or 4 minutes after administration of sugammadex, the patients began to breathe spontaneously and were extubated without complications. Conclusion: Sugammadex can be used successfully to reverse neuromuscular blockade in patients with motor neuron disease.

Although controversial, probiotics and dietary fiber are commonly used for patients with irritable bowel syndrome (IBS). We evaluated the effects of multistrain probiotics on the symptoms of IBS to determine whether the addition of dietary fi ber had an additive effect on constipation-predominant IBS.A total of 142 participants who met the Rome III criteria were recruited and randomized into a control group or a test group. Participants in the control group received multistrain probiotic fermented milk with Streptococcus thermophilus, Lactobacillus acidophilus and Bifidobacterium infantis; the participants in the test group received the same probiotic fermented milk mixed with dietary fi ber such as sea tangle extracts, radish extracts and glasswort extracts. The patients were treated for four weeks.Most of the symptoms of IBS, with the exception of fl atulence, stool consistency, and frequency of defecation, signifi cantly improved in both groups. In the analysis of IBS subtypes, especially constipation-predominant IBS, the frequency and duration of defecation and straining at stool were improved more in the test group than in the control group.Dietary fiber had additive benefits for the symptoms of constipation, especially in constipation-predominant IBS.

BACKGROUND Aquafol, a microemulsion propofol, causes more severe and frequent pain on injection than propofol. The purpose of this study was to compare a combination of lidocaine and ketamine on aquafol-induced pain with lidocaine or ketamine alone during the induction of anesthesia. METHODS In this prospective, randomized, double-blinded study, 130 healthy patients who were undergoing elective surgery under general anesthesia were enrolled. The patients received IV lidocaine 40 mg plus ketamine 25 mg (Group LK, n = 43), lidocaine 40 mg (Group L, n = 42), or ketamine 25 mg (Group K, n = 45) with a rubber tourniquet on the forearm 1 min before the injection of microemulsion propofol. The pain score was assessed by a 4-point verbal rating scale (VRS) at 10 seconds after injection of microemulsion propofol 30 mg and during the injection of the remaining total dose. RESULTS The incidence and severity of pain was significantly lower in Group LK than Group L or Group K at 10 seconds after the injection of microemulsion propofol 30 mg (P < 0.05). And the incidence and severity of pain was significantly lower in Group LK and Group K than Group L during the injection of the remaining total dose (P < 0.05). CONCLUSIONS Pretreatment with IV lidocaine 40 mg plus ketamine 25 mg with a rubber tourniquet on the forearm 1 min before the injection of microemulsion propofol is more effective than lidocaine 40 mg or ketamine 25 mg alone in preventing pain from the injection of microemulsion propofol.

Ramosetron is a new selective 5-hydroxytryptamine type 3 (5-HT(3)) receptor antagonist that reportedly has more potent antiemetic effects compared with other 5-HT(3) receptor antagonists. The purpose of this study was to evaluate the efficacy of ramosetron for the prevention of postoperative nausea and vomiting (PONV) with that of ondansetron or placebo in high-risk patients undergoing gynaecological surgery.In this prospective, randomized, double-blinded, placebo-controlled study, 162 healthy patients who were undergoing gynaecological operation under general anaesthesia using sevoflurane were enrolled. Patients were divided into three groups: the ramosetron group (0.3 mg i.v.; n=54), the ondansetron group (8 mg i.v.; n=54), and the placebo group (normal saline i.v.; n=54). The treatments were given before the end of surgery. The incidence of PONV, severity of nausea, and the use of rescue antiemetic requirements during the first 24 h after surgery were evaluated.The incidence of nausea was lower in the ramosetron (50%) and ondansetron (44%) groups compared with the placebo group (69%) (P0.05). In addition, the incidence of vomiting was lower in both the ramosetron (17%) and the ondansetron (20%) groups than in the placebo group (44%) during the first 24 h after surgery (P0.05). The visual analogue scale score for nausea was also lower in the ramosetron and ondansetron groups compared with the placebo group (P0.05). The proportion of patients requiring rescue antiemetics was significantly lower with ramosetron (15%) when compared with the placebo group (41%) during the 24 h after surgery (P0.05). However, there were no significant differences in the incidence of nausea and vomiting, severity of nausea, and required rescue PONV between the ramosetron and the ondansetron groups.Ramosetron 0.3 mg i.v. was as effective as ondansetron 8 mg i.v. in decreasing the incidence of PONV and reducing nausea severity in female patients during the first 24 h after gynaecological surgery.

Awareness of intraoperative events in patients under general anesthesia is rare, but awareness during anesthesia is a serious complication that leads to anxiety and post-traumatic stress disorder. The Bispectral Index (BIS) has generally been accepted as a measurement of hypnosis under anesthesia. It is derived from a processed electroencephalogram and computer algorithm that assigns a numerical value based on the probability of consciousness. A 46-year-old, 65-kg male without underlying disease underwent elective surgery for ventral hernia. The patient in this case was administered an anesthetic that we frequently use and then average BIS value are 35. But he experienced awake during general anesthesia. We describe the first case of intraoperation awake under BIS 40 using desflurane.

순천향대학교 의과대학 순천향대학교 서울병원 안과학교실, 순천향대학교 의과대학 순천향대학교 부천병원 안과학교실, 순천향대학교 의과대학 순천향대학교 천안병원 안과학교실, 순천향대학교 의과대학 순천향대학교 서울병원 마취통증의학교실 Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea Department of Ophthalmology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

We present a case of acute prostatitis with abscess. The patient had undergone intravesical bacillus Calmette-Guérin (BCG) immunotherapy for bladder cancer. A prostate biopsy demonstrated tuberculous prostatitis with abscess. This case illustrates that when bladder cancer is treated with BCG, a tuberculous prostate abscess can develop.

Although rare, intraoperative anaphylaxis can lead to significant morbidity and mortality. Aquafol® (Daewon Pharmaceutical Co. Ltd., Seoul, Korea), a microemulsion propofol, was developed to eliminate lipid solvent-related adverse events, and was used in clinical anesthesia since 2009 with little data about severe side effects such as anaphylaxis. A healthy 16-yr-old male patient who had past medical history with two previous operations of no complications developed cardiovascular shock with generalized erythema following administration of microemulsion propofol during anesthesia induction. Intravenous injection of epinephrine and steroid rescued him. He remained in a stable state without any problems postoperatively and was discharged. Clinicians should consider this rare but serious complication during induction of anesthesia with propofol.

Background: The loss of resistance (LOR) method is most commonly used to identify the epidural space. This method is thought to rely on the penetration of the ligamentum flavum. Unfortunately the exact morphology of the ligamentum flavum is variable at different vertebral lev els. Especially, it has been pointed out that the lower cervical ligamentum flavum may be discontinuous in the mi dline in up to 50% of patients. Thus, the LOR method may be inaccurate to confirm the cervical epidural space . The aim of this study is to determine which method is the safest and most exact for confirming the cervical epidural space. Methods: 100 adult, chronic renal failure patients who were undergoing an arteriovenous bridge graft for hemodialysis at the upper arm under cervical epidural anesthesia were recruited for this study. During the cervical epidural puncture, we identified the cervical epidural space by subjectively feeling the resistance with using a finger just through the ligamentum flavum, and we also used the drip infusion method, the loss of resistance method using air, and the hanging drop method. By using 5 grades, we classified the extent of whether or not the techniques were effective. Results: Using the drip infusion method, we identify the epidural space in all the patients as ＋/＋＋ grade. The catheter insertion method was also successful in identifying those epidural spaces over a ± grade. The pseudo LOR was over ± grade in 47 patients. Conclusions: The combined LOR/hanging drop with drip infusion method is useful for confirming the cervical epidural space. (Korean J Pain 2009; 22: 158-162)

Hypercapnia augments cardiac output and can initiate a sympathetically mediated release of catecholamines to increase cardiac output. Many studies of hemodynamic changes by hypercapnia under general anesthesia with inhalation anesthetics besides sevoflurane. This study examined the hemodynamic changes by increasing end-tidal carbon dioxide (EtCO2) under sevoflurane-N2O anesthesia.Twenty patients were enrolled in the study. We studied stable, mechanically ventilated patients under general anesthesia maintained with O2 2 L/min - N2O 2 L/min - sevoflurane (1.5-2.5 vol%). Hypercapnia were obtained by reducing tidal volume and respiratory rate. EtCO2 was adjusted to 30, 40, 50 mmHg with each concentration maintained for 15 min. Global hemodynamic variables were monitored with a pulmonary artery catheter.There were no changes in mean arterial pressure or heart rate by hypercapnia. Acute moderate hypercapnia increased cardiac output (4.9 +/- 1.7, 5.5 +/- 1.7, 6.2 +/- 2.1 L/min; P0.05), cardiac index (3.0 +/- 0.9, 3.4 +/- 0.9, 3.8 +/- 1.1 L/min/m2; P0.05), pulmonary artery pressure (16.9 +/- 3.7, 19.6 +/- 4.2, 23.0 +/- 4.7 mmHg), but did not decrease systemic vascular resistance (1,558.3 +/- 500.4, 1,423.5 +/- 678.6, 1,156.8 +/- 374.0 dynes.sec/cm5; P0.05).When we changed patient EtCO2 to 30, 40, and 50 mmHg, there were no changes in mean arterial blood pressure and heart rate, but systemic vascular resistance decreased, and cardiac output, cardiac index and mean pulmonary arterial pressure increased significantly.

Urinary retention is a common post-operative complication that has been associated with opioid therapy. In this study, we investigated whether an intraoperative remifentanil infusion increased postoperative urinary retention in patients undergoing general anesthesia. Methods: Sixty-two healthy patients having elective minor surgery under general anesthesia were enrolled in this prospective, randomized, double-blind study. Anesthesia was maintained with either sevoflurane (S group, n = 31) alone or with sevoflurane combined with a remifentanil infusion (0.1−0.2μg/kg/min) (RS group, n = 31). Bladder urine volume and voiding difficulty were evaluated at 2 and 6 hours after the operation. Results: The incidence of urinary retention was 13% in the S group and 6% in the RS group at 2 hours after operation, which was not a significant difference. The total incidence of urinary retention was 13% in both groups at 6 hours after operation. Conclusions: Intraoperative remifentanil infusion did not increase the postoperative urinary retention.

Internal jugular vein cannulation is commonly used for the anesthetic management of patients undergoing a major operation. Complications associated with internal jugular vein cannulation such as a carotid artery puncture, pneumothorax and hemothorax, have been reported; however, thrombotic complications of arteries due to accidental arterial punctures are rare. We report a case of thrombotic obstruction of the subclavian artery associated with inadvertent arterial puncture following an attempted internal jugular vein cannulation. (Korean J Anesthesiol 2008; 55: 95～8)

Background: The purpose of this study was to evaluate the effect of head rotation on the anatomical relationship of the right internal jugular vein (RIJV) and the carotid artery (CA) with using ultrasound images in Korean patients. Methods: We investigated 117 patients (age range: 16−87 years old) who were placed in the supine position, but not in the Trendelenburg position. An ultrasound probe was placed on the right neck at the apex of the triangle formed by the head of the sternocleidomastoid muscle and the clavicle, and it was directed toward the ipsilateral nipple at a 30 degree angle to the coronal plane. For each head rotation (0, 30, 60 degrees), we measured the horizontal diameter of the RIJV and CA, and the percentage of overlap of the CA and the RIJV with using an ultrasound system. Results: The mean RIJV diameter was 18.4 ± 4.3 mm and the mean CA diameter was 7.5 ± 1.2 mm at the neutral head position. Following head rotation, the percentage overlap of the CA and RIJV increased significantly (0o: 32.7%, 30o: 45.4%, 60o: 57.0%) (P ＜ 0.05). The percentage overlap of the CA and RIJV in the neutral head position increased more in the patients with a BMI over 25. However, age did not have any effect on the percentage of overlap. Conclusions: Head rotation toward the contralateral side increases the percentage of overlap of the CA and RIJV. To decrease the risk of CA puncture, rotate the head from the neutral position as little as possible when performing RIJV catheterization.