Korea is regarded as a country that provides a high level of medical services despite a low burden of public health insurance premiums. However, patients face the burden of covering the costs of medical services that are not covered by health insurance, and providers face difficulties because the price of the medical service guaranteed by the health insurance system is very low. In this situation, the government is trying to expand health insurance coverage in the form of the ‘preliminary coverage system’ also known as the ‘selective coverage system’. In this system the government sets the price for a particular health care service not covered by health insurance and then the patient pays for the majority (50% to 90%) of the cost. Although it is possible to manage information about the amount of medical service usage at the national level through this system, it still places a high economic burden on patients with low incomes. In addition, since medical providers are forced to receive uniformly undervalued prices, specialized technologies that have been optimized by medical research institutions are threatened with extinction. Therefore, the preliminary coverage system needs to be reviewed before implementation of expanded coverage within this framework. First, the concept of essential medical care should be established. Based on this concept, the percentage of the cost to be paid by patients should be derived. If the preliminary coverage system is applied to medical services that are not covered by health insurance, a reasonable classification system should be developed and applied along with pricing considering customary market prices.
Classification ; Delivery of Health Care ; Humans ; Insurance ; Insurance, Health ; Korea ; Public Health

Korea is regarded as a country that provides a high level of medical services despite a low burden of public health insurance premiums. However, patients face the burden of covering the costs of medical services that are not covered by health insurance, and providers face difficulties because the price of the medical service guaranteed by the health insurance system is very low. In this situation, the government is trying to expand health insurance coverage in the form of the ‘preliminary coverage system’ also known as the ‘selective coverage system’. In this system the government sets the price for a particular health care service not covered by health insurance and then the patient pays for the majority (50% to 90%) of the cost. Although it is possible to manage information about the amount of medical service usage at the national level through this system, it still places a high economic burden on patients with low incomes. In addition, since medical providers are forced to receive uniformly undervalued prices, specialized technologies that have been optimized by medical research institutions are threatened with extinction. Therefore, the preliminary coverage system needs to be reviewed before implementation of expanded coverage within this framework. First, the concept of essential medical care should be established. Based on this concept, the percentage of the cost to be paid by patients should be derived. If the preliminary coverage system is applied to medical services that are not covered by health insurance, a reasonable classification system should be developed and applied along with pricing considering customary market prices.

Dexmedetomidine is a new selective alpha2-adrenoreceptor agonist that can be described as a useful, safe adjunct in neuroanesthesia and neurocritical care practice. This alpha2-adrenoreceptor agonist offers a unique "cooperative sedation" +/- anxiolysis and analgesia without respiratory depression. Cerebral effects are generally consistent with a desirable neurophysiological profile, including neuroprotective characteristics. In addition, sympatholytic and antinociceptive properties allow for hemodynamic stability at critical moments of neurosurgical stimulation. This paper reviews the pharmacokinetic profiles and current clinical uses of dexmedetomidine in the area of neurosurgery patient care.
Analgesia ; Anesthesia ; Dexmedetomidine ; Hemodynamics ; Neurosurgery ; Patient Care ; Respiratory Insufficiency

Perioperative care process in a hospital is considerably complex, involving multiple subprocesses, healthcare professionals, and systems in support of surgical care. The perioperative process is often the primary source of hospital admissions, driving the dominant part of hospital margins and accounts for a major part of all adverse events occurring in hospitals. The recent trend stresses the importance of adopting patient-centered and quality-proven care in many medical fields. Further, the emphasis on changing from fee-for-service to fee-for-value is increasing. These changes present challenges to anesthesiologists who play a central role in perioperative medicine.Current Concepts: Anesthesiologists are in contact with many surgeons and patients and are positioned to improve clinical outcomes. They need to have up-to-date, evidence-based knowledges on perioperative clinical management and know-how to apply, organize and practice them into efficient pathways for optimal outcomes. To accomplish such purposes, anesthesiologists need to acquire communication skills to reason and convincing related personnel including surgeons and patients.Discussion and Conclusion: The recent changing climate of perioperative medicine calls upon anesthesiologists to acquire knowledges driving quality care and demands the application of communicative skills to accomplish the required tasks.

Perioperative care process in a hospital is considerably complex, involving multiple subprocesses, healthcare professionals, and systems in support of surgical care. The perioperative process is often the primary source of hospital admissions, driving the dominant part of hospital margins and accounts for a major part of all adverse events occurring in hospitals. The recent trend stresses the importance of adopting patient-centered and quality-proven care in many medical fields. Further, the emphasis on changing from fee-for-service to fee-for-value is increasing. These changes present challenges to anesthesiologists who play a central role in perioperative medicine.Current Concepts: Anesthesiologists are in contact with many surgeons and patients and are positioned to improve clinical outcomes. They need to have up-to-date, evidence-based knowledges on perioperative clinical management and know-how to apply, organize and practice them into efficient pathways for optimal outcomes. To accomplish such purposes, anesthesiologists need to acquire communication skills to reason and convincing related personnel including surgeons and patients.Discussion and Conclusion: The recent changing climate of perioperative medicine calls upon anesthesiologists to acquire knowledges driving quality care and demands the application of communicative skills to accomplish the required tasks.

Ankylosing spondylitis is a chronic and systemic disease involving the axial skeleton. In patients with involved cervical spine ankylosing spondylitis, endotracheal intubation by direct laryngoscope may be difficult because they have a limitation of cervical movement and anatomical anomalies. We experienced the evaluation of thirteen patients with involved cervical spine ankylosing spondylitis by the Mallampati classification, Cormack and Lehane grade, thyromental distance and orolaryngeal angle. By Mallampati class and Cormack and Lehane grade, patients were almost class 3 or 4. Thyromental distance was 5.3 +/- 0.4 cm, and orolaryngeal angle was 90.4 +/- 8.0o.
Airway Management* ; Anesthesia* ; Classification ; Humans ; Intubation, Intratracheal ; Laryngoscopes ; Skeleton ; Spine* ; Spondylitis, Ankylosing*

BACKGROUND: The alpha2-agonist clonidine is an adjunct in general anesthesia. Clonidine constricts cerebral arteries and decreases cerebral blood flow (CBF), but does not alter cerebral metabolic rate (CMR). Thus cerebral ischemia is possible due to CBF/CMR imbalance. This study was designed to prove the effects of clonidine bolus up on CBF and CO2 reactivity in desflurane anesthesia. METHODS: Thirty patients were divided into a clonidine group (n = 15) and a control group (n = 15). Anesthesia was induced with thiopental and pancuronium, and maintained with 50% N2O/O2/ Desflurane. The jugular bulb was cannulated to measure jugular bulb oxygen saturation (SjO2). MAP and SjO2 were measured after induction, after clonidine (2 microgram/kg) or normal saline administration and during hyperventilation. RESULTS: After clonidine administration, MAP decreased from 95.7+/-9.8 mmHg to 81.1+/-6.3 mmHg and was 79.9+/-5.0 mmHg during hyperventilation. In the control group, the corresponding MAP values 95.7+/-9.8 mmHg, 81.1+/-6.3 mmHg and 79.9+/-5.0 mmHg. After clonidine administration, SjO2 was decreased from 84.7+/-3.7% to 81.1+/-5.2%, and was 71.5+/-8.4% during hyperventilation (P = 0.003, P = 0.000) and in control group, there were 95.7+/-9.8%, 81.1+/-6.3% and 79.9+/-5.0%, respectively. CO2 reactivity was expressed as a change of SjO2 per unit change of PaCO2, 1.15+/-1.19%/mmHg versus 1.43+/-0.98%/mmHg (P = 0.49). CONCLUSIONS: During desflurane anesthesia, clonidine-induced constriction of the cerebral arteries was demonstrated but CO2 reactivity was well preserved.
Anesthesia* ; Anesthesia, General ; Brain Ischemia ; Carbon Dioxide* ; Carbon* ; Cerebral Arteries ; Clonidine* ; Constriction ; Humans ; Hyperventilation ; Oxygen* ; Pancuronium ; Thiopental

Freeman-Sheldon syndrome is a rare congenital myopathy principally characterized by facial and skeletal abnormalities. We report a case of a Freeman-Sheldon syndrome in 12-year-old girl correction of undergoing kyphoscoliosis under somatosensory evoked potential monitoring. She had a characteristic appearance of Freeman-Sheldon syndrome such as hypoplastic alae nasi, high narrow palate, marked microstomia with pursed lips and clenched fingers. On arriving at the operating room, she was intubated by awake nasotracheal intubation with fiberoptic bronchoscopy and anesthetized with propofol and fentanyl.
Bronchoscopy ; Child ; Evoked Potentials, Somatosensory ; Female ; Fentanyl ; Fingers ; Humans ; Intubation ; Lip ; Microstomia ; Muscular Diseases ; Operating Rooms ; Palate ; Propofol

Thrombelastography (TEG) performed by an anesthesiologist provides a rapid assessment of coagulation at the bedside. TEG analyzing coagulation status of native whole blood is a more accurate test with a relatively good sensitivity and specificity than PT and aPTT. We experienced an unexpected coagulopathy during the perioperative period. The case was a 47-year-old male patient with blood type O who underwent elective spine surgery. Perioperative coagulation tests (PT, aPTT, BT, CT, etc.) were within normal limits. Anesthesia was induced with propofol 90 mg, vecuronium 8 mg and alfentanil 0.5 mg and maintained with 1.0 1.5 vol% enflurane and 50% N2O in O2. Then we performed acute normovolemic hemodilution (ANH) with monitoring pre- and post-hemodilutional TEG. Hemostasis was revealed as abnormal by a pre-hemodilution TEG (CI = -11.06) and post-hemodilution TEG (CI = -13.06). We managed this coagulopathy with blood components and drugs on the basis of a follow-up TEG so that abnormal hemostasis and TEG findings improved (CI = -4.35). We report a case where undetected coagulopathy was revealed and treated successfuly with TEG.
Alfentanil ; Anesthesia ; Anesthesia, General* ; Enflurane ; Follow-Up Studies ; Hemodilution ; Hemostasis ; Humans ; Male ; Middle Aged ; Perioperative Period ; Propofol ; Sensitivity and Specificity ; Spine ; Thrombelastography* ; Vecuronium Bromide

BACKGROUND: Improvement of coagulation function by acute normovolemic hemodilution (ANH) is well evidenced in modern medical practice. It has been reported that there are fixed differences in the plasma concentrations of von Willebrand factor and factor VIII according to ABO blood types. Therefore, the changes of coagulation state among ABO blood types during ANH are expected but have not yet been studied. This study was designed to establish the changes of coagulation state among ABO blood types during ANH by intraoperative thrombelastography (TEG). METHODS: Fifty one healthy adult patients scheduled for spine surgery were enrolled in this study. All patients were grouped by ABO blood types and underwent ANH after the induction of general anesthesia. While autologous blood (25% of EBV) was procured, warmed 0.9% saline, 3 times the blood volume deficit, was infused to maintain normovolemia. Platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), factor VIII activity and TEG were performed to evaluate coagulation state before and after ANH. Statistical analysis was conducted to determine the dilutional effects and intergroup differences. RESULTS: Improvement of coagulation function after ANH was visible only by TEG, and not by PT, APTT or factor VIII activity. Fourteen of fifteen patients with type O blood showed decreased factor VIII activity to under the normal limit after ANH. In patients with blood type O, changes of APTT (P = 0.093, P = 0.086) and factor VIII activity (P = 0.001, P = 0.004) during ANH were remarkable in comparison with blood type B and AB. CONCLUSIONS: ANH enhances coagulation function evaluated by means of TEG. No difference was observed in terms of the changes of coagulation state among ABO blood types during ANH. However, ANH should be instituted cautiously in patients with type O blood because there is a possibility of impairing factor VIII activity.
Adult ; Anesthesia, General ; Blood Volume ; Factor VIII ; Hemodilution* ; Humans ; Partial Thromboplastin Time ; Plasma ; Platelet Count ; Prothrombin Time ; Spine ; Thrombelastography ; von Willebrand Factor