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*

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

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

BACKGROUND: Unanticipated difficulties during tracheal intubation are related to perioperative morbidity and mortality, but the success of direct laryngoscopic intubation depends largely on clinician's experience and the upper airway anatomy. The lightwand was introduced as alternative intubation technique, but the indicators of difficult lightwand intubation (DLWI) have not been identified. Accordingly authors conducted this study to identify subject factors that affect DLWI, and to compare these with those of difficult laryngoscopic intubation. METHODS: Seventy-three healthy subjects requiring tracheal intubation for elective surgery were enrolled. Anatomic factors, such as, body mass index (BMI), Mallampati classification (MC), inter-incisor gap, thyromental distance, neck circumference, extent of head and neck motion, and Cormack-Lehane grade (CL) were determined and evaluated in terms of their abilities to predict DLWI, which was described using intubation time and number of intubation attempts. Multiple regression analyses were performed to identify predictors using a variable selection technique. RESULTS: Only MC and BMI were found to predict DLWI. The weighted sum of time and number of attempts (r2 = 0.854, P = 0.000) was found to be better predictor of DLWI than their product (r2 = 0.734, P = 0.000). Cormack-Lehane grade was not found to be significantly related to DLWI (P = 0.093). CONCLUSIONS: Of the anatomic factors examined, only Mallampati classification and body mass index were found to predict difficult lightwand intubation.
Body Mass Index ; Head ; Intubation ; Intubation, Intratracheal ; Neck ; Prospective Studies

The purpose of a conculation is to seek the opinions and advice of those whom we recognize to be more expert in a particular field of medicine than we are. Most surgeons regard the anesthesiolgist as a conculatant. Thus we analyzed 308 cases of interdepartmental consulatation submitted to our department from June 1991 to Novermber 1991. All case were elective ones and emergent cases were excluded. The analysis were as follow. 1) The overall conculation rate were 11.5%. 2) The highest rate of consultation were requested from orthopedic surgery department(29.9%) followed by ophthalmology department(25.0%), neurosurgery department(24.6%) and urology department(13.4%). 3) Male was 42.8% and female was 57.2%. 4) Most requestered problem was hepatic diseases including elevated transaminase, hepatitis and liver cirrhosis(35.1%) and then cardiovascular problem was 20.5%. 5) Because of our opinion, 22 cases were postponed. 6) Consultation rate increased according to advancing of age.
Female ; Hepatitis ; Humans ; Liver ; Male ; Neurosurgery ; Ophthalmology ; Orthopedics ; Urology