BACKGROUND: There had been few regulations or agreements between medical schools how to teach undergraduate medical students during anesthesiology clerkship. We conducted this survey to figure out the current status of the clerkships of medical schools in Korea, and suggest the direction of development. METHODS: The questionnaires about anesthesiology clerkship were sent to chairpersons or clerkship directors of 42 medical schools in Korea by electric mail. The answers were collected by internet system. RESULTS: 33 schools answered the questionnaires. The clerkships were elective in 19 schools, but 26 schools answered that the anesthesiology clerkship should be included in core clerkships. Only a few schools oriented the students about ethical issues and occupational health during clerkship. Most schools evaluated the students by evaluation sheet or written examination. Oral or skill tests were used at only 8 and 5 schools, respectively. CONCLUSIONS: The answers of survey showed that there were many aspects to be improved in anesthesiology clerkship although the responses of students toward the clerkship were positive.
Anesthesiology ; Humans ; Internet ; Korea ; Occupational Health ; Postal Service ; Surveys and Questionnaires ; Schools, Medical ; Social Control, Formal ; Students, Medical

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

BACKGROUND: This study was designed to figure out how anesthesiologists think about their job values and expected tendencies through questionnaires. METHODS: The directions for completing internet questionnaires were sent to all members and semi-members of the Korean Society of Anesthesiologists by email. Paper version of the same questionnaires was sent to residents of some university hospitals, who did not answer the internet questionnaires. The questionnaires consisted of items of basic, 14 job values and 80 expected tendencies. The answerers were asked to choose 4 items among job values and 10 items among 80 tendencies. The answers were analyzed according to the groups of job positions, subspecialties, ages and gender. RESULTS: Among items of job values, 'decision making', 'taking care of people', 'working with my hands' and 'working with my mind' were chosen by more than 40% of answerers, and answer rates were similar between each comparative groups. Among items of expected tendencies, 'be calm in crisis', 'make decisions rapidly', 'be perfectionistic', 'be good coordinators', 'be self-confident', 'think logically', 'be tolerant of others', 'be able to do more than one thing at a time', and 'be persevering' showed high answer rate, but the answer rate of individual items showed some differences between groups. CONCLUSIONS: Although there were some items that showed different answer rates between groups, there was little difference in job values and expected tendencies between groups on the whole.
Electronic Mail ; Hospitals, University ; Internet ; Surveys and Questionnaires

Carthamus tinctorius L.is known to improve fracture healing, and bone morphogenetic proteins (BMPs) are associated with the formation and healing process of bone. BMP-2 and BMP-7 are two of the most important BMPs during the bone healing process. Human osteosarcoma MG63 cells and rats were used to determine the effects of Carthamus tinctorius L. extract (CTE) on BMP-2 gene expression. BMP-2 gene expression by CTE treatment in human osteosarcoma MG63 cells was not different from the control group until 8 hours of incubation, but was significantly higher, by 31%, than that of the control group at 16 hr of incubation. Microscopic findings of the 9th rib 3 weeks after fracture showed typical rimming of the osteoblast and immature bone formation in control and CTE groups. BMP-2 gene expression by in situ hybridization was remarkably increased by a CTE-supplemented diet in the fracture group compared to the control group. In conclusion, Carthamus tinctorius L. increased BMP-2 gene expression in human osteosarcoma cells and fractured bone. But further studies would be needed to elucidate the effect of CTE on fracture healing in vivo because our results did not show any evidence of healing improvement histologically 3rd week after fracture.
Animals ; Bone Morphogenetic Protein 7 ; Bone Morphogenetic Proteins ; Carthamus tinctorius* ; Carthamus* ; Diet ; Fracture Healing ; Fractures, Bone* ; Gene Expression* ; Humans ; In Situ Hybridization ; Osteoblasts ; Osteogenesis ; Osteosarcoma ; Rats* ; Ribs

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

BACKGROUND: The aim of this prospective, double-blind randomized study was to compare the recovery characteristics of desflurane-remifentanil and propofol-remifentanil anesthesia in patients undergoing a laparoscopic cholecystectomy under BIS monitoring. METHODS: Eight patients (ASA I-II, 20-65 yr) undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol-remifentanil anaesthesia or desflurane-remifentanil. The BIS was monitored and maintained between 45-55. At the end of surgery all anesthetics were discontinued. Time to eye opening and time to extubation was recorded. Subsequently, the patients were transported to the post-anesthetic care unit (PACU) and the modified aldrete score, visual analogue scale (VAS), blood pressure, heart rate, and postoperative nausea and vomiting (PONV) were recorded upon arrival at the PACU, as well as at 15 min, 30 min, 1 hr, 2 hr, and 24 hr. RESULTS: There were no significant differences in the incidence of PONV between the two groups. Modified aldrete scores were significantly higher in the propofol group at 15 min postoperative period (P = 0.013, Propofol = 9.87, Desflurane = 9.62). Further, VAS scores were significantly higher in the desflurane group at 30 min (P = 0.037, Propofol = 4.26, Desflurane = 5.0), and the number of antiemetic injections were significantly higher in the desflurane group at arrival to the PACU (P = 0.035, Propofol = 0, Desflurane = 0.11 +/- 0.052) and at 24 hr (P = 0.03, Propofol = 0.41 +/- 0.562, Desfluarane = 0.62 +/- 0.157). CONCLUSIONS: In patients undergoing laparoscopic cholecystectomy with BIS monitoring, there is no significant differences in the incidence of PONV. The use of propofol is associated with less postoperative pain.
Anesthesia ; Anesthesia Recovery Period ; Anesthetics ; Blood Pressure ; Cholecystectomy, Laparoscopic ; Consciousness Monitors ; Eye ; Heart Rate ; Humans ; Incidence ; Isoflurane ; Pain, Postoperative ; Piperidines ; Postoperative Nausea and Vomiting ; Postoperative Period ; Propofol ; Prospective Studies

Appropriate anticoagulation is essential for safe cardiopulmonary bypass (CPB). Two patients with infective endocarditis were scheduled for valve replacement. After an intravenous heparin injection for the CPB, the increases in the activated clotting time (ACT) in both patients were less than expected. Subsequent additional heparin administration failed to maintain a sufficient ACT for the CPB, and antithrombin III (AT III) tests during the CPB revealed low activities in both patients. Heparin resistance, due to consumption of circulating AT III as a result of infective endocarditis or prior heparinization, was postulated. While fresh frozen plasma (FFP) could not be timely administered in the first patient, ACT was successfully prolonged after the administration of FFP in the second. It is strongly suggested that adequate management of heparin resistance should be prepared for patients with infective endocarditis who require CPB.
Antithrombin III ; Antithrombin III Deficiency ; Cardiopulmonary Bypass* ; Endocarditis* ; Heparin* ; Humans ; Plasma

Appropriate anticoagulation is essential for safe cardiopulmonary bypass (CPB). Two patients with infective endocarditis were scheduled for valve replacement. After an intravenous heparin injection for the CPB, the increases in the activated clotting time (ACT) in both patients were less than expected. Subsequent additional heparin administration failed to maintain a sufficient ACT for the CPB, and antithrombin III (AT III) tests during the CPB revealed low activities in both patients. Heparin resistance, due to consumption of circulating AT III as a result of infective endocarditis or prior heparinization, was postulated. While fresh frozen plasma (FFP) could not be timely administered in the first patient, ACT was successfully prolonged after the administration of FFP in the second. It is strongly suggested that adequate management of heparin resistance should be prepared for patients with infective endocarditis who require CPB.
Antithrombin III ; Antithrombin III Deficiency ; Cardiopulmonary Bypass* ; Endocarditis* ; Heparin* ; Humans ; Plasma

BACKGROUND: Hydroxyethylstarch (HES) solutions are commonly used for intravascular volume expansion with varying effect on coagulation depending on molecular weight and mode of hydroxyl substitution.Clopidogrel and aspirin have been shown to reduce cardiovascular complications in patients with coronaryartery occlusive disease which renders patients to higher risk of bleeding complications who require surgery.The purpose of this study was to evaluate the effect of HES 200/0.5, 130/0.4 and crystalloid on blood loss and transfusion requirement in patients with recent antiplatelet therapy undergoing off-pump coronary bypass surgery (OPCAB) in a prospective, randomized trial. METHODS: Sixty patients scheduled for OPCAB, who received clopidogrel and aspirin within 5 days of surgery were randomly allocated into 3 groups:HES 200/0.5 (n = 20), HES 150/0.4 (n = 20), and Crystalloid (n = 20).Routine coagulation profile were measured before and 2 days after the surgery.Amount of perioperative blood loss, transfusion requirement and fluids input and output were recorded until 2 days postoperatively. RESULTS: The 3 groups were similar with regard to patients and operative characteristics.There were no significant differences in the amount of perioperative blood loss and transfusion requirement among the 3 groups. CONCLUSIONS: Both HES solutions were safe to use in terms of blood loss and transfusion requirement in patients undergoing OPCAB who received antiplatelet agents within 5 days of surgery.
Aspirin ; Hemorrhage ; Hetastarch ; Humans ; Isotonic Solutions ; Molecular Weight ; Platelet Aggregation Inhibitors ; Prospective Studies ; Ticlopidine

Sodium nitroprusside (SNP) is an anti-hypertensive drug, commonly used to decrease the systemic vascular resistance and lower the blood pressure. When the amount of cyanide generated by the SNP exceeds the metabolic capacity for detoxification, cyanide toxicity occurs. Under general anesthesia and cardiopulmonary bypass (CPB), it may be difficult to detect the development of cyanide toxicity. In cardiac surgical patients, hemolysis, hypothermia and decreased organ perfusion, which emphasize the risk of cyanide toxicity, may develop as a consequence of CPB. In particular, hemolysis during CPB may cause an unexpected overproduction of cyanide due to free hemoglobin release. We experienced a patient who demonstrated SNP tachyphylaxis and cyanide toxicity during CPB, even though the total amount of SNP administered was much lower than the recommended dose. We therefore report this case with a review of the relevant literature.
Anesthesia, General ; Blood Pressure ; Cardiopulmonary Bypass* ; Cyanides ; Hemolysis ; Humans ; Hypothermia ; Nitroprusside* ; Perfusion ; Tachyphylaxis ; Vascular Resistance