This review discusses the challenges of implementing enhanced recovery after surgery (ERAS) programs in South Korea. ERAS is a patient-centered perioperative care approach that aims to improve postoperative recovery by minimizing surgical stress and complications. While ERAS has demonstrated significant benefits, its successful implementation faces various barriers such as a lack of manpower and policy support, poor communication and collaboration among perioperative members, resistance to shifting away from outdated practices, and patient-specific risk factors. This review emphasizes the importance of understanding these factors to tailor effective strategies for successful ERAS implementation in South Korea’s unique healthcare setting. In this review, we aim to shed light on the current status of ERAS in South Korea and identify key barriers. We hope to encourage Korean anesthesiologists to take a leading role in adopting the ERAS program as the standard for perioperative care. Ultimately, our goal is to improve the surgical outcomes of patients using this proactive approach.

Background: Recognizing the seriousness of the misuse and abuse of medical narcotics, the South Korean government introduced the world's first narcotic management system, the Narcotics Information Management System (NIMS). This study aimed to explore the recent one-year opioid prescribing patterns in South Korea using the NIMS database. Methods: This study analyzed opioid prescription records in South Korea for the year 2022, utilizing the dispensing/ administration dataset provided by NIMS. Public data from the Korean Statistical Information Service were also utilized to explore prescription trends over the past four years. The examination covered 16 different opioid analgesics, assessed by the total number of units prescribed based on routes of administration, type of institutions, and patients’ sex and age group. Additionally, the disposal rate for each ingredient was computed. Results: In total, 206,941 records of 87,792,968 opioid analgesic units were analyzed. Recently, the overall quantity of prescribed opioid analgesic units has remained relatively stable. The most prescribed ingredient was oral oxycodone, followed by tapentadol and sublingual fentanyl. Tertiary hospitals had the highest number of dispensed units (49.4%), followed by community pharmacies (40.2%). The highest number of prescribed units was attributed to male patients in their 60s. The disposal rates of the oral and transdermal formulations were less than 0.1%. Conclusions Opioid prescription in South Korea features a high proportion of oral formulations, tertiary hospital administration, pharmacy dispensing, and elderly patients. Sustained education and surveillance of patients and healthcare providers is required.

Background: Recognizing the seriousness of the misuse and abuse of medical narcotics, the South Korean government introduced the world's first narcotic management system, the Narcotics Information Management System (NIMS). This study aimed to explore the recent one-year opioid prescribing patterns in South Korea using the NIMS database. Methods: This study analyzed opioid prescription records in South Korea for the year 2022, utilizing the dispensing/ administration dataset provided by NIMS. Public data from the Korean Statistical Information Service were also utilized to explore prescription trends over the past four years. The examination covered 16 different opioid analgesics, assessed by the total number of units prescribed based on routes of administration, type of institutions, and patients’ sex and age group. Additionally, the disposal rate for each ingredient was computed. Results: In total, 206,941 records of 87,792,968 opioid analgesic units were analyzed. Recently, the overall quantity of prescribed opioid analgesic units has remained relatively stable. The most prescribed ingredient was oral oxycodone, followed by tapentadol and sublingual fentanyl. Tertiary hospitals had the highest number of dispensed units (49.4%), followed by community pharmacies (40.2%). The highest number of prescribed units was attributed to male patients in their 60s. The disposal rates of the oral and transdermal formulations were less than 0.1%. Conclusions Opioid prescription in South Korea features a high proportion of oral formulations, tertiary hospital administration, pharmacy dispensing, and elderly patients. Sustained education and surveillance of patients and healthcare providers is required.

Background: Recognizing the seriousness of the misuse and abuse of medical narcotics, the South Korean government introduced the world's first narcotic management system, the Narcotics Information Management System (NIMS). This study aimed to explore the recent one-year opioid prescribing patterns in South Korea using the NIMS database. Methods: This study analyzed opioid prescription records in South Korea for the year 2022, utilizing the dispensing/ administration dataset provided by NIMS. Public data from the Korean Statistical Information Service were also utilized to explore prescription trends over the past four years. The examination covered 16 different opioid analgesics, assessed by the total number of units prescribed based on routes of administration, type of institutions, and patients’ sex and age group. Additionally, the disposal rate for each ingredient was computed. Results: In total, 206,941 records of 87,792,968 opioid analgesic units were analyzed. Recently, the overall quantity of prescribed opioid analgesic units has remained relatively stable. The most prescribed ingredient was oral oxycodone, followed by tapentadol and sublingual fentanyl. Tertiary hospitals had the highest number of dispensed units (49.4%), followed by community pharmacies (40.2%). The highest number of prescribed units was attributed to male patients in their 60s. The disposal rates of the oral and transdermal formulations were less than 0.1%. Conclusions Opioid prescription in South Korea features a high proportion of oral formulations, tertiary hospital administration, pharmacy dispensing, and elderly patients. Sustained education and surveillance of patients and healthcare providers is required.

STUDY DESIGN: Finite element models of the thoracolumbar spine with various techniques used in spinal fractures were developed to investigate the effects of fixation techniques on spinal stiffness. OBJECTIVES: To develop finite element models of the thoracolumbar spine with various fixation techniques to compare their spinal stiffness characteristics. SUMMARY OF LITERATURE REVIEW: Various anterior and posterior instrumentation options have been applied to stabilize unstable burst fractures of the thoracolumbar spines. The biomechanical effects of different instrumentation options on spinal stability are still unknown. MATERIALS AND METHODS: The 3-D finite element model of the human thoracolumbar spine (T12-L2) was reconstructed from CT images. Various anterior and posterior instrumentation techniques, 1-rod and 2-rod anterior fixations, anterior fixations with posterior fixation, and posterior fixation only, were virtually performed in the developed model with a long cage after corpectomy. Five loading cases, axial compression, flexion, extension, lateral bending, and torsion, were applied up to 1000 N and 10 Nm, respectively. The axial displacement and the rotations of T12 with respect to L2 were measured to analyze the stiffness of the spinal segments. RESULTS: The posterior fixation technique increased the stiffness of the spine the most. The addition of an anterior rod from 1 to 2 increased the stiffness significantly without posterior fixation, but little effect was found with posterior fixation. Among all fixation techniques, the inter-segmental stiffnesses were similar to those of the intact model in torsion cases. In the other loading cases, the inter-segmental stiffnesses were much greater than those of the intact models. CONCLUSIONS: Finite element models of the thoracolumbar spine were developed with various fixation methods. The intact models were validated with in-vitro experimental tests. The posterior fixation technique had a more significant effect on spine stability than did anterior fixation. And anteroposterior fixation techniques provided increased spinal stiffness
Humans ; Spinal Fractures ; Spine

Authors report a case of giant mucocele at frontal sinus. It was so large that almost whole portion of ipsilateral frontal lobe was compressed. Nevertheless presenting symptom was exceptionally trivial. With brief review of literatures, we discuss the etiology, pathogenesis, and so on.
Frontal Lobe ; Frontal Sinus* ; Mucocele*

BACKGROUND: An adequate uteroplacental and fetal blood flow during labor and cesarean delivery is of prime importance for fetal well-being and neonatal outcome. METHODS: Using the vascular smooth muscle of the human isolated umbilical arteries, this study was performed to see whether commonly used local anesthetics (bupivacaine, lidocaine and 2-chloroprocaine) and opioids (morphine,fentanyl and meperidine) could induce contracion or relaxation of these resting and precontracted vessels. Rings from human umbilical arteries were prepared by microdissection. The vessel rings were mounted in tissue baths for an isometric recording of the contractile activity. For resting muscles, the reactivity to drugs is expressed as a percentage of a maximal KCl-induced contraction, and for precontracted muscle, it is expressed as a percentage of a submaximal KCl-induced contraction. RESULTS: Bupivacaine, lidocaine and 2-chloroprocaine all induced contractions. Bupivacaine showed a maximal contraction (46.7 +/- 10.5%) at concentrations of 43 micrometer, lidocaine 19.7 +/- 4.8% at 0.11 mM. and 2-chloroprocaine showed 14.6 +/- 2.9% at 0.65 mM. Morphine, fentanyl and meperidine all induced contractions. Morphine showed a maximal contraction (19.6 +/- 7.1%) at a concentration of 10 4 M, meperidine at 17.2 +/- 8.4% at 3 x 10 5 M, and fentanyl at 1.7 +/- 2.0% at 3 x 10(-6)M. When umbilical arteries were induced to contract with a submaximal concentration of KCl, bupivacaine and lidocaine showed an ability to increase the magnitude of the sustained contraction, but 2-chloroprocaine showed a relaxation of the sustained contraction. Morphine, fentanyl and meperidine showed no change in the sustained contraction. CONCLUSIONS: This study demonstrates these local anesthetics and opioids as vasoactive on human umbilical arteries. If applicable in vivo, these drugs might have some influence on umbilical vessel tone and thus might reduce umbilical blood flow.
Analgesics, Opioid* ; Anesthetics, Local* ; Baths ; Bupivacaine ; Fentanyl ; Fetal Blood ; Humans* ; Lidocaine ; Meperidine ; Microdissection ; Morphine ; Muscle, Smooth, Vascular ; Muscles ; Relaxation ; Umbilical Arteries*

Hip and knee replacement arthroplasty is one of the important causes of pulmonary embolism, of which the incidence was reported to be from 2 to 16% But, there are no reports about the incidence of pulmonary embolism after these operations in Korea. The authors' intention was to study the incidence and clinical manifestations of pulmonary embolism after hip and knee surgery. Lung perfusion scans and inhalation scans were done preoperatively and 7 days postoperatively for 139 hip or knee replacement arthrosplasty patients in Asan Medical Center. We studied 62 cases of avascular necrosis of the femoral head, 33 cases of femur neck fractures, 45 cases of degenerative arthritis of the hip and knee joints and 17 cases of other diseases. In this study, hip replacement arthroplasties were done in 114 cases, knee replacement arthrosplasties in 25 cases. On preoperative lung scan, high or intermediate probability findings of pulmonary embolism were shown in 18 cases and all of them were asymptomatic. 139 cases showed normal or low probability on preoperative lung scan, of which 5 cases were changed to high probability and 7 cases to intermediate probability on postoperative lung scan. Four of the 7 intermediate probability cases were confirmed to be pulmonary embolism on pulmonary angiography. Of these 9 cases, hip replacement arthroplasties were done in 6 cases and knee replacement arthroplasties in 3 cases. There were 5 cases of osteoarthritis of hip and knee, 3 cases of avascular necrosis of femoral head and 1 case of femoral neck fracture. We concluded that preoperative and postoperative incidences of pulmonary embolism in Korea were similar to those in western countires. Most of the pulmonary embolism patients were asymptomatic and so lung perfusion scans and inhalation scans were helpful in the early diagnosis of pulmonary embolism.
Angiography ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Chungcheongnam-do ; Early Diagnosis ; Femoral Neck Fractures ; Head ; Hip ; Humans ; Incidence ; Inhalation ; Intention ; Knee Joint ; Knee ; Korea ; Lung ; Necrosis ; Osteoarthritis ; Osteoarthritis, Hip ; Perfusion ; Pulmonary Embolism

PURPOSE: For the management of patent ductus arteriosus(PDA) in premature infants, fluid restriction, correction of anemia, mechanical ventilation, diuretics, and surgery have been used, and the closure rate of PDA has improved significantly since the introduction of indomethacin and mefenamic acid as pharmacologic treatments of PDA. We studied to evaluate and compare the therapeutic effects of indomethacin and mefenamic acid in the management of premature infants with PDA. METHODS: 32 inborn premature infants who were hospitalized in NICU and diagnosed as PDA by cardiac sector were retrospectively studied and divided into two groups : An indomethacin treated group and a mefenamic acid treated group. Their gestational age, birth weight, blood urea nitrogen(BUN), creatinine(Cr), platelet count, urine output, fluid therapy, postnatal age, closure rate of PDA, and etc. were examined and conpared through the medical record review. RESULTS: The mean postnatal age on drug use was 4.6 days in intravenous indomethacin treated group(n=18), 9.0 days in oral mefenamic acid treated group(n=14), and the mean gestational age was 32.0 weeks and 32.3 weeks, respectively. After the use of each drugs, platelet count and urine output decreased, whereas blood urea nitrogen and creatinine increased. The closure rate of PDA was 94.4%(17/18) in the indomethacin treated group and 85.7%(12/14) in the mefenamic acid treated group(P=0.568). On the multivariate analysis except for the drugs, the most significant factor on PDA closure in preterm neonates was total amount of intake(P=0.000). CONCLUSION: We conclude that intravenous indomethacin is as effective as oral mefenamic acid in the therapy of preterm infants with PDA.
Anemia ; Birth Weight ; Blood Urea Nitrogen ; Creatinine ; Diuretics ; Ductus Arteriosus, Patent* ; Fluid Therapy ; Gestational Age ; Humans ; Indomethacin* ; Infant, Newborn ; Infant, Premature* ; Medical Records ; Mefenamic Acid* ; Multivariate Analysis ; Platelet Count ; Respiration, Artificial ; Retrospective Studies ; Urea

Endoscopic variceal ligation(EVL) is an accepted alternatives to endoscopic injection sclero- therapy(EIS) in many patients with bleeding esophageal varices. Esophageal hematoma is rare and an unusual complication after EVL or EIS. We present a patient with liver cirrhosis who developed an obstructive esophageal hematoma after EVL.
Esophageal and Gastric Varices ; Hematoma* ; Hemorrhage ; Humans ; Ligation* ; Liver Cirrhosis