BACKGROUND: The Korean Journal of Anesthesiology (KJA) was first published in 1968 containing only 16 articles. In 1998, the number is 291. However, the quantitative growth does not mean a qualitative growth. There are many aspects to improving quality. One of them is statistical accuracy. I have examined the statistical methods in our field and checked the accuracy of the methods. Then, I compared the results with the methods in the 1980s and examined what kinds of changes exist. METHODS: I reviewed all the articles except case reports and review articles in KJA published from 1994 to 1998. I focused on the methods of inferential statistics because those kinds of statistics were usually mentioned in the articles. It is based on the mentioned technique in the article to decide which inferential statistics are used, even though sometimes they are not accurate. I adopted the similar statistical error criteria selected by Ko. RESULTS: Basic statistical error, for example no statistics used even though statistical methods are needed, were dramatically reduced compared to the 1980s. It is increased to use the mean comparison methods correctly, but, some statistical methods are still misused frequently, for example Chi-square test, nonparametric analysis, multiple comparison methods and improperly adopted methods based on the variable scale. CONCLUSION: Generally, based on my criteria statistical errors are reduced from about 75% in the 1980s to about 60% in the 1990s.
Anesthesiology*

There are a lot of units used in Anesthesiology field. Sometimes, we could not compare two units describing the same physical category. For example, I cannot find reference materials explaining whether a 7 French catheter is larger than a 16 Gauge catheter. Furthermore, I would like to know why there are so many differences of blood calcium levels between regular check and intraoperative emergency reports. As for liquid drug concentrations, we usually use the mg/ml during a clinical practice, however, basic researchers report it as mole/liter (molarity, M). I would like to answer these questions. So, I have searched some references and have summarized them to explain length, concentration, temperature, particle size, pressure, and ratio units commonly used in our clinical practice, Anesthesiology.
Anesthesiology* ; Calcium ; Catheters ; Emergencies ; Particle Size

No abstract available.
Humans ; Jehovah's Witnesses

BACKGROUND: For a rapid transfusion, pressure is sometimes applied to packed red blood cells during the operation. However, there are neither standard guidelines nor reported data regarding adequate change interval of transfusion kits. The aim of this study is to present relevant data by simulating a surgical situation. METHODS: Each unit of packed red blood cells was mixed with 50 mL of normal saline. Pressure (250 mmHg) was applied to the mixed red blood cells. Each filtration time was measured without change of the transfusion kit. The weight of the mixed red blood cells was measured before and after administration. The passed blood was examined microscopically for detection of possible microaggregation. Eight transfusion sets were tested with 70 packed red blood cells. RESULTS: International guidelines have recommended replacement of the transfusion set if flow rate decreased to less than 100 mL/min. The flow rate of five transfusion sets was recorded as less than 100 mL/min. The flow rate of the third packed red blood cells decreased to less than 100 mL/min. No microaggregate was detected. CONCLUSION: Therefore, we recommended replacement of the blood filter after filtering two units of packed red blood cells with pressure under operation room circumstances.
Erythrocyte Transfusion ; Erythrocytes ; Filtration

No abstract available.
Heparin

BACKGROUND: Procedures in medical papers should be described in sufficient detail to allow other researchers to reproduce the results. The apparatus including anesthesia machine should be given, too. Anesthesia machine has dramatically improved as bioengineering has developed. There are several ventilator settings in modern anesthesia machines. However, it seems that only a few ventilator settings are described even though modern ventilators are used in research. The purpose of this study is to investigate that how many ventilator parameters were described in the papers of the Korean Journal of Anesthesiology from 2001 to 2006. METHODS: All of papers with human general anesthesia were reviewed except case reports, and papers regarding only induction or intubation procedures. Recruited articles were grouped into papers with strongly related to respiratory parameters (STP), and into ones with slightly related to them based on the research topics. The description of following categories was counted in each paper; the type of anesthesia machine, tidal volume, respiratory rate, inspiratory:expiratory ratio, mode of ventilation, pressure set in pressure targeted ventilation, positive end expiratory pressure, inspiratory pause, and inspiratory rising rate. RESULTS: The description rate of each parameters in STP were 36% in the type of anesthesia machine, 66% in tidal volume, 54% in respiratory rate, and 24% in inspiratory:expiratory ratio. The other settings were seldomly mentioned. CONCLUSIONS: Description on the ventilator parameters was sometimes missed. We should describe adequate ventilator settings to reproduce the results because the modern anesthesia machine has additional ventilator options.
Anesthesia* ; Anesthesia, General ; Anesthesiology ; Bioengineering ; Humans ; Intubation ; Positive-Pressure Respiration ; Respiration, Artificial ; Respiratory Rate ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical*

BACKGROUND: Three kinds of conditions should be considered to reduce free hemoglobin production using an autologous cell salvage device. They are the negative suction pressure, the size of suction tip, and the air contact during suction. We want to examine which condition is the most important factor to produce free hemoglobin. METHODS: One pack of red blood cell and one pack of fresh frozen plasma with the same blood type were mixed. They were aspirated based on the two suction pressure (-150 mmHg or -300 mmHg), three sizes of suction tips, and the two conditions of air contact, in which the suction tip was located in the surface of blood or in the middle of the blood. Seven ml sized EDTA tube was used to collect 5 ml blood. All the procedure repeated ten times. Free hemoglobin, total hemoglobin, and hematocrit were measured. Hemolysis ratio was calculated with following formula. Hemolysis ratio = (new free hemoglobin production) x (100-hematocrit) / (total hemoglobin). RESULTS: Free hemoglobin production and hemolysis ratio were increased when the suction tip was positioned in the surface than when it was in the middle of the blood. The pressure of negative suction and three kinds of the suction tips did not influence the production of free hemoglobin nor the hemolysis ratio. CONCLUSIONS: The air contact is the most important factor to reduce hemolysis using autologous cell salvage device. Suction pressure or suction tip diameter have little influence to produce hemolysis.
Blood Transfusion, Autologous ; Edetic Acid ; Erythrocytes ; Hematocrit ; Hemoglobins ; Hemolysis ; Plasma ; Suction ; Toxicology

BACKGROUND: Empirical use of fresh frozen plasma (FFP) in perioperative blood transfusion leads to high wastage of FFP. However, coordination of many related clinical departments is difficult. Therefore, quality improvement (QI) activities for establishment of appropriate use of FFP are needed. METHODS: Departments of surgery (all surgery departments except ophthalmology) and the departments of anesthesiology, clinical pathology, and nurses met each month from March, 2011 to October, 2011. Each department investigated the number of FFP usages, wastage, and coagulation tests. Primary measured variables and objectives were decrease of 50% of FFP wastage rate compared with the previous year and 50% increase of coagulation testing before using FFP. Secondary measured variables were total amount of FFP usage and report time for coagulation tests. RESULTS: After the QI activities (March, 2011~October, 2011), FFP wastage decreased, from 71.5 units during the second half of 2010 to 37.8 units during the second half of 2011 (-47.1%). Rate of coagulation testing before using FFP more than doubled during the second half of 2011 (57%) compared with the second half of 2010 (25%). The rate of less than 30 minutes report time for coagulation testing increased from 60% to 75%. FFP transfusion per 1,000 surgical cases decreased to from 190 units to 118 units. CONCLUSION: Rate of FFP wastage and transfusion decreased and rate of performance of the blood coagulation test was enhanced through education and training on transfusion and QI activities.
Anesthesiology ; Blood Coagulation Tests ; Blood Transfusion ; Pathology, Clinical ; Plasma ; Qi ; Quality Improvement

Retrobulbar block is commonly performed under monitored anesthesia prior to cataract surgery. Known complications associated with retrobulbar block include cranial nerve palsies, seizures, and cardiorespiratory arrest. We report a case of severe shivering following a retrobulbar block. Two minutes after the block was administered, the patient experienced severe shivering, which subsided after injection of pethidine 25 mg. The likely etiology of the shivering was inadvertent dural puncture of the optic nerve sheath and local anesthetic spread into the cerebrospinal fluid space. Shivering may be a warning sign of brain stem anesthesia, and in such a scenario the clinician should direct special attention to possible life-threatening complications.
Anesthesia ; Brain Stem ; Cataract ; Cranial Nerve Diseases ; Humans ; Meperidine ; Nerve Block ; Optic Nerve ; Punctures ; Seizures ; Shivering

BACKGROUND: Nitrous oxide concentration is easily controlled by respiratory ventilation. It suppresses bone marrow via the inhibition of thymidylate synthesis. The aim of this work was to determine the optimal pressure and exposure duration of nitrous oxide, as well as methotrexate concentration that maximizes the suppression of 4 cancer cells: CCRF-CEM, K562, A549 and MDA-MB-231. METHODS: Each cancer cell was cultured in a hyperbaric chamber at 1, 2 and 3 atmosphere of 74% nitrous oxide for 24, 48, and 72 hours at 0, 0.3, 0.7, 1, 2, 5 and 10 microM methotrexate (MTX), respectively. The results were expressed in the ratio of the number of cancer cells cultured under specific conditions (S cells) to that under normal conditions (N cells). RESULTS: The S/N ratio of CCRF-CEM cells was 87.4% in 24-hour culture, 95.0% in 48-hour culture and 115.9% in 72-hour culture (P < 0.05). The S/N ratio of K562 cells was 103.6% at 1 atm, 102.4% at 2 atm and 115.6% at 3 atm (P < 0.05). The S/N ratio of A549 cells was 94.3% at 1 atm, 94.1% at 2 atm, 99.3% at 3 atm, 96.2% in 24-hour culture, 99.2% in 48-hour culture and 99.3% in 72-hour culture (P > 0.05). However, the S/N ratio of MDA-MB 231 cells was 66.9% in 24-hour culture, 83.1% in 48 hour culture and 87.8% in 72-hour culture (P < 0.05). CONCLUSIONS: Only the growth of the MDA-MB-231 cells was significantly reduced after a longer exposure time to nitrous oxide, but those of the other cells were not.
Atmosphere ; Bone Marrow ; K562 Cells ; Methotrexate ; Nitrous Oxide ; Ventilation