BACKGROUND: Patient-controlled analgesia (PCA) is a widely used method of postoperative analgesia with the advantage of tailored dosing for each individual. In spite of its popularity, there have been few reports on the current state of PCA in Korea. In this study, the data on PCA management and PCA regimens of medical institutions in Korea were collected and analyzed. METHODS: Members of the Korean Society for Anesthetic Pharmacology were questioned as to the state of postoperative PCA management, such as acute pain services (APS) and pain assessment. A list of PCA regimens for each institution was also requested and analyzed. RESULTS: Among 65 hospitals, APS was run in 30 and the severity of postoperative pain was assessed in 60. The safety and efficacy of PCA was evaluated only in 9 hospitals. A total 518 PCA regimens were reported (414, 95 and 9 regimens for intravenous, epidural and other routes, respectively). For intravenous PCA, fentanyl only and fentanyl-ketorolac regimens comprised 33.8 and 30.9% of treatments, respectively. In 95.9% of the regimens, background infusion was used. For epidural PCA, fentanyl-ropivacaine or fentanyl-levobupivacaine regimens made up the majority (47.4 and 13.7%, respectively). CONCLUSIONS: In Korea, APS was used in less than 50% of the hospitals and the evaluation of the safety and efficacy of PCA is not carried out in the majority. Background infusion, known to have little advantage in most cases, was widely used in intravenous PCA.
Analgesia ; Analgesia, Patient-Controlled* ; Fentanyl ; Korea* ; Pain Clinics ; Pain Measurement ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Pharmacology

Opioids are the cornerstone for treating moderate to severe pain and are commonly used for anesthesia and pain management. However, large inter-individual variability exists in the analgesic and adverse effects. It would be very helpful to predict the opioid response of each patient, considering the serious outcomes related to insufficient pain control and fatal side effects. Pharmacogenetic data on opioids have accumulated; thus, the aim of this article is to review the pharmacogenetic studies related to opioids frequently used for anesthesia and pain management.
Analgesia ; Analgesics, Opioid ; Anesthesia* ; Humans ; Pain Management* ; Pharmacogenetics*

BACKGROUND: Hip fracture surgery on elderly patients is associated with a high incidence of morbidity and mortality. The aim of this study is to identify the risk factors related to the postoperative mortality and complications following hip fracture surgery on elderly patients. METHODS: In this retrospective study, the medical records of elderly patients (aged 65 years or older) who underwent hip fracture surgery from January 2011 to June 2014 were reviewed. A total of 464 patients were involved. Demographic data of the patients, American Society of Anesthesiologists physical status, preoperative comorbidities, type and duration of anesthesia and type of surgery were collected. Factors related to postoperative mortality and complications; as well as to intensive care unit admission were analyzed using logistic regression. RESULTS: The incidence of postoperative mortality, cardiovascular complications, respiratory complications and intensive care unit (ICU) admission were 1.7, 4.7, 19.6 and 7.1%, respectively. Postoperative mortality was associated with preoperative respiratory comorbidities, postoperative cardiovascular complications (P < 0.05). Postoperative cardiovascular complications were related to frequent intraoperative hypotension (P <0.05). Postoperative respiratory complications were related to age, preoperative renal failure, neurological comorbidities, and bedridden state (P < 0.05). ICU admission was associated with the time from injury to operation, preoperative neurological comorbidities and frequent intraoperative hypotension (P < 0.05). CONCLUSIONS: Adequate treatment of respiratory comorbidities and prevention of cardiovascular complications might be the critical factors in reducing postoperative mortality in elderly patients undergoing hip fracture surgery.
Aged* ; Anesthesia ; Comorbidity ; Hip Fractures ; Hip* ; Humans ; Hypotension ; Incidence ; Intensive Care Units ; Length of Stay ; Logistic Models ; Medical Records ; Mortality ; Renal Insufficiency ; Retrospective Studies ; Risk Factors*

BACKGROUND: The performance of a target controlled infusion (TCI) system needs to be confirmed in a clinical setting. Aquafol(TM), a microemulsion propofol, can be used for TCI with its pharmacokinetic parameters. The aim of this study is to evaluate the predictive performance of Aquafol(TM) TCI by using a PION TCI(R) pump incorporating the previously established pharmacokinetic parameters and ke0. METHODS: Thirty adult patients were enrolled in the study. General anesthesia was maintained with TCI of Aquafol(TM) and remifentanil using a PION TCI(R) pump. During the maintenance of anesthesia with a constant target effect-site concentration of propofol for at least for 20 minutes, blood was drawn and the propofol plasma concentration was measured. The predictive performance of Aquafol(TM) TCI was evaluated by determining the median performance error (MDPE), median absolute performance error (MDAPE), divergence, and wobble from the intra-individual and pooled performance errors. The acceptability of the TCI system was determined based on the pooled predictive performance. RESULTS: A total of 153 propofol blood samples were analyzed. The estimates of pooled MDPE, MDAPE, divergence and wobble were 8.59% (1.61), 19.1% (1.12), -1.12%/h and 9.87% (1.01), respectively. The MDAPE indicating the accuracy of the TCI infusion system was within the clinically acceptable range (< 20-30%) and the bias (MDPE) was also acceptable (< 10-20%). CONCLUSIONS: The performance of Aquafol(TM) TCI using a PION TCI(R) pump was acceptable for the clinical use.
Adult ; Anesthesia ; Anesthesia, General ; Bias (Epidemiology) ; Drug Delivery Systems ; Humans ; Mesons* ; Plasma ; Propofol

Antley-Bixler syndrome is a congenital anomaly of multiple bones and cartilage, and this was first reported by Antley and Bixler in 1975. It is characterized by craniosynostosis, midface hypoplasia with choanal stenosis and atresia, radiohumeral synostosis and femoral bowing. This is sometimes accompanied by cardiac, renal, gastrointestinal and genital malformations. The risk of respiratory distress is high in the infants with this syndrome, and this is most commonly caused by choanal stenosis and atresia. Careful anesthetic management is needed for these infants because of the potential risk of a difficult airway and respiratory complications. We report here on our experience with the anesthetic management of a neonate with Antley-Bixler syndrome and we review the relevant literature.
Anesthesia ; Antley-Bixler Syndrome Phenotype ; Cartilage ; Constriction, Pathologic ; Craniosynostoses ; Humans ; Infant ; Infant, Newborn ; Synostosis

Massive pulmonary embolism is associated with significant perioperative morbidity and mortality. We report here on a case of a 69-year-old man who suffered a massive pulmonary embolism with pulseless electrical activity during knee arthroscopic surgery. After a diagnosis was made by performing transthoracic echocardiography, the patient was treated with recombinant tissue-type plasminogen activator. The patient was transferred to the intensive care unit after his hemodynamic status improved. The patient went on to make a full cardiopulmonary recovery without any complications.
Aged ; Arthroscopy ; Echocardiography ; Hemodynamics ; Humans ; Intensive Care Units ; Knee ; Pulmonary Embolism ; Thrombolytic Therapy ; Tissue Plasminogen Activator

No abstract available.
Resin Cements

Genetic and/or environmental factors lead to large inter-individual variability in the efficacy and the side effects of drugs. Pharmacogenetics is the study of genetically determined differences in drug response. It focuses on the genetic variations involved in drug metabolism, transporters and receptors, which result in the pharmacokinetic and pharmacodynamic differences. Recently, pharmacogenetic studies on anesthetics and analgesics have been carried out actively. The pharmacogenetics of the commonly used drugs in anesthetic practice is reviewed.
Analgesics ; Anesthetics ; Genetic Variation ; Pharmacogenetics

Aortic dissection during cardiopulmonary bypass for aortic aneurysm surgery is a rare complication. If unrecognized in early time, it would be a fatal consequence. Neurological sequelae remain a well-recognized complication of cardiac surgery. Monitoring of cerebral oxygenation may be a useful technique for identifying vulnerable periods for the development of neurological injury. We report the experience of the decreasing left radial blood pressure and left rSO2 which caused by retrograde aortic dissection during the ascending aortic aneurysm replacement surgery.
Aortic Aneurysm ; Blood Pressure ; Cardiopulmonary Bypass ; Oxygen ; Thoracic Surgery

No abstract available
Anesthetics, Intravenous* ; Pharmacogenetics*