Randomized trial of subfascial infusion of ropivacaine for early recovery in laparoscopic colorectal cancer surgery / 대한마취과학회지

BACKGROUND: There is a need for investigating the analgesic method as part of early recovery after surgery tailored for laparoscopic colorectal cancer (LCRC) surgery. In this randomized trial, we aimed to investigate the analgesic efficacy of an inverse ‘v’ shaped bilateral, subfascial ropivacaine continuous infusion in LCRC surgery. METHODS: Forty two patients undergoing elective LCRC surgery were randomly allocated to one of two groups to receive either 0.5% ropivacaine continuous infusion at the subfascial plane (n = 20, R group) or fentanyl intravenous patient controlled analgesia (IV PCA) (n = 22, F group) for postoperative 72 hours. The primary endpoint was the visual analogue scores (VAS) when coughing at postoperative 24 hours. Secondary end points were the VAS at 1, 6, 48, and 72 hours, time to first flatus, time to first rescue meperidine requirement, rescue meperidine consumption, length of hospital stay, postoperative nausea and vomiting, sedation, hypotension, dizziness, headache, and wound complications. RESULTS: The VAS at rest and when coughing were similar between the groups throughout the study. The time to first gas passage and time to first rescue meperidine at ward were significantly shorter in the R group compared to the F group (P = 0.010). Rescue meperidine was administered less in the R group; however, without statistical significance. Other study parameters were not different between the groups. CONCLUSIONS: Ropivacaine continuous infusion with an inverse ‘v ’ shaped bilateral, subfascial catheter placement showed significantly enhanced bowel recovery and analgesic efficacy was not different from IV PCA in LCRC surgery.

Clinical benefits of preemptive thoracic epidural analgesia with hydromorphone and bupivacaine in open thoracotomy lung surgery

BACKGROUND: Preemptive analgesia is known to decrease the sensitization of the central nervous system and reduce subsequent amplification of nociceptive stimuli. We investigated whether preemptive thoracic epidural analgesia (TEA) demonstrated intraoperative and postoperative short and long term clinical advantages. METHODS: Thirty patients scheduled for open thoracotomy were randomly allocated to one of two groups to receive continuous TEA (0.15% bupivacaine and 8 microg/ml hydromorphone) either before surgical incision (preemptive group) or at the end of the operation (nonpreemptive group). Incidence of hypotension during surgery was recorded. Numerical rating scales (NRS) and the incidence of side effects such as nausea, pruritus, sedation, hypotension, and respiratory depression were recorded at 2, 6, 24, and 48 hours postoperatively. Pulmonary function test (PFT) was performed before, 24 and 48 hours after the operation. Persistence of pain control was investigated at 6 months postoperatively. RESULTS: The NRS score, side effects, and PFT changes were comparable between the two groups. TEA and intravenous rescue morphine consumed at 2, 6, 24, and 48 hours postoperatively were not different between the two groups. During surgery, the incidence of hypotension was significantly higher in the preemptive group (P = 0.027). At 6-month follow up, two patients in the nonpreemptive group complained of persistent pain at wound and none in the preemptive group. CONCLUSIONS: Preemptive TEA with hydromorphone and bupivacaine during surgery may cause unnecessary intraoperative hypotension without a prominent advantage in reducing acute or chronic pain or enhancing pulmonary function after thoracotomy. The advantageous concept of preemptive TEA may be dubious and may not provide perioperative clinical benefits.

Comparison of respiratory mechanics between sevoflurane and propofol-remifentanil anesthesia for laparoscopic colectomy / 대한마취과학회지

BACKGROUND: The creation of pneumoperitoneum and Trendelenburg positioning during laparoscopic surgery are associated with respiratory changes. We aimed to compare respiratory mechanics while using intravenous propofol and remifentanil vs. sevoflurane during laparoscopic colectomy. METHODS: Sixty patients undergoing laparoscopic colectomy were randomly allocated to one of the two groups: group PR (propofol-remifentanil group; n = 30), and group S (sevoflurane group; n = 30). Peak inspiratory pressure (PIP), dynamic lung compliance (Cdyn), and respiratory resistance (Rrs) values at five different time points: 5 minutes after induction of anesthesia (supine position, T1), 3 minutes after pneumoperitoneum (lithotomy position, T2), 3 minutes after pneumoperitoneum while in the lithotomy-Trendelenburg position (T3), 30 minutes after pneumoperitoneum (T4), and 3 minutes after deflation of pneumoperitoneum (T5). RESULTS: In both groups, there were significant increases in PIP and Rrs while Cdyn decreased at times T2, T3, and T4 compared to T1 (P < 0.001). The Rrs of group PR for T2, T3, and T4 were significantly higher than those measured in group S for the corresponding time points (P < 0.05). CONCLUSIONS: Respiratory mechanics can be adversely affected during laparoscopic colectomy. Respiratory resistance was significantly higher during propofol-remifentanil anesthesia than sevoflurane anesthesia.

Adequate time of initiation of continuous infusion of nitroglycerin for controlling pulmonary arterial pressure during ethanol embolotherapy of congenital arteriovenous malformation of the extremities / 대한마취과학회지

No abstract available.

Adequate time of initiation of continuous infusion of nitroglycerin for controlling pulmonary arterial pressure during ethanol embolotherapy of congenital arteriovenous malformation of the extremities / 대한마취과학회지

No abstract available.

A Study on Bioethical Consideration to Prospective Clinical Research Papers published in Journal of Korean Society of Emergency Medicine

PURPOSE: There is increasing concern about ethical conduct of human research in the field of medicine. The purpose of this study was to assess the ethical review process by institutional review boards for human research articles published in the journal of Korean Society of Emergency Medicine. METHODS: We reviewed human research papers published in the journal of Korean Society of Emergency Medicine from the 1st edition, 1990 to the 6th edition, 2006. A checklist was used to review the articles. RESULTS: The total number of prospective clinical research paper was 250. Among them, there were 63 papers (25.2%) in which the obtaining of informed consent was described in the article. Only two studies (0.8%) published in the journal were noted to have IRB approval. Invasive techniques were employed in 134 studies (53.6%). Among the 134, only 22 (16.4%) mentioned that informed consent taken was given during the study. Studies which may have involved discrimination totaled 21 (8.4%), and the number of studies that may have violated the patients' right to privacy was 20 (8%). The number of studies that may have a conflict of interest but was not declared was 12 (4.8%). CONCLUSION: There should be greater concern about the ethical conduct of research in studies with human research subjects in the journal of the Korean Society of Emergency Medicine.

Comparison of cardiopulmonary hemodynamic changes according to different ethanol bolus injection doses in piglets: the applicability of the study of ethanol injection effects on cardiopulmonary hemodynamic changes in sclerotherapy of congenital arterioven / 대한마취과학회지

BACKGROUND: Ethanol injection during a sclerotherapy for the treatment of arteriovenous malformation, which performed under general anesthesia, can cause significant hemodynamic changes, even cardiovascular collapse. However, guideline for adequate management of hemodynamic change or preventing detrimental complication has still not been proposed. METHODS: Twenty-two piglets were randomly allocated to one of two groups: a 2.5 ml and a 4.0 ml ethanol. After baseline hemodynamic measurements, 2.5 ml or 4.0 ml of absolute ethanol was repeatedly administered in distal portion of renal vein with 10 minute intervals, and hemodynamic parameters were measured immediately before and after bolus injection of absolute ethanol until 10 minutes after final injection. RESULTS: Compared with 2.5 ml group, systolic, mean and diastolic pulmonary arterial pressures (PAP) and pulmonary vascular resistance (PVR) of 4.0 ml group showed significant differences from the first bolus injection of absolute ethanol. Hemodynamic parameters of 2.5 ml group did not show the increasing or decreasing tendency during a session, whereas, in 4.0 ml group, systolic, mean and diastolic PAP and PVR showed significantly increasing tendency. However, systemic arterial blood pressure, heart rate, central venous pressure, pulmonary capillary wedge pressure, cardiac output, and systemic vascular resistance did not show increasing or decreasing tendency in both groups. CONCLUSIONS: Based on the hemodynamic alterations observed from piglet model, the bolus injection of absolute ethanol during sclerotherapy in congenital arteriovenous malformation requires careful hemodynamic monitoring. We strongly recommend that anesthesiologist should carefully monitor the hemodynamic parameters after injection of relatively large amount of absolute ethanol.

Effects of ascorbic acid on coagulation during living donor liver transplantation in adults / 대한마취과학회지

BACKGROUND: Prompt correction of hemostatic and thrombotic derangements during liver transplantation can play a key role in preventing excessive blood transfusion or thrombotic complications. It is well known that reactive oxygen species can affect coagulant and anticoagulant systems. Therefore, we investigated whether ascorbic acid (AA), one of potent antioxidant agents, can improve the coagulation during living donor liver transplantation (LDLT). METHODS: Thirty three adult patients undergoing LDLT were enrolled in this study. The blood samples of these patients were collected at 90 minutes after the beginning of operation and at 150 and 300 minutes after reperfusion. At each time period, blood samples were categorized into hypocoagulation, normal, and hypercoagulation. Within each category, the samples were further divided into three groups: whole blood (WB) (0.36 ml of native WB), AA (0.33 ml of native WB mixed with 0.03 ml of AA solution), and normal saline (NS) groups (0.33 ml of native WB mixed with 0.03 ml of NS), and these samples were analyzed using thromboelastogram (TEG). We compared the parameters of TEG (gamma time, K time, alpha angle, maximum amplitude (MA), and LY60) in each coagulation status. RESULTS: AA did not significantly affect TEG parameters in hypocoagulation or normal coagulation during LDLT. However, AA significantly decreased gamma time, alpha angle and MA at 150 minutes, and, K time and alpha angle at 300 minutes after reperfusion in the blood samples of hypercoagulation category. CONCLUSIONS: We may conclude that ascorbic acid inhibits hypercoagulation after reperfusion period during living donor liver transplantation.

The Determination of Optimal Intramuscular Injection Time of Midazolam as a Premedication Agent for Minimizing Decrease of Serum Potassium / 대한마취과학회지

BACKGROUND: Pre-operative anxiety is known to cause an increase in plasma catecholamine levels, which, in turn, attributes to the decrease in serum K+ concentration. Midazolam is one of the most commonly used premedication agent for the purpose of anxiolysis in the pre-operative period. In this study, by measuring serum K+ concentration, we investigated the optimal intramuscular injection time for midazolam which maximally prevents the reduction of serum K+ concentration. METHODS: One hundred twenty three patients undergoing breast surgery were randomly assigned to one of 5 groups. Control group (n = 24) had no premedication. 30-minute group (n = 30), 60-minute group (n = 25), 90-minute group (n = 22) and 120-minute group (n = 22) received IM injection of midazolam (0.05 mg/kg) at 30, 60, 90, and 120 minutes before induction of anesthesia, respectively. Anxiety level, serum K+ concentrations, blood pressures and heart rates of all patients were measured at 7:00pm of the day before surgery and immediately before induction of anesthesia. RESULTS: Serum K+ concentrations of all groups showed significant decrease in the preinduction time compared with those values at 7:00 pm of the day before surgery. There were no significant changes of heart rates in all groups. Blood pressures immediately before induction of anesthesia elevated compared with those at 7"00 pm of the day before surgery in all groups. Immediately before induction of anesthesia, the K+ levels of 60-minute and 90-minute groups were higher than those of the control group. At this time, the rates of hypokalemia (K+ <3.5 mEq/L) of 60-minute and 90-minute groups were lower than those of the control group. 30-minute and 60-minute groups had significantly lower anxiety levels than the control group. CONCLUSIONS: When we consider anxiety and serum potassium levels, the optimal intramusculr injecting time of midazolam was 60 minutes before induction of anesthesia.

The Effect of H1-Receptor Antagonist on Hemodynamic Change during Anesthesia / 대한마취과학회지

baseline for safe use of a drug. RESULTS: SVR and PVR failed to show statistically significant changes. Heart rates were increased only at 2 minute after administration of chlorpheniramine maleate. Blood pressures were increased but returned to basal level within 4 minutes. Cardiac output showed statistically significant increase until 8 minutes. However, the changes of hemodynamic values were maintained within 20% of basal levels. CONCLUSIONS: Chlorpheniramine maleate is observed to cause statistically significant hemodynamic change after intravenous administration during anesthesia. But the changes were within 20% of basal levels, and we can safely use chlorpheniramine maleate 8 mg IV in the view of hemodynamic changes.

Effects of Insulin on the Resuscitation by Epinephrine for Bupivacaine-Induced Cardiovascular Depression in Dogs / 대한마취과학회지

BACKGROUND: Because of the difficulty of resuscitation caused by bupivacaine-induced cardiotoxicity, the choice of resuscitation medication is still unclear. We investigated whether insulin can improve outcomes of resuscitation by epinephrine from bupivacaine-induced cardiovascular collapse. METHODS: Twenty-four mongrel dogs were randomly allocated to one of the two groups: an EPI group (n = 12), and an EPI + RI group (n = 12). Sixty minutes after induction of general anesthesia, baseline measurement of hemodynamic parameters and arterial blood gas tension was performed. Bupivacaine infusion was started at a rate of 0.5 mg/kg/min and kept until mean arterial blood pressure fell below 40 mmHg and heart rate 40 beats per minute. At this point, bupivacaine infusion was stopped and resuscitation was started, with epinephrine in EPI group and epinephrine combined with regular insulin in EPI + RI group. RESULTS: Bupivacaine infusion caused significant decreases in mean arterial blood pressure, heart rate, cardiac output, and systemic vascular resistance and increases in mean pulmonary blood pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, and central venous pressure. The recovery rate of EPI + RI group (8/12) was higher than that of EPI group (2/12). CONCLUSIONS: Combined administration of epinephrine and regular insulin improves outcomes of resuscitation of bupivacaine-induced cardiovascular collapse. Therefore, we believe that prompt administration of insulin should be strongly considered in case of bupivacaine-induced cardiotoxicity.

Clinical Review of Inappropriate Use of Adenosine in Tachycardic Patients at the Emergency Department

PURPOSE: For tachycardic patients not in need of immediate cardioversion, the International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care emphasize specific rhythm diagnosis and avoidance of simplistic overuse of adenosine. The purpose of this study was to identify the rhythms for which adenosine was inappropriately prescribed at the emergency department after the International Guidelines 2000 had been adopted. METHODS: We retrospectively investigated 128 tachycardic patients who had been prescribed adenosine at the emergency department from September 2000 to March 2003. Patients were divided into two groups. The Appropriate Use Group was comprised of patients for whom had been prescribed for narrow QRS-complex tachycardia on the initial ECG. The Inappropriate Use Group was comprised of patients for whom adenosine had been prescribed for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin on the initial ECG. RESULTS: Of the 128 patients, 31 (24.2%) were in the Inappropriate Use Group. Among them, atrial fibrillation was involved in 15, atrial flutter in 3, atrial tachycardia in 2, sinus tachycardia in 8, and wide QRS-complex tachycardia of unknown origin in 3. CONCLUSION: Approximately 24% of the emergency department patients who were treated with adenosine received the medication unnecessarily for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin. Additional education on electrocardiographic recognition of tachyarrhythmias, and the Tachycardia Algorithms of Guidelines 2000 may be necessary for residents of emergency department.

Correlation of AEP, BIS and OAA/S Scores Under Stepwise Sedation Using Propofol TCI in Orthopedic Patients Undergoing Total Knee Replacement Arthroplasty Under Spinal Anesthesia / 대한마취과학회지

BACKGROUND: We performed a prospective, randomized study to investigate the relations between BIS (bispectral index, BISTM monitor), AAI (mid-latency AEP, A-line ARX index) and depth of sedation, and assessed two different memory functions at OAA/S score 2 under spinal anesthesia. METHODS: 44 ASA physical status 1-2 patients, scheduled for elective total knee replacement arthroplasty were randomly allocated to either the BIS group (22) or the AEP group (22). Under spinal anesthesia, patients were sedated with propofol TCI to OAA/S score 2. BIS and AAI at each OAA/S score were measured and patients were maintained at an OAA/S score 2. A specific picture was shown during the operation. At PACU, an interview was done to determine whether patients recalled specific picture (picture recall) or any intra-operative noises or scenes (op recall). RESULTS: BIS decreased as OAA/S score reduced from 5 to 2 (P < 0.05), but AAI could not differentiate between an OAA/S score 3 and 2 (P = 0.0690). There were correlations of 0.827 and 0.610, respectively, (Spearman's rho) between BIS and OAA/S scores and between AAI and OAA/S scores. BIS was higher at all OAA/S scores (P < 0.05), and the standard deviations of BIS were smaller. There was a statistically significant difference between the recalls (P = 0.0253). CONCLUSIONS: Both BIS and AAI provided information about the depth of sedation, but BIS was more accurate. The difference between 'op recall' and 'picture recall' requires further investigation.

The Effect of Prehydration on Sensory Block Level in the Isobaric Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Even though the effect of prehydration on the spinal anesthesia-induced hypotension has not yet been concluded, prehydration prior to spinal anesthesia is recommended in order to reduce the incidence and severity of hypotension. We investigated the effects of prehydration on hemodynamic change during spinal anesthesia with isobaric 0.5% tetracaine. METHODS: We prospectively performed this study on 96 patients who underwent elective transurethral surgery from October 2002 to January 2004. Patients were randomly allocated to receive either no prehydration or 10 ml/kg crystalloids administered over 10 15 min prior to spinal anesthesia. We compared dermatomal spreads of spinal anesthesia, hemodynamic parameters (blood pressure, heart rate), incidences of hypotension and bradycardia between two groups. RESULTS: Hemodynamic parameters, incidences of hypotension and bradycardia showed no statistically significant differences during spinal anesthesia between two groups. There were statistically significant differences in the dermatomal spread of sensory levels between two groups from 5 to 90 min after spinal anesthesia. Sensory block levels in prehydration group were statistically lower than no prehydration group. CONCLUSION: We hypothesized that prehydration can be one of factors that influence on dermatomal spread of local anesthetics in isobaric spinal anesthesia. The difference of dermatomal spread between two groups may be caused by brain blood barrier (BBB)-freely passing crystalloids, which may influence on the volume and density of cerebrospinal fluids. To verify this phenomenon found in our study, further investigation is still warranted.

Anesthetic Management of Pulmonary Arterial Pressure Change during the Ethanol Sclerotherapy of Peripheral Arteriovenous Malformations / 대한마취과학회지

BACKGROUND: We frequently experience the elevation of pulmonary arterial pressure (PAP) during ethanol sclerotherapy of arteriovenous malformations. But, the study on the degree of PAP elevation during ethanol sclerotherapy has not yet been made. Therefore, we evaluated the PAP elevation during ethanol sclerotherapy. METHODS: We retrospectively reviewed PAP changes in 124 procedures conducted on 41 arteriovenous malformation patients during ethanol sclerotherapy. We investigated the degree of elevation of PAP and the incidences of pulmonary arterial hypertension during ethanol sclerotherapy. RESULTS: High incidences of pulmonary arterial hypertension were observed during ethanol sclerotherapy (53/124 procedures, 42.7%). The mean highest PAP values were 33.8 +/- 10.9 mmHg (systolic), 25.2 +/- 7.9 mmHg (mean), and 18.3 +/- 7.4 mmHg (diastolic). Incidence of nitroglycerine administration was 47.5% (59/124 procedures). Mean PAP values at the end of procedure was 29.1 +/- 9.1 mmHg (systolic), 22.0 +/- 7.0 mmHg (mean), and 16.1 +/- 6.4 mmHg (diastolic). Conclusion: The incidences of pulmonary hypertension during ethanol sclerotherapy were high. Therefore, cautious management and close cooperation between anesthesiologist and interventional radiologist are essential to prevent dreadful outcome.

Does the Venovenous Bypass influence Coagulation Status in Living-Related Liver Transplantation? / 대한마취과학회지

BACKGORUND: Venovenous bypass (VVB) in liver transplantation has been used to decrease the acute hemodynamic and metabolic changes during anhepatic periods. But, the use of VVB in patients undergoing liver transplantation is still under debate concerning its relative risks and benefits. Therefore, the aim of this study was to examine the influences of VVB on the coagulation status and the amount of transfusion in living-related liver transplantation. METHODS: We conducted this retrospective study on 39 patients who underwent orthotopic living-related liver transplantation using the piggyback technique from March 2001 to April 2002. While 19 patients did not receive venovenous bypass, 20 patients received. We compared the two groups in terms of coagulation-related parameters (prothrombin time, activated partial thromboplastin time, platelet count, fibrinogen and thromboelastograph), the amount of transfusion during intraoperative and post-operative 1day. We also compared the incidences of post-reperfusion syndrome in the two groups. RESULTS: The group that underwent living-related liver transplantation with VVB required more packed red blood cell (p-RBC) transfusion than the other group without VVB from post-reperfusion untill the end of operation (P<0.05). This difference in the amount of p-RBC transfusion may be due to the blood remained in the VVB circuit at the termination of VVB. However, the two groups were similar in terms of coagulation-related parameters, the amount of other blood components, such as fresh frozen plasma, platelet concentrates, cryoprecipitate, total amount of transfusion during the 24 hours post- operatively, and the incidence of post-reperfusion syndrome. CONCLUSiONS: We conclude that the using of venovenous bypass in living-related liver transplantation did not influence coagulation status and the amount of transfusion perioperatively.

Ultrastructural Alterations Induced by 5-Fluorouracil or Mitomycin C on the Gastric Parietal Cells of Mouse / 대한해부학회지

This experiment was performed to evaluate the morphological responses of 5-fluorouracil or mitomycin C on the gastric parietal cells of mouse. 5 -fluorouracil (30 mg/kg) or mitomycin C (400 micro gram/kg) were injected subcutaneously every other day, and the animals were sacrificed at 4th day and 7th day following the first injection. Pieces of the tissue were taken from the stomach, prefixed with 2.5% glutaraldehyde -1.5% paraformaldehyde, followed by post-fixation with 1% osmium tetroxide. The ultrathin sections were stained with uranyl acetate and lead citrate. In both of the 5-fluorouracil or the mitomycin C treated groups, most parietal cells showed severely reduced luminal spaces of the intracellular canaliculi, since microvilli of intracellular canaliculi were very irregular shaped and nearly contacted with each other, and the cytoplasmic tubulovesicular membranes were disintegrated and indistinct. The changes in the 5-fluorouracil treated group were more indistinct than in those of the mitomycin C treated group. In the 5-fluorouracil treated group, balooning of the cytoplasm, focal cytolysis, myelin figures, lysosomes and multivesicular bodies in the parietal cells were observed more frequently than in those of the mitomycin C treated group. Above results suggest that the 5-fluorouracil or mitomycin C treated animals might suffer from reduced acid secretion of the parietal cell, since the collapsed lumen of the intracellular canaliculi, the disintegration of the tubulovesicular membranes, and the reduction of cell organelles in the parietal cells are occurred within a few days following injections. 5-fluorouracil was proved more harmful on the parietal cell than mitomycin C does.

The Comparison of Coagulation Status in the Cadaveric Donor and Living-Related Liver Transplantation / 대한마취과학회지

BACKGROUND: Orthotopic liver transplantation is widely regarded as the only effective treatment for many acute or chronic end-stage liver diseases. However, the shortage of cadaveric organs is one of the most crucial limitations to the liver transplantation. Recently, in our hospital, living-related liver transplantation (LR LT) cases have remarkably increased during the last two years. Because there are differences in the surgical procedure and graft volume between the cadaveric donor liver transplantation (Cd LT) and LRLT, the intraoperative coagulation status may be different, too. With the knowledge of coagulation status, the anesthetic mangement of liver transplantation will be improved. METHODS: A retrospective evaluation was performed on 36 patients, who underwent an orthotopic liver transplantation between October 1999 and April 2001. Seventeen patients received a Cd LT and 19 patients underwent a LRLT. We compared the two groups in the aspects of coagulation related parameters; 1) ischemic time, 2) venovenous bypass (VVB) flow, 3) the percentages of occurrence of postreperfusion syndrome (PRS), 4) the ratio of activated clotting time (ACT) exceeding 200 seconds after reperfusion, 5) the ratio of hyperfibrinolysis, LY60 > 20%, on a thromboelastograph (TEG) after reperfusion, and 6) the amounts of transfusion and fluid administration before and after reperfusion. RESULTS: The ischemic time was shorter in the LR LT group than the Cd LT group (115.4 +/- 25.4 min versus 409.2 +/- 115.6 min). The VVB flow was greater in the Cd LT group than the LR LT group. The ratio of occurrence of PRS was also lower in the LR LT group (11%) than the Cd LT group (53%). The percentage of ACT exceeding 200 seconds after reperfusion was only 11% in the LR LT group, but 59% in the Cd LT group. The percentages of LY 60 > 20% on the TEG after reperfusion were not statistically different in each group, but the percentage of tranexamic acid administration due to persistent, severe hyperfibrinolysis was higher in the Cd LT group than the LR LT group. The amounts of transfusion and fluid administration were significantly smaller in the LR LT group compared to those in the Cd LT group. CONCLUSIONS: We found that there were many differences in the coagulation status between the Cd LT and the LR LT groups. Therefore, anesthesiologists should consider these differences and manage each case of liver transplantation properly.

Incidental Diagnosis of Multiple Myeloma during Conservative Treatment for Vertebral Fracture / 대한마취과학회지

A 42-year-old male came to our pain clinic for consultation for the control of pain caused by compression fractures at T12 and L1. About 2 months ago, the patient had a T9 compression fracture after a trivial injury. We started to control the pain with epidural steroid injections and epidural patient controlled analgesia (PCA). The patient got new fractures at T8 and L2, even though on bed rest. No evidence of metabolic bone disease or malignancy was noted on routine laboratory tests. Increased uptake of radioactivity at multiple vertebrae was shown on bone scan and the magnetic resonance imaging (MRI) finding was suspected to be an infiltrative bone marrow disease. Therefore, we consulted an oncologist for further evaluation, then the patient was diagnosed with multiple myeloma with bone marrow biopsy. This case report suggests that clinicians should consider the possibility of malignancy in the case of multiple compression fractures of vertebrae especially in young male patients.

Ramsay Hunt Syndrome during the Treatment of Zoster Sine Herpete / 대한마취과학회지

Ramsay Hunt syndrome (RHS) might cause serious complications, such as facial paralysis and hearing loss if diagnosis and treatments are delayed. Early diagnosis is therefore very important to avoid such serious complications. We report a case of RHS that was occurred during the treatment of postherpetic neuralgia resulted from zoster sine herpete. The patient showed severe segmental intercostal neuralgia at the right 11 and 12th thoracic level. There were no history of the trauma, operation and skin rash and vesicle on the lesion site. Varicellar-zoster virus (VZV) IgG Antibody was positive but VZV IgM antibody was negative. Pain nature was severe sharp, electrical shock like pain, but no paresthesia and dysesthesia was not existed. About two month later, small painful vesicular eruptions were occurred around the ipsilateral auricle. At this time, VZV IgM antibody was positive. Acyclovir, prednisolone, fexofenadine were immediately prescribed. The patient relieved from RHS without any complications. Clinician should be suspect the possibility of zoster sine herpete if the patient showed severe atypical chest wall pain.