U-shaped association between body mass index and health-related quality of life impairment in Korean cancer survivors: a nationwide representative cross-sectional survey.

PURPOSE: Although obesity is an important risk factor for cancer incidence, the effect of body mass index (BMI) on health-related quality of life (HRQoL) after cancer treatment remains unknown. This population-based cross-sectional study assessed different levels of BMI as an important factor associated with impaired HRQoL in long-term cancer survivors. METHODS: The study enrolled 1104 cancer survivors from the fourth to seventh Korea National Health and Nutrition Examination Surveys (KNHANES 2007-2018) who were alive at least 5 years after their cancer diagnoses. The BMI was classified into four categories: < 20 (underweight), 20-22.9 (healthy weight), 23-24.9 (overweight), and ≥ 25 kg/m2 (obese). Impaired HRQoL was defined as the lowest quartile of European Quality of Life 5-Dimensions (EQ-5D) questionnaire scores. RESULTS: Cancer survivors who were underweight or obese were more likely to report health problems on each dimension of the EQ-5D compared to the other BMI groups. In multivariate logistic regression analysis, the two extreme BMI categories were significantly associated with impaired HRQoL (BMI < 20 kg/m2: odds ratio [OR] = 1.73, 95% confidence interval [CI] = 1.08-2.86; BMI ≥ 25 kg/m2: OR = 2.14, 95% CI = 1.41-3.25; P trend = 0.049), especially in the gastrointestinal cancer group (P heterogeneity = 0.007). Moreover, the association between underweight/obese and impaired HRQoL showed a significant sex difference (P heterogeneity = 0.019). CONCLUSIONS: The results of this study suggest that deviations from normal BMI, such as being underweight or obese, are negatively associated with HRQoL in long-term cancer survivors; to some extent, this may depend on cancer type and sex. IMPLICATIONS FOR CANCER SURVIVORS: Reaching or maintaining a healthy weight should be emphasized for cancer survivors as a long-term goal even after cancer treatment.

Identifying the Relationship between the Korean Medicine and Western Medicine in Factors Affecting Medical Service Use.

This study was conducted using data from the Korea Medical Panel Survey (KMPS) carried out in 2015. Importantly, the purpose of this study was to investigate the relationship between Korean medicine (KM) and Western medicine (WM) in medical service use. The general characteristics and the frequency of utilization of medical services were analyzed for 18,130 participants. Chi-square analysis was used to examine the factors that affected medical service use. Additionally, logistic regression analysis was conducted to examine the odds ratio (OR) between the KM Use with WM Use and KM&WM Use with disease group. The proportion of respondents who used KM&WM was the highest among those over 65 years of age and it was found to be statistically significant (p < 0.001). The OR for using KM and WM was 3.236 and it was also statistically significant (p < 0.001). Further, the ORs of KM&WM Use for all seven disease groups were greater than 1 and were statistically significant (p < 0.001) except for respiratory disease. The significant ORs of KM&WM Use were 10.342 (musculoskeletal), 2.073 (exogenous causes), 1.988 (nervous), 1.677 (digestive), 1.541 (circulatory) and 1.386 (skin). The findings in this study were attributed to a combination of social aspects such as the increasing incidence of chronic diseases among the elderly population, policy aspects such as the collaborative pilot project to promote collaborative treatment (CT), economic aspects, such as a lower total cost for CT and scientific aspects such as evidence supporting the efficacy of CT.

Patterns and predictors of smoking relapse among inpatient smoking intervention participants: a 1-year follow-up study in Korea.

OBJECTIVES: This study aimed to identify relapse patterns in smokers who participated in an inpatient treatment program and to investigate factors related to relapse. METHODS: The participants comprised 463 smokers who participated in an inpatient treatment operated by the Daejeon Tobacco Control Center from 2015 to 2018. Participants received high-intensity smoking cessation intervention for 5 consecutive days, including pharmacotherapy and behavioral support, and continued with follow-up for 1 year to determine whether they maintained smoking cessation after discharge from inpatient treatment. Kaplan-Meier and Cox proportional hazard models were used in the analysis. RESULTS: Participants' relapse rate within 1 year was 72.8%, and 59.8% of participants smoked again within 6 months after participation. A higher number of counseling sessions was significantly associated with a lower risk of relapse (hazard ratio [HR], 0.23; 95% confidence interval [CI], 0.17 to 0.32 for ≥9 vs. ≤5 counseling sessions). Conversely, higher relapse rates were significantly associated with the use of nicotine replacement therapy (NRT) (HR, 1.91; 95% CI, 1.43 to 2.55 for use vs. no use), and higher levels of baseline expired carbon monoxide (CO) (HR, 1.58; 95% CI, 1.21 to 2.06 for expired CO concentrations of 10-19 ppm vs. expired CO concentrations <10 ppm). CONCLUSIONS: High-intensity smoking cessation interventions in hospital settings can be effective for smoking cessation in smokers with high nicotine dependence. In addition, the results suggest that for quitters to maintain long-term abstinence, they should receive regular follow-up counseling for 1 year after completing a high-intensity smoking cessation intervention.

Neighborhood Deprivation and Unmet Health Care Needs: A Multilevel Analysis of Older Individuals in South Korea.

OBJECTIVES: In this study the relationship between neighborhood deprivation and the unmet health care needs of elderly individuals (≥ 65 years) was examined. Some previous studies suggested that neighborhood characteristics affect access to health care, yet research on the unmet needs of older individuals is limited. METHODS: Multilevel logistic regression analysis was used to assess the relationship of neighborhood-level factors with unmet health care needs due to costs, adjusting for individual-level factors, in individuals ≥ 65 years in the 2017 Korean Community Health Survey (n = 63,388). RESULTS: There were 2.6% of elderly individuals who experienced unmet health care needs due to costs. Following adjustment for individual and neighborhood characteristics, the neighborhood deprivation in urban areas was found to have an inverse association with unmet needs (odds ratio = 0.50; 95% confidence interval = 0.24-1.06) for the most deprived quartile versus the least deprived quartile). However, in rural areas neighborhood deprivation was not a significant variable. Among the individual-level variables, household income was one of the strongest correlates with unmet needs in both urban and rural areas. CONCLUSION: The present findings suggest that targeted policy interventions reflecting both neighborhood and individual characteristics, should be implemented to reduce the unmet health care needs of elderly individuals.

Relationship Between Catastrophic Health Expenditures and Income Quintile Decline.

OBJECTIVES: The aims of this study were to investigate the proportion of households facing catastrophic health expenditures based on household income quintiles, and to analyze the relationship between expenditures and household income quintile decline. METHODS: Study data were obtained from an annually conducted survey of the 2012-2013 Korean health panel. There were 12,909 subjects aged 20-64 years from economically active households, whose income quintile remained unchanged or declined by more than one quintile from 2012 to 2013. Logistic regression analysis was performed to determine whether catastrophic health expenditures in 2012 were related to more than one quintile income decline in 2013. RESULTS: Households facing catastrophic health expenditures of ≥ 40%, ≥ 30%, and ≥ 10% of a household's capacity to pay, were 1.58 times (p < 0.003), 1.75 times (p < 0.000), and 1.23 times (p < 0.001) more likely to face a decline in income quintile, respectively. CONCLUSION: Over a 1 year period, the proportion of households facing more than one quintile income decline was 16.4%, while 2.1% to 2.5% of households in Korea faced catastrophic health expenditures. Catastrophic health expenditure experienced in 2012 was significantly associated with income quintile decline 1 year later. Therefore, lowering the proportion of households with catastrophic health expenditure may reduce the proportion of households with income quintiles decline.

Analyzing the Historical Development and Transition of the Korean Health Care System.

OBJECTIVES: Many economically advanced countries have attempted to minimize public expenditures and pursue privatization based on the principles of neo-liberalism. However, Korea has moved contrary to this global trend. This study examines why and how the Korean health care system was formed, developed, and transformed into an integrated, single-insurer, National Health Insurance (NHI) system. METHODS: We describe the transition in the Korean health care system using an analytical framework that incorporates such critical variables as government economic development strategies and the relationships among social forces, state autonomy, and state power. This study focuses on how the relationships among social forces can change as a nation's economic development or governing strategy changes in response to changes in international circumstances such as globalization. RESULTS: The corporatist Social Health Insurance (SHI) system (multiple insurers) introduced in 1977 was transformed into the single-insurer NHI in July 2000. These changes were influenced externally by globalization and internally by political democratization, keeping Korea's private-dominant health care provision system unchanged over several decades. CONCLUSION: Major changes such as integration reform occurred, when high levels of state autonomy were ensured. The state's power (its policy capability), based on health care infrastructures, acts to limit the direction of any change in the health care system because it is very difficult to build the infrastructure for a health care system in a short timeframe.

The Association Among Individual and Contextual Factors and Unmet Healthcare Needs in South Korea: A Multilevel Study Using National Data.

OBJECTIVES: The objective of this study is to investigate associations between contextual characteristics and unmet healthcare needs in South Korea after accounting for individual factors. METHODS: The present study used data from the 2012 Korean Community Health Survey (KCHS) of 228 902 adults residing within 253 municipal districts in South Korea. A multilevel analysis was conducted to investigate how contextual characteristics, defined by variables that describe the regional deprivation, degree of urbanity, and healthcare supply, are associated with unmet needs after controlling for individual-level variables. RESULTS: Of the surveyed Korean adults, 12.1% reported experiencing unmet healthcare needs in the past. This figure varied with the 253 districts surveyed, ranging from 2.6% to 26.2%. A multilevel analysis found that the association between contextual characteristics and unmet needs varied according to the factors that caused the unmet needs. The degree of urbanity was associated with unmet need due to "financial burden" (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.42 to 0.66 for rural vs. metropolitan), but not unmet need due to "service not available when needed." There were no significant associations between these unmet need measures and regional deprivation. Among individual-level variables, income level showed the highest association with unmet need due to "financial burden" (OR, 5.63; 95% CI, 4.76 to 6.66), while employment status showed a strong association with unmet need due to "service not available when needed." CONCLUSIONS: Our finding suggests that different policy interventions should be considered for each at-risk population group to address the root cause of unmet healthcare needs.

Nurse-Perceived Patient Adverse Events depend on Nursing Workload.

OBJECTIVES: The purpose of this study was to investigate the correlation between nursing workload and nurse-perceived patient adverse events. METHODS: A total of 1,816 nurses working in general inpatient units of 23 tertiary general hospitals in South Korea were surveyed, and collected data were analyzed through multilevel logistic regression analysis. RESULTS: Among variables related to nursing workload, the non-nursing task experience had an influence on all four types of patient adverse events. Nurses with non-nursing tasks experienced patient adverse events-falls [odds ratio (OR) = 1.31], nosocomial infections (OR = 1.23), pressure sores (OR = 1.16), and medication errors (OR = 1.23)-more often than occasionally. In addition, when the bed to nurse ratio was higher, nurses experienced cases of pressure sores more often (OR = 1.35). By contrast, nurses who said the nursing workforce is sufficient were less likely than others to experience cases of pressure sores (OR = 0.78). Hospitals with a relatively high proportion of nurses who perceived the nursing workforce to be sufficient showed a low rate of medication error (OR = 0.28). CONCLUSION: The study suggested that the high level of nursing workload in South Korea increases the possibility of patient adverse events.

Dental Care Utilization for Examination and Regional Deprivation.

OBJECTIVES: Receiving proper dental care plays a significant role in maintaining good oral health. We investigated the relationship between regional deprivation and dental care utilization. METHODS: Multilevel logistic regression was used to identify the relationship between the regional deprivation level and dental care utilization purpose, adjusting for individual-level variables, in adults aged 19+ in the 2008 Korean Community Health Survey (n=220 258). RESULTS: Among Korean adults, 12.8% used dental care to undergo examination and 21.0% visited a dentist for other reasons. In the final model, regional deprivation level was associated with significant variations in dental care utilization for examination (p<0.001). However, this relationship was not shown with dental care utilization for other reasons in the final model. CONCLUSIONS: This study's findings suggest that policy interventions should be considered to reduce regional variations in rates of dental care utilization for examination.

Unmet healthcare needs depending on employment status.

OBJECTIVES: The purpose of study is to find relevance between unmet healthcare needs and employment status and if factors have relevance to unmet healthcare needs due to "economic burden" and "no time to spare". METHODS: The study conducted a survey of 9163 respondents who said they needed a medical treatment or checkup were asked why the need for care was unmet. RESULTS: 22.9% of the respondents said they did not receive a medical treatment or checkup they needed at least once. The rate of unmet healthcare needs caused by "economic burden" was higher among temporary workers (ORs=2.13), day workers (ORs=1.92). However, the rate of unmet needs due to "no time to spare" was lower for temporary workers (ORs=.58) than for regular workers, studies (ORs=.33), housework (ORs=.26), early retirement (ORs=.19) and disease or injury (ORs=.07). CONCLUSION: Non-regular waged workers were more likely to have an unmet need for healthcare due to "economic burden" than regular waged workers. On the other hand, regular waged workers were less likely to receive necessary healthcare services due to "no time to spare" than non-regular waged workers and economically inactive people.

Influence of the nursing practice environment on job satisfaction and turnover intention.

OBJECTIVES: To examine whether the nursing practice environment at the hospital-level affects the job satisfaction and turnover intention of hospital nurses. METHODS: Among the 11 731 nurses who participated in the Korea Health and Medical Workers' Union's educational program, 5654 responded to our survey. Data from 3096 nurses working in 185 general inpatient wards at 60 hospitals were analyzed using multilevel logistic regression modeling. RESULTS: Having a standardized nursing process (odds ratio [OR], 4.21; p<0.001), adequate nurse staffing (OR, 4.21; p<0.01), and good doctor-nurse relationship (OR, 4.15; p<0.01), which are hospital-level variables based on the Korean General Inpatients Unit Nursing Work Index (KGU-NWI), were significantly related to nurses' job satisfaction. However, no hospital-level variable from the KGU-NWI was significantly related to nurses' turnover intention. CONCLUSIONS: Favorable nursing practice environments are associated with job satisfaction among nurses. In particular, having a standardized nursing process, adequate nurse staffing, and good doctor-nurse relationship were found to positively influence nurses' job satisfaction. However, the nursing practice environment was not related to nurses' turnover intention.

Nurse-perceived patient adverse events and nursing practice environment.

OBJECTIVES: To evaluate the occurrence of patient adverse events in Korean hospitals as perceived by nurses and examine the correlation between patient adverse events with the nurse practice environment at nurse and hospital level. METHODS: In total, 3096 nurses working in 60 general inpatient hospital units were included. A two-level logistic regression analysis was performed. RESULTS: At the hospital level, patient adverse events included patient falls (60.5%), nosocomial infections (51.7%), pressure sores (42.6%) and medication errors (33.3%). Among the hospital-level explanatory variables associated with the nursing practice environment, 'physician- nurse relationship' correlated with medication errors while 'education for improving quality of care' affected patient falls. CONCLUSIONS: The doctor-nurse relationship and access to education that can improve the quality of care at the hospital level may help decrease the occurrence of patient adverse events.

The incidence of stroke by socioeconomic status, age, sex, and stroke subtype: a nationwide study in Korea.

OBJECTIVES: To date, studies have not comprehensively demonstrated the relationship between stroke incidence and socioeconomic status. This study investigated stroke incidence by household income level in conjunction with age, sex, and stroke subtype in Korea. METHODS: Contributions by the head of household were used as the basis for income levels. Household income levels for 21 766 036 people were classified into 6 groups. The stroke incidences were calculated by household income level, both overall within income categories and further by age group, sex, and stroke subtype. To present the inequalities among the six ranked groups in a single value, the slope index of inequality and relative index of inequality were calculated. RESULTS: In 2005, 57 690 people were first-time stroke patients. The incidences of total stroke for males and females increased as the income level decreased. The incidences of stroke increased as the income level decreased in those 74 years old and under, whereas there was no difference by income levels in those 75 and over. Intracerebral hemorrhage for the males represented the highest inequality among stroke subtypes. Incidences of subarachnoid hemorrhage did not differ by income levels. CONCLUSIONS: The incidence of stroke increases as the income level decreases, but it differs according to sex, age, and stroke subtype. The difference in the relative incidence is large for male intracerebral hemorrhage, whereas the difference in the absolute incidence is large for male ischemic stroke.

A randomized comparison of ropivacaine 0.1% and 0.2% for continuous interscalene block after shoulder surgery.

BACKGROUND: The optimal concentration of ropivacaine for continuous interscalene block after shoulder surgery is currently unknown. METHODS: Fifty-six patients received a perineural infusion of either ropivacaine 0.1% or 0.2% for 48 hours after shoulder surgery. We assessed pain scores as primary end points and supplemental analgesia, ropivacaine consumption, motor block, side effects, and patient satisfaction as secondary end points. RESULTS: Pain scores were not statistically different during the infusion periods; however, supplemental analgesia consumption was higher in the group receiving ropivacaine 0.1% during the first 24 hours (64% vs 28%, P = 0.022). Other secondary end points were statistically inconclusive. CONCLUSIONS: These results suggest that ropivacaine 0.2% provides more effective analgesia than ropivacaine 0.1% during the first 24 hours for continuous interscalene block after shoulder surgery.

Application of revised nursing work index to hospital nurses of South Korea.

PURPOSE: Based on the Revised Nursing Work Index (NWI-R), this research aimed to develop a Korean Hospital General Inpatient Unit-Nursing Work Index (KGU-NWI). This study also aimed to compare the common points and differences between the subfactors of the KGU-NWI and the subfactors from previous studies. METHODS: Based on opinions from 3,151 nurses in Korean hospital general inpatient unit, this research used 57 items of NWI-R and the principal axis factor analysis for deriving subfactors. We evaluated the convergent validity through factor analysis and the content validity of KGU-NWI in terms of the association between nurses' job outcome and the subfactors derived. RESULTS: Six subfactors and 26 items for KGU-NWI were derived from NWI-R. Among them, 'physician-nurse relationship', 'adequate nurse staffing' and 'organizational support and management of hospital' were the same with results from previous studies. In addition, two subfactors, 'participation of decision-making processes' and 'education for improving quality of care', which were similar with results from previous Korean studies, were newly added by using Korean hospital cases. In contrast to previous Korean studies, a unique subfactor this study found was 'nursing processes'. This research confirmed that the six subfactors were highly correlated with job satisfaction, intention to leave, and quality of health care, which represented a nurse's job outcome. CONCLUSION: KGU-NWI including six subfactors and 26 items is an applicable instrument to investigate nurse work environment in Korean hospital general inpatient unit.

Effects of increasing the dose of ropivacaine on vertical infraclavicular block using neurostimulation.

BACKGROUND: Use of an infraclavicular block is appropriate for surgery of the upper limb. However, it does not consistently block the entire brachial plexus. The aim of this study was to investigate whether increasing the dose of ropivacaine could enhance the success rate, onset time, and efficacy of the sensory and motor block during the use of a vertical infraclavicular block using neurostimulation in upper limb surgery. METHODS: TWO HUNDREDS AND TEN PATIENTS WERE PROSPECTIVELY RANDOMIZED INTO THREE GROUPS: Group 1 (30 ml of 0.5% ropivacaine; n = 70), Group 2 (40 ml of 0.5% ropivacaine; n = 70), and Group 3 (40 ml of 0.75% ropivacaine; n = 70). Patients in each group received a vertical infraclavicular block using neurostimulation and obtained a distal motor response of the ulnar or median nerve. Recorded outcome measures included block success rate, onset time, sensory and motor blocks, and adverse events. RESULTS: No differences were found in the block success rate among the three groups (92.8%, 97.1%, and 94.2% for Groups 1, 2, and, 3, respectively; P = 0.346). There were no significant differences in onset time (P = 0.225) among groups, nor was there enhancement in the sensory block, but the motor block was enhanced. Local anesthetic toxicity was observed in five female patients from group 3 (P = 0.006). CONCLUSIONS: Although the efficacy of the motor block was significantly improved, success rate, onset time, and efficacy of sensory block were not enhanced significantly among groups despite differences in volume and volume/concentration of the local anesthetic.

Correlation of epithelial-mesenchymal transition markers with clinicopathologic parameters in adenocarcinomas and squamous cell carcinoma of the lung.

Epithelial-mesenchymal transition (EMT) is characterized by the loss of epithelial cell junction proteins and the gain of mesenchymal markers. The aim of this study was to analyze the associations between the EMT-related markers vimentin, E-cadherin, ß-catenin, slug, snail, and twist1 and clinicopathologic parameters as well as epidermal growth factor receptor (EGFR) gene copy number and protein expression in non-small cell lung carcinoma (NSCLC). Fifty-nine squamous cell carcinomas (SCC) and 43 adenocarcinomas (AD) were immunohistochemically examined for respective EMT markers and for EGFR, using the EGFR PharmDx kit (Dako) for protein expression and automated silver enhanced in situ hybridization (SISH) for copy number. Vimentin expression in tumor epithelia was significantly higher in AD samples than in SCC samples (P=0.015). Among AD samples, vimentin expression was positively correlated with histologic grade (2 vs. 3; P=0.021) and exhibited a tendency toward a positive correlation with pTNM stage (I vs. II-IV; P=0.052). EGFR gene copy number was positively correlated with EGFR protein expression among both AD samples (P=0.008) and SCC samples (P=0.042), with EGFR protein expression being significantly higher in SCC samples compared with AD (P=0.038). Among AD samples, EGFR protein expression was associated with higher cytoplasmic expression of ß-catenin (P=0.031). Among SCC samples, EGFR protein expression was negatively correlated with nuclear expression of ß-catenin (P=0.033) but positively with nuclear slug (P=0.021). The expression pattern of EMT markers in AD suggests that vimentin is a possible immunohistochemical predictor of tumor progression.

Inequalities in medical care utilization by South Korean cancer patients according to income: a retrospective cohort study.

This study explores income inequalities in the utilization of medical care by cancer patients in South Korea, according to type of medical facilities and survival duration. The five-year retrospective cohort study used data drawn from the Korean Cancer Registry, the National Health Insurance database, and the death database of the Korean National Statistical Office. The sample consisted of 43,433 patients diagnosed with cancer in 1999. The authors found significant quantitative inequalities as a function of income in the patients' utilization of medical care. Cancer patients from the highest income class used inpatient and outpatient care more frequently than did patients from the lowest income class. Those with higher incomes tended to use more inpatient and outpatient services at major tertiary hospitals, which were known as providing better medical care than other types of hospitals and clinics. Moreover, horizontal inequality in cancer-care expenditures favoring those with higher incomes was observed during earlier periods of treatment. In conclusion, income substantially affects the utilization of inpatient and outpatient services, amount of medical expenditures, and type of medical facilities.

A clinical comparison of continuous interscalene brachial plexus block with different basal infusion rates of 0.2% ropivacaine for shoulder surgery.

BACKGROUND: A continuous interscalene brachial plexus block is a highly effective postoperative analgesic modality after shoulder surgery. However, there is no consensus regarding the optimal basal infusion rate of ropivacaine for a continuous interscalene brachial plexus block. A prospective, double blind study was performed to compare two different basal rates of 0.2% ropivacaine for a continuous interscalene brachial plexus block after shoulder surgery. METHODS: Sixty-two patients receiving shoulder surgery under an interscalene brachial plexus block were included. The continuous interscalene brachial plexus block was performed using a modified lateral technique with 30 ml of 0.5% ropivacaine. Surgery was carried out under an interscalene brachial plexus block or general anesthesia. After surgery, the patients were divided randomly into two groups containing 32 each. During the first 48 h after surgery, groups R8 and R6 received a continuous infusion of 0.2% ropivacaine at 8 ml/h and 6 ml/h, respectively. The pain scores at rest and on movement, supplemental analgesia, motor block, adverse events and patient's satisfaction were recorded. RESULTS: The pain scores, supplemental analgesia, motor block, adverse events and patient's satisfaction were similar in the two groups. CONCLUSIONS: When providing continuous interscalene brachial plexus block after shoulder surgery, 0.2% ropivacaine at a basal rate of 8 ml/h or 6 ml/h produces similar clinical efficacy. Therefore, decreasing the basal rate of CISB is more appropriate considering the toxicity of local anesthetics.

The effect of thoracic epidural anesthesia on pulmonary shunt fraction and arterial oxygenation during one-lung ventilation.

OBJECTIVE: To compare the effect of thoracic epidural local anesthetic, epidural opioid, and intravenous opioid on pulmonary shunt fraction, arterial oxygenation, and hemodynamic changes during one-lung ventilation (OLV) in patients undergoing thoracic surgery. DESIGN: A prospective, randomized, double-blind study. SETTING: A university hospital. PARTICIPANTS: Thirty-nine patients undergoing OLV for pulmonary resection. INTERVENTIONS: Patients were randomized into 1 of 3 groups: epidural bupivacaine (TEA-B group, n = 13), epidural sufentanil (TEA-S group, n = 13), or intravenous remifentanil (IV-R group, n = 13) during general anesthesia with propofol. A double-lumen tube was inserted, and mechanical ventilation with 100% oxygen was used in the lateral decubitus position. MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables and arterial and mixed venous blood gas analysis from the radial and pulmonary artery catheter were measured and shunt fraction was calculated during two-lung ventilation (TLV), 15, 30, and 60 minutes after the initiation of OLV, and 15 minutes after the reinstitution of TLV. Although mean arterial pressures 15 and 30 minutes after OLV in the IV-R group were significantly higher than the value in TEA-S group, cardiac output and pulmonary vascular resistance were maintained. Decreases in PaO(2), SaO(2), PvO(2), and SvO(2) and an increase in the shunt fraction after OLV were not different among groups and returned to baseline value after the resumption of TLV. CONCLUSIONS: Thoracic epidural bupivacaine, epidural sufentanil, and intravenous remifentanil-combined general intravenous anesthesia have comparable effects on shunt fraction and arterial oxygenation during OLV in patients undergoing thoracic surgery.