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1.  Remote cerebellar hemorrhage after unruptured cerebral aneurysm surgery: two cases report 
Korean Journal of Anesthesiology  2014;67(3):213-216.
Remote cerebellar hemorrhage (RCH) occurring distant to the site of original surgery, such as supratentorial or spinal surgery, is rare but potentially fatal. Because the pathophysiology of RCH is thought to be excessive cerebrospinal fluid drainage during the perioperative periods, its diagnosis usually depends on the occurrence of unexpected neurologic disturbances and/or postoperative brain computerized tomography imaging. Because of its rarity, RCH-associated neurologic disturbances such as delayed awakening or nausea and vomiting may often be misdiagnosed as the effects of residual anesthetics or the effect of postoperative analgesic agents unless radiologic images are taken. Treatment for RCH ranges from conservative treatment to decompressive craniectomy, with prognoses ranging from complete resolution to fatality. Here, we report two cases of RCH after surgical clipping of an unruptured cerebral aneurysm of the anterior communicating artery and review anesthetic considerations.
PMCID: PMC4188769  PMID: 25302099
Cerebellum; Intracranial aneurysm; Intracranial hemorrhages
2.  Undiagnosed light chain systemic amyloidosis: does it matter to anesthesiologists? -a case report- 
Korean Journal of Anesthesiology  2013;65(5):453-455.
Light chain systemic amyloidosis is rare but may accompany laryngeal or pulmonary involvement, which may increase the risk in airway management. We present a case of a patient planned for resection of cervical epidural mass. The patient had face and neck ecchymoses and purpuras with an unknown cause. Mask ventilation and intubation were successful, but the operation was cancelled to evaluate bleeding from facial skin lesions. A diagnosis of light chain systemic amyloidosis prompted evaluation of involvement of other organs and treatment. This case shows the importance of preoperative evaluation and careful airway management in patients with systemic amyloidosis.
PMCID: PMC3866343  PMID: 24363850
Amyloidosis; Anesthesia
3.  Effects of ulinastatin treatment on myocardial and renal injury in patients undergoing aortic valve replacement with cardiopulmonary bypass 
Korean Journal of Anesthesiology  2012;62(2):148-153.
We determined the protective effects of a high dose of ulinastatin on myocardial and renal function in patients undergoing aortic valve replacement with cardiopulmonary bypass (CPB).
Sixty patients were assigned randomly to either the ulinastatin group (n = 30) or the control group (n = 30). In the ulinastatin group, ulinastatin (300,000 U) was given after the induction of anesthesia, ulinastatin (400,000 U) was added to the CPB pump prime, and then ulinastatin (300,000 U) was administered after weaning from CPB. In the control group, the same volume of saline was administered at the same time points. Creatine kinase-MB levels were assessed 1 day before surgery, and on the first and second postoperative day (POD 1 and 2). Serum creatinine and cystatin C levels were assessed 1 day before surgery, upon intensive care unit arrival, and on POD 1 and 2. The level of plasma neutrophil gelatinase-associated lipocalin was assessed before induction of anesthesia, upon ICU arrival, and on POD 1.
No significant differences were observed in serum levels of creatine kinase-MB and biomarkers of renal injury between the two groups at any point during the study period.
Ulinastatin showed no cardiac or renal protective effects after CPB in patients undergoing aortic valve replacement.
PMCID: PMC3284737  PMID: 22379570
Cardiac surgical procedures; Cardiopulmonary bypass; Myocardiac protection
4.  Direct-write polymer nanolithography in ultra-high vacuum 
Polymer nanostructures were directly written onto substrates in ultra-high vacuum. The polymer ink was coated onto atomic force microscope (AFM) probes that could be heated to control the ink viscosity. Then, the ink-coated probes were placed into an ultra-high vacuum (UHV) AFM and used to write polymer nanostructures on surfaces, including surfaces cleaned in UHV. Controlling the writing speed of the tip enabled the control over the number of monolayers of the polymer ink deposited on the surface from a single to tens of monolayers, with higher writing speeds generating thinner polymer nanostructures. Deposition onto silicon oxide-terminated substrates led to polymer chains standing upright on the surface, whereas deposition onto vacuum reconstructed silicon yielded polymer chains aligned along the surface.
PMCID: PMC3304329  PMID: 22428096
additive lithography; polymer; scanning probe lithography; ultra high vacuum
5.  Remifentanil-induced pronociceptive effect and its prevention with pregabalin 
Korean Journal of Anesthesiology  2011;60(3):198-204.
Experimental and clinical studies have suggested that remifentanil probably causes acute tolerance or postinfusion hyperalgesia. This study was designed to confirm whether remifentanil given during propofol anesthesia induced postoperative pain sensitization, and we wanted to investigate whether pregabalin could prevent this pronociceptive effect.
Sixty patients who were scheduled for total abdominal hysterectomy were randomly allocated to receive (1) a placebo as premedication and an intraoperative saline infusion (control group), (2) a placebo as premedication and an intraoperative infusion of remifentanil at a rate of 3-4 ng/ml (remifentanil group), or (3) pregabalin 150 mg as premedication and an intraoperative infusion of remifentanil at a rate of 3-4 ng/ml (pregabalin-remifentanil group). Postoperative pain was controlled by titration of fentanyl in the postanesthetic care unit (PACU), followed by patient-controlled analgesia (PCA) with fentanyl. The patients were evaluated using the visual analogue scale (VAS) for pain scores at rest and after cough, consumption of fentanyl, sedation score and any side effects that were noted over the 48 h postoperative period.
The fentanyl titration dose given in the PACU was significantly larger in the remifentanil group as compared with those of the other two groups. At rest, the VAS pain score in the remifentanil group at 2 h after arrival in the PACU was significantly higher than those in the other two groups.
The results of this study show that remifentanil added to propofol anesthesia causes pain sensitization in the immediate postoperative period. Pretreatment with pregabalin prevents this pronociceptive effect and so this may be useful for the management of acute postoperative pain when remifentanil and propofol are used as anesthetics.
PMCID: PMC3071484  PMID: 21490822
Hyperalgesia; Pregabalin; Remifentanil; Tolerance
6.  d-(+)-Galactose-Conjugated Single-Walled Carbon Nanotubes as New Chemical Probes for Electrochemical Biosensors for the Cancer Marker Galectin-3 
d-(+)-Galactose-conjugated single-walled carbon nanotubes (SWCNTs) were synthesized for use as biosensors to detect the cancer marker galectin-3. To investigate the binding of galectin-3 to the d-(+)-galactose-conjugated SWCNTs, an electrochemical biosensor was fabricated by using molybdenum electrodes. The binding affinities of the conjugated SWCNTs to galectin-3 were quantified using electrochemical sensitivity measurements based on the differences in resistance together with typical I-V characterization. The electrochemical sensitivity measurements of the d-(+)-galactose-conjugated SWCNTs differed significantly between the samples with and without galectin-3. This indicates that d-(+)-galactose-conjugated SWCNTs are potentially useful electrochemical biosensors for the detection of cancer marker galectin-3.
PMCID: PMC3116166  PMID: 21686160
biosensor; cancer marker; galectin-3; galactose; single-walled carbon nanotubes
7.  The effect of milrinone infusion on right ventricular function during coronary anastomosis and early outcomes in patients undergoing off-pump coronary artery bypass surgery 
During coronary anastomosis in off-pump coronary artery bypass surgery (OPCAB), hemodynamic alternations can be induced by impaired diastolic function of the right ventricle. This study was designed to examine the effect of milrinone on right ventricular function and early outcomes in patients undergoing OPCAB.
Forty patients undergoing OPCAB were randomly assigned in a double-blind manner to receive either milrinone (milrinone group, n = 20) or normal saline (control group, n = 20). Hemodynamic variables were measured after pericardiotomy (T1), 5 min after stabilizer application for anastomosis of the left anterior descending coronary artery (LAD, T2), the obtuse marginalis branch (OM, T3), the right coronary artery (RCA, T4), 5 min after sternal closure (T5), and after ICU arrival. The right ventricular ejection fraction (RVEF) and right ventricular volumetric parameters were also measured using the thermodilution technique. For evaluation of early outcomes, the 30-day operative mortality and morbidity risk models were used.
There was no significant difference in hemodynamic variables, including mean arterial pressure, between the 2 groups, except for the cardiac index and RVEF. The cardiac index and RVEF were significantly greater at T3 in the milrinone group than in the control group.
Continuous infusion of milrinone demonstrated a beneficial effect on cardiac output and right ventricular function in patients undergoing OPCAB, especially during anastomosis of the graft to the OM artery, and it had no adverse effect on early outcomes.
PMCID: PMC2926436  PMID: 20740213
Milrinone; Off-pump coronary artery bypass; Right ventricular function
8.  Parent-Controlled Analgesia in Children Undergoing Cleft Palate Repair 
Journal of Korean Medical Science  2008;23(1):122-125.
The aims of this study were to find an optimal basal infusion dose of fentanyl for parent-controlled analgesia (PrCA) in children undergoing cleft palate repair and the degree of parents' satisfaction with PrCA. Thirty consecutive children between 6 months and 2 yr of age were enrolled. At the end of surgery, a PrCA device with a basal infusion rate of 2 mL/hr and bolus of 0.5 mL with lockout time of 15 min was applied. Parents were educated in patient-controlled analgesia (PCA) devices, the Wong Baker face pain scoring system, and monitoring of adverse effects of fentanyl. Fentanyl was infused 0.3 µg/kg/hr at first, and we obtained a predetermined fentanyl regimen by the response of the previous patient to a larger or smaller dose of fentanyl (0.1 µg/kg/hr as the step size), using an up-and-down method. ED50 and ED95 by probit analysis were 0.63 µg/kg/hr (95% confidence limits, 0.55-0.73 µg/kg/hr) and 0.83 µg/kg/hr (95% confidence limits, 0.73-1.47 µg/kg/hr), respectively. Eighty seven percent of the parents were satisfied with participating in the PrCA modality. PrCA using fentanyl with a basal infusion rate of 0.63 µg/kg/hr can be applied effectively for postoperative pain management in children undergoing cleft palate repair with a high level of parents' satisfaction.
PMCID: PMC2526495  PMID: 18303211
Analgesia, Parent-Controlled; Cleft Palate; Fentanyl; Pain, Postoperative

Results 1-8 (8)