A survey was carried out on 331 female anesthesiologists to clarify their career obstacles. It was found that 53% of female anesthesiologists felt a gender inequity. One of the possible obstacles to career goals was domestic responsibilities. Systematic effort is required to grapple with gender inequality problems and to make changes in the social organization of the field of medicine.

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To investigate the effects of a bolus infusion of landiolol (0.25 mg · kg^-1) on hemodynamic changes during extubation of the tracheal tube and recovery from general anesthesia, we examined the changes in heart rate (HR) and blood pressure (BP) in 46 ASA I or II patients. After regaining spontaneous breathing following antagonized muscle relaxation, each patient received landiolol or saline intravenously for 5 seconds. During the recovery period, both HR and BP increased significantly, showing a maximal change of HR to 10±15% for landiolol group and to 21±17% for the saline group and systolic BP to 6±10% for the landiolol group and to 18±17% for the saline group. These parameters were decreased significantly by landiolol infusion, but no profound bradycardia or hypotension were observed. These results indicate that a bolus administration of landiolol can be used effectively and safely during the recovery period from general anesthesia.

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We evaluated the reliability of oscillometric ankle blood pressure measurement in hemodialysis patients using waveform analyzer. In 42 patients scheduled for elective surgery, simultaneous blood pressure measurement at the bilateral upper arms and bilateral ankles was performed before and after induction of general anesthesia. Ankle-brachial index (ABI) and pulse wave velocity (PWV) were calculated each time.
Under general anesthesia, there were good correlations between brachial and ankle systolic blood pressures. It showed the trend that systolic ankle blood pressure was lower than systolic brachial pressure when ankle pressure values ≤100-120mmHg. On the other hand, when ankle pressure values ≥150-170mmHg, systolic ankle blood pressure tended to be higher than systolic brachial pressure. The mean difference between ankle and brachial systolic blood pressure measurements was about 20mmHg or more. PWV showed no significant changes after anesthesia induction, which indicated a decrease in arterial wall compliance in hemodialysis patients.
We concluded that we can also use oscillometric ankle blood pressure for blood pressure monitoring in hemodialysis patients. However, we should be aware that oscillometric ankle blood pressure does not always reflect upper arm blood pressure.

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We investigated the probability of difficult intubation at our hospital from January 2000 to December 2002. Intubation in patients with a history of head and neck surgeries was more difficult than in patients with breast cancer without a history of head and neck surgeries.
We evaluated the usefulness of the intubating laryngeal mask airway (ILMA) for cases with predicted difficult intubation due to a history of head and neck surgeries for cancer. Seventeen patients with a history of head and neck surgery were included in this study. Insertion of the ILMA and intubation through the ILMA were successfully performed in all patients with the bronchofiberscope.
In summary, endotracheal intubation through the ILMA was useful for patients with predicted difficult intubation due to a history of head and neck surgeries for cancer.

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We successfully prevented tachycardia and myocardial ischemia with landiolol during anesthesia while undergoing gastrectomy. In both cases, we started continuous infusion of landiolol with relatively low doses at induction of anesthesia. After endotracheal intubation, the patients had hypotension and bradycardia, which was immediately managed with ephedrine and temporary discontinuation of landiolol. There was no significant change in blood pressure and heart rate during extubation. The present cases suggest that landiolol is useful in controlling heart rate during anesthetic management of elderly patients with ischemic heart disease, although careful management is required at induction of anesthesia.

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We report a case of difficult ventilation and intubation due to a giant nasal tip tumor. A 70-year-old man was scheduled for giant nasal tip tumor resection. Difficult mask ventilation and intubation was predicted due to a 9.6×7.2×8.0cm nasal tip tumor. Anesthesia was induced with propofol and fentanyl. After the patient was anesthetized, intubating laryngeal mask airway (ILMA) was inserted to maintain spontaneous respiration. Endotracheal intubation was successful using a fiberoptic bronchoscope. Anesthesia was maintained with propofol (2-6mg · kg^-1 · h^-1), nitrous oxide and oxygen. The intraoperative course and extubation were uneventful.

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This report describes two cases of air embolism during craniotomy in the prone and supine position.
Case 1 : A 36-year-old male patient underwent craniotomy for brain tumor resection in the prone position. About 1 hour after the beginning of the operation, a sudden decrease in EtCO₂ and SpO₂ followed by hypotension were developed. Repositioning with feet elevated, ventilating with 100% O₂ and flooding the surgical field with saline restored EtCO₂ and SpO₂. Transesophageal echocardiography was performed immediately after surgery and showed trivial air bubble shadows in the right atrium.
Case 2 : A 73-year-old male patient underwent craniotomy for brain tumor resection in the supine position. During surgery, visibility of the surgical field was compromised due to hemorrhage from a sinus injury, and the surgeon requested elevation of the patient's head. Immediately following the change in position, an acute decrease in EtCO₂, SpO₂ and systolic BP occurred.
Although air was not aspirated from the central venous catheter inserted in the femoral vein, various therapies as provided case 1 restored the vital signs to normal values.
It is important to recognize the possible occurrence of air embolism in not only the sitting position but also in the prone and supine positions during craniotomy.
Therefore, careful monitoring and paying close attention when readjusting the patient's position are necessary for the early diagnosis and treatment of air embolism.

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We report intraoperative coronary spasm in a 52-year-old man undergoing repair of incisional hernia. His past history includes hypertension, but not angina pectoris or myocardial infarction. Preoperative electrocardiogram (ECG) showed normal sinus rhythm and no abnormalities. Epidural tubing was performed through the Th₁₂-L₁ inter-vertebral space before induction of anesthesia. Lead II of the ECG showed normal sinus rhythm. About one hour and twenty minutes after the beginning of the surgery, his blood pressure decreased, and intravenous ephedrine was administered immediately. Just after this treatment, lead II of the ECG showed a marked ST-segment elevation. The ST-segment elevation spontaneously returned to baseline without any medication. Postoperative coronary angiography revealed no stenosis in his coronary arteries.
This transient ST-segment elevation may be due to coronary spasm induced by ephedrine. However, the contribution of epidural anesthesia cannot be denied. In conclusion, our case report suggests that administration of ephedrine under epidural anesthesia may induce coronary spasm.

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In the United States, the steadily increasing number of women applying to medical schools exceeded that of male applicants for the first time for the 2003-2004 school year. Obviously, the choices of specialties for women physicians will be an important factor for the workforce. A recent sign of the growing interest in gender-based issues for academic women physicians is evident in a recent survey. This article described the current status of women anesthesiologists in the U.S. and Japan. This was based on results from a survey that compared the obstacles which women versus men in the field of anesthesiology faced. It contrasted the gender-related differences in the professional growth and retention rates in the U.S. and Japan. In addition, the article suggested factors influencing an observed trend of young female academic anesthesiologists leaving the field, and some general recommended approaches that could increase the retention rate of female anesthesiologists to positively affect the anesthesia practice in Japan.

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Epidural block (EB) is widely used in postoperative pain control because of its excellent analgesia property. Severe complications are believed to be rare, but non-severe EB-related side effects are quite common and diminish patient satisfaction. These side effects also deteriorate the patient's outcome and prolong hospitalization which results in burdened medical costs.
Some common side effect such as nausea/vomiting, pruritus, numbness of lower extremities, motor paralysis, hypotension, respiratory depression, and urinary retension are known to be associated with post-operative epidural analgesia. These side effects do occur somewhat frequentry, but, apart from respiratory depression, are not considered serious since they are not life-threatening. Results from our study and The Study of Postoperative Pain, revealed a 30-50% incidence of nausea/vomiting, 30% motor paralysis/numbness in the lower extremities, and 20% pruritus.
Severe complications associated with epidural block include epidural hematoma, abscess, meningitis, encephalitis, total spinal anesthesia, and local anesthetic intoxication which cause persistent neurological deficits or death in some cases. In recent years, attention has been paid to epidural compartment syndrome, in which neurological symptoms develop by compression of the spinal cord forward with fluid in epidural space. Although severe complications seldom occur, these considerations should be kept in mind anytime epidural analgesia is used for postoperative pain management.
Postoperative rounds are strongly recommended in order to prevent EB-related complications. Guidelines for equipment manipulation or prior treatment for possible side effects should be in the manual. Educational strategies and systems should be established for doctors and nurses working on postoperative pain management in wards.

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We prospectively examined the effect of continuous epidural pain relief on postoperative micturition in 120 patients without preoperatively known urologic abnormalities undergoing open thoracic or open abdominal surgery. In 15 patients, urinary retention occurred during postoperative epidural pain relief after removing the bladder catheter. The remaining 105 patients were able to micturate voluntarily. Postoperative urological examination revealed urological pathologies which were not preoperatively diagnosed in 12 patients of the 15 patients with urinary retention. In only 3 patients of the 15 patients, continuous epidural pain relief was a cause of urinary retention. We discussed predisposing factors, pathophysiology and mechanism, and recommendations for the prevention and management of postoperative urinary retention during continuous epidural pain relief after open thoracic or open abdominal surgery.

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Strategies for relief and prevention of adverse events in pediatric postoperative pain management were reported. The incidence of major adverse events, e.g., vomiting, pruritus and sedation were 36%, 11% and 16%, respectively in intravenous patient-controlled analgesia (IV-PCA), and were 18%, 22% and 21%, respectively in patient-controlled epidural analgesia (PCEA). Vomiting was more frequent in IV-PCA than in PCEA. The incidence of vomiting in IV-PCA was about 50% in schoolchildren. Pruritus was more frequent in PCEA than in IV-PCA. The incidence of pruritus in PCEA was about 30% in schoolchildren. To relieve adverse events, reduction of continuous infusion is recommended in PCA when antiemetics or antipruritics are ineffective. Addition of non-steroidal anti-inflammatory drugs and acetaminophen to opioids is also recommended when children are suffering from pain and the adverse effects of opioids. Strict care of the catheter is important in epidural analgesia. The principle in relief and prevention of adverse events is early diagnosis and immediate treatment. It is important to understand the characteristic in adverse events according to age. Continuous monitoring of respiration using a pulse oximeter and regular assessment of pain and sedation level should be emphasized. Regular rounds by acute pain service are also desirable in pediatric postoperative pain management.

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Background : Postoperative analgesia may improve postoperative outcome and have appreciable effect on the surgical stress response. Operative and postoperative analgesia has become a major concern for anesthesiologists. We have reviewed the efficacy and side effects of continuous intravenous fentanyl with disposable infusion pump for postoperative pain relief. Method : Five hundred five patients received postoperative continuous intravenous fentanyl with disposable infusion pump for pain relief between January 2002 and December 2002. Four hundred fifty-seven of these patients for whom complete outcome data were available were enrolled for the study. Postoperative pain relief, the level of consciousness, respiratory and cardiovascular depression, nausea, and vomiting were evaluated retrospectively. Results : Upon arrival to the ward, 299 patients (65.4%) had clear consciousness, 148 (32.4%) somnolence, and 10 (2.2%) poor recovery. Three patients (0.7%) were delirious. Seventeen patients (3.7%) had airway obstruction and airway opening maneuvers was needed for 5 of these patients. Two patients (0.4%) had apnea for short period. Twenty patients (4.4%) had SpO₂ less than 90% either with or without face-mask oxygen delivery. Ten patients (2.2%) and 43 (9.4%) had a heart-rate of less than 50 bpm, and systolic blood pressure less than 90 mmHg, respectively. Seventy-seven patients (21%) had postoperative nausea and 55 (12%) vomiting. Pain scores were satisfactory in approximately half of the total patients without the supplement of the postoperative analgesics. Thirty-four patients (7.2%) required a supplement of other analgesics more than 3 times during postoperative 24 hours. Conclusion : Intraoperative and postoperative continuous intravenous fentanyl analgesia is an easy and reliable option for postoperative analgesia as an alternative to the epidural analgesia.

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