Method: From legal journals published before the end of 2001, we investigated 98 sentences in criminal actions regarding the anesthetic field and medicament. Results: The most common issue was medicament, followed by blood transfusions, anesthesia/pain control, and mis-administration of nitrous oxide/oxygen. There were no marked increases compared to civil actions. When the sentences were reviewed, the rate of responsibility was high. Penalties included accidental homicide and accidental infliction of injury. However, punishment for accidental infliction of injury were not always lighter than those to accidental homicide. Concerning anesthesia/pain control, the criminal actions were related to medical activities lower than the medical practice level. For physicians, the rate of imprisonment was high. Conclusion: The high rate of imprisonment for physicians may be because physicians make the final medical decision and because their duties are unclear. However, penalties were sentenced based on the established system. As medical strategy, a system including responsibility allotment should be established.

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We investigated the effects of thyamilal's injection speed, injection routes and atropine premedication on the occurrence of coughing. We compared the incidence of coughing with rapid (about 2ml•sec-1) and slow (about 1ml•sec-1) thyamilal injection into the central vein and peripheral vein with or without atropine 0.5mg premedication. Rapid injection into the central vein caused a significantly higher incidence of coughing as compared with that of slow injection. Without atropine premedication, the incidence of coughing significantly reduced compared with atropine premedication under the same rapid thyamilal injection into the central vein. Rapid injection into the peripheral vein induced no cough reflex. Since coughing during anesthetic induction might cause serious complications, it is worth noting that rapid thyamilal injection into the central vein correlates to a high incidence of coughing and atropine premedication does not prevent it.

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We used transcutaneous monitoring of carbon dioxide tension for two patients undergoing LVRS and compared of transcutaneous, end-tidal and arterial measurements of carbon dioxide (PtcCO₂, P_ETCO₂ and PaCO₂). The PaCO₂ of each patient was high, 52-91mmHg and 46-60mmHg, respectively. The P_ETCO₂-PaCO₂ gradients of these patients were 10-35mmHg and 7-15mmHg, respectively. However, the PtcCO₂-PaCO₂ gradients of these patients were smaller and within 5mmHg of each other. PtcCO₂ monitoring cannot take the place of P_ETCO₂ because it can not show the change in each breath. But these results show that PtcCO₂ monitoring is more useful than P_ETCO₂ for patients with ventilation-perfusion mismatching, such as during LVRS.

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We experienced a case of pulmonary edema due to upper airway obstruction which was caused by the stimulation associated with LMA extubation. After confirming that the patient could respond to verbal commands at the end of orthopedic surgery under general anesthesia LMA was extubated. The patient developed laryngospasm and ventilation with a face mask was unsuccessful. The patient was intubated immediately with a endotracheal tube with the aid of muscle relaxant. Pink froth was suctioned though endotracheal tube. The diagnosis of pulmonary edema was ascertained with chest X-P. The patient stayed in the ICU for one night. Careful history-taking in the ward later revealed that he had had an irritated throat for two to three days prior to the surgery. We have to be careful in the selection of the patient when we utilize LMA.

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Use of TIVA has become increasingly common, due to the advantages of propofol and the disadvantages of nitrous oxide and volatile anesthetic. BIS monitoring is expected to prove useful for monitoring anesthetic depth since control of this parameter is reported to be difficult with TIVA. However, many issues regarding the reliability of BIS monitoring during oral surgery should be investigated, such as interference caused by the close proximity of the sensor attachment to the surgery site. We investigated the reliability of BIS monitoring during oral surgery using TIVA and observed that the incidence of a good EEG (electroencephatogram) satisfying all conditions of: EMG<50dB; SQI>25%; and impedance<10kΩ), was 94.6±2.3%. BIS monitoring is therefore considered to be a reliable technique for use during oral surgery.

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