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Background:In the Korean National Health Insurance Corporation (KNHIC), payment for inhaled anesthetics are made according to the simulated dose and not the consumed dose. We compare the consumption of inhaled anesthetics according to fresh gas flow (FGF) and anesthetic circuits to compare the consumption of anesthetics and the guidelines for KNHIC payments.Methods: 161 patients were randomized into six groups who received isoflurane using a closed circuit (group I-C), a semi-closed circuit with FGF 3 L/min (group I-3), or 4 L/min (group I-4), as for the sevoflurane group (group S-C, S-3, and S-4). Mean arterial pressure (MAP) and heart rate (HR) were maintained within ± 20% of baseline. Minimum alveolar concentration (MAC) and consumption of inhaled anesthetics were recorded by a new anesthetic machine.Results: There were no significant differences among the groups for MAP, HR, and MAC. During anesthesia maintenance, the mean consumption per 15 minutes of inhaled anesthetics was significantly lower in group I-C (1.0 ± 0.3 ml) than in group I-3 (3.5 ± 0.7 ml) and than group I-4 (4.9 ± 0.9 ml) and similar to the sevoflurane groups (group S-C [1.3 ± 0.4 ml] vs group S-3 [5.3 ± 1.0 ml] vs group S-4 [6.9 ± 1.3 ml], respectively; P ＜ 0.05).Conclusions: In sevoflurane groups, inhaled anesthetics were consumed more than in isoflurane groups. The KNHIC payment guidelines were close to the actual consumption of inhaled anesthetics under using a semi-closed circuit with FGF 3 L/min in sevoflurane and FGF 4 L/min in isoflurane.

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Cardiopulmonary bypass (CPB) is widely used for cardiac surgery by virtue of its proven safety over the course of its use during the past half century. Even though perfusion is safer, incidents still occur. During the repair of a ventricular-septal defect in an 11-month-old infant, we experienced a critical incident related to the potential hazardous effect of volatile anesthetics on the polycarbonate connector of extra-corporeal circuit. The damage to the polycarbonate connector had occurred after spillage of isoflurane during the filling of the vaporizer, causing it to crack and leak. The incident was managed by replacement of the cracked connector during a temporary circulatory arrest. The patient was hypothermic and the time off bypass was less than 1.5 min. There were no neurologic sequelae, the patient made an uneventful recovery. In conclusion, the spillage of volatile anesthetics can cause cracks in the polycarbonate connector of the extra-corporeal circuit, leading to potentially interruption of CPB.

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Al doped ZnO thin films have been deposited by a RF magnetron sputtering technique from a ZnO (2 wt.% Al 2 O 3 ) target onto glass substrates heated at temperature ranging from RT to 400 o C. X-ray diffraction analysis shows that the deposits have a preferential growth along the c-axis of a hexagonal structure. The full with at half maximum decreases from 0.45 to 0.43 o in the studied temperature range. The root main square surface roughness increases with substrate temperature from 1.89 to 2.67 nm. All films are transparent up to 80% in the visible wavelength range and the adsorption edge is red-shifted with substrate temperature from RT to 400 o C. The sheet resistance increases from 92 ohm/sq to 419 ohm/sq when the deposition temperature increases from RT to 400 o C. The increment of sheet resistance is caused by lowered carrier concentration resulting from an increase in surface roughness.

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