Experience of Management in "Preadmission Anesthesia Consultation Clinic" / 대한마취과학회지

BACKGROUND: Some of elective surgical procedures may be postponed or cancelled due to inadequate preoperative assessment and preparation. To minimize this problem, our preadmission anesthesia consultation clinic had been designed and managed at the outpatient department. The case referral pattern and efficacy of the clinic were evaluated for 1 year. METHODS: The study was done collected prospectively on 881 patients referred to the clinic from January to December 1997, 1 year. The age, sex, departmental distribution of consultation, ASA physical status of patients, the clinical department and reasons of consultation, and satisfaction of the patients or their parents were analized prospectively. The preoperative hospital stay periods before and after the opening of the clinic were compared. RESULTS: The sex ratio(M/F) were 6/4. Thirty-seven percent of the patients were under 10 years old and 11.8% were twenties. ENT(48.4%), ophthalmology(15.6%), general surgery(12.6%) were mainly referral departments. Reasons for consultation were related to chest X-ray abnormality(28.9% of the cases) and EKG abnormality(17.9%). The majority of consultation had pediatric(30%) and cardiologic problem(26%). URI(54.2%) and liver disease(12.6%) were major disease entities to postpone their surgery. In 2.7% of the patients, their admission or operation were postponed by the anesthesiologists in the clinic. Ninety-one percent of the patients were satisfied to visit the clinic. CONCLUSION: We conclude that reduction in preoperative hospital stay and shortening in delay of surgery are provided, and most patients are satisfied to the preadmission anesthesia consultation clinic.

Vecuronium or Pancuronium as a Priming Agent is Effective to Shorten the Onset of Mivacurium-Induced Neuromuscular Block for Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Mivacurium is a non-depolarizing neuromuscular blocking agent which has short duration of action. The goal of this study was to describe a technique which could shorten the onset time of mivacurium for rapid endotracheal intubation by using priming principle. METHODS: Thirty-one patients were randomly allocated into four groups. Patients in group I(n=8) received a single dose of 0.12 mg/kg mivacurium. Those in group II(n=10), III(n=6), and IV(n=7) received 0.015 mg/kg pancuronium, 0.012 mg/kg vecuronium, and 0.008 mg/kg mivacurium 4 minutes before the intubating dose of 0.12 mg/kg mivacurium was given respectively. Accelerographic response to train-of-four(TOF) stimulation of ulnar nerve at 15 seconds interval was used for neuromuscular monitoring. The onset time, the duration and recovery indices were compared between groups. RESULTS: The onset time in group II (2.9 0.49 min) and III (2.33 0.4 min) were significantly faster than that in group I (5.19 0.47 min). In the group II, the duration (26.3 1.9 min) and recovery index (12.35 2.45 min) were significantly prolonged than those in group I (9.12 1.21 and 4.75 0.52 min), respectively. CONCLUSION: The onset time is more rapid when pancuronium or vecuronium is used as priming agent than when mivacurium as single bolus injection or priming agent.