Characteristics of Industrial Accident Deaths by Year and Industry / 한국직업건강간호학회지

Purpose@#The current status and rationale of industrial accidents needs to be examined to develop scientific and systemic preventive measures. @*Methods@#The aim of this study is to analyze the current data on industrial accidents provided by the Ministry of Employment and Labor and categorize work-related deaths by types of industries and annual report. @*Results@#First, the highest number of deaths occurred in industries that had less than 50 people. Second, in the manufacturing industry, the highest death rate was found in workers in the age group 50-59 years. In the construction industry, workers aged 50 and above had the highest number of deaths. In other industries, workers aged 60 and above had the highest number of deaths. Third, the highest number of deaths occurred in workers with less than one year of experience in any industry Fourth, in most industries, the highest work-related deaths occurred during weekdays (Monday~Friday). In 2015, the warehouse delivery industry had 33% higher work-related deaths on the weekends (Saturday and Sunday) as compared to other industries. Fifth, in most industries, the highest work-related deaths occurred from 8 AM to 6 PM. The warehouse delivery industry had higher work-related deaths from 10 PM to 8 AM as compared to other industries. @*Conclusion@#In order to increase the efficacy of industrial accident prevention, it is necessary to establish an effective health management system and apply strict safety management activities.

Factors associated with Interpersonal Relationship Ability of Undergraduates: A Mediation Analysis of Smartphone Addiction Tendency / 정신간호학회지

PURPOSE: The aims of this study were to evaluate a hypothetical model explaining undergraduates' interpersonal relationship ability associated with the stress of life, self-esteem, and their communication ability and to identify the mediating effect of a smartphone addiction tendency on the identified associations. METHODS: Data were collected from 201 undergraduates using a structured questionnaire from August to September 2017. Data analyses included descriptive statistics, Pearson's correlation coefficients, and structural equation modeling with SPSS AMOS 22.0. RESULTS: The participants' interpersonal relationship ability was 65.9%, explained by the stress of life, self-esteem, communication ability, and smartphone addiction tendency. The factors of undergraduates' interpersonal relationship ability were self-esteem (β=.10, p<.01) and communication ability (β=.14, p<.001). Stress of life (β=.15, p<.01) directly affected the participants' smartphone addiction tendency, which was not associated with interpersonal relationship ability. CONCLUSION: Based on our study findings, self-esteem and communication ability should be considered for developing nursing interventions to improve interpersonal relationship ability. However, a smartphone addiction tendency may be managed for undergraduates who experience excessive stress of life rather than interpersonal relationship ability. Thus, a tailored approach targeting specific needs or competence should be developed based on our data-based framework.

Wire-reinforced endotracheal tube fire during tracheostomy: A case report / 대한마취과학회지

Every operation could have a fire emergency, especially in the case of a tracheostomy. When a flammable gas meets a source of heat, the danger of fire is remarkable. A tracheal tube filled with a high concentration of oxygen is also a great risk factor for fire. Intra-tracheal tube fire is a rare, yet critical emergency with catastrophic consequences. Thus, numerous precautions are taken during a tracheostomy like, use of a special tube to prevent laser damage, ballooning of the tube with normal saline instead of air, and dilution of FiO2 with helium or nitrogen. Since the first recorded cases on tube fires, most of the fires were initiated in the balloon and the tip. In the present case report, however, we came across a fire incidence, which originated from the wire.

Neuromuscular Blocking Effect of Vecuronium in Electric Burned Patients for Endotracheal Intubation / 대한마취과학회지

BACKGROUND: In inducing anesthesia for burn patients, nondepolarizing muscle relaxant (NDMR) is usually used, because succinylcholine, a widely used muscle relaxant may cause hyperkalemia. It is well known that because burn patients show resistance to NDMR, a high dose of NDMR is needed for them. In this study, we wanted to know whether there is significant difference of the relaxation effect between 0.1 mg/Kg and 0.15 mg/Kg dose's of vecuronium, and between burn and unburn patients. METHODS: Subjects are 40 male patients having 1 or 2 ASA physical status (20 are burn patients and the other 20 are unburn patients). We divided them into 4 groups; 1) Group BI (burn patients, vecuronium 0.1 mg/Kg) 2) Group BII (burn Pts, vecuronium 0.15 mg/Kg) 3) Group UBI (unburn Pts, vecuronium 0.1 mg/Kg) 4) Group UBII (unburn Pts, vecuronium 0.15 mg/Kg). Average onset times (time from injection of vecuronium to zero first twitch height (T1)) were measured and intubating condition were scored on 0 to 4 scale. RESULTS: The onset time of vecuronium and distribution of intubation scores didn't show statistical differences among 4 groups. CONCLUSION: The onset time of vecuronium and intubating condition in burn patients dosen't show a difference from unburn patient.

The Action of Enflurane and Desflurane in Aotic Rings of Rabbit Pretreated with LNAME (L-nitrow arginine methyl ester) and MB (methylene blue) / 대한마취과학회지

BACKGROUND: Desflurane is a new inhaled anesthetic with the lowest blood/gas partition coefficient and enflurane is one of the major anesthetics in these days. But the effect of volatile anesthetics and the site of action on the blood vessel are still controversial. Since Furchgott (1980) discovered endothelium derived relaxing factor (EDRF) from endothelium, many investigators have studied about the relationship between the EDRF and the effect of the volatile anesthetics on blood vessels. In this study, we evaluated that the effect and the action site of enflurane and desflurane on isolated aortic rings of the rabbit. METHODS: Each of obtained thoracic aorta from rabbits (1.5~2.5 kg) was divided into 4~6 mm rings, and a half of that were denuded. All of the aortic rings were preconstricted with phenylephrine 1.5 10-7 Mole in warm organ bath filled with modified Krebs' solution, and then LNAME (inhibitor of nitric oxide synthase, 3 10-4Mole) was administered to one group of aortic rings. MB (inhibitor of soluble guanylyl cyclase, 2 10-5Mole) was administered to another one group and neither of LNAME nor MB was administered to the other group. And then enflurane (1%, 2%, 3%, 4%) or desflurane (6%, 9%, 12%) was administered to all of aortic rings. The polygraph recorded the changes of tension of aortic ring which was transmitted through the force transducer. RESULTS: It was proved that basal EDRF was released from endothelium by the fact that intact aortic rings were more constricted after LNAME or MB administration. The intact aortic rings were constricted in all concentration of enflurane and both intact and denuded rings were maintained from control tension in all concentrations of desflurane. CONCLUSION: It is concluded that enflurane in all concentrations has an endothelium-mediated vasoconstriction effect and desflurane in all concentrations has no effect on isolated aortic rings of rabbit.

The action of Halothane and Isoflurane in Aortic Rings of Rabbit Pretreated with LNAME (L-nitrow arginine methyl ester) and MB (methylene blue) / 대한마취과학회지

BACKGROUND: The action of the volatile anesthetics on various organs in the body is not well known. Since Furchgott (1980) discovered endothelium derived relaxing factor (EDRF) from endothelium, many studies have been tried. Many investigators were studied about the relationship between the EDRF and the effect of the volatile anesthetics on blood vessels too. But the effect of volatile anesthetics and the site of action on the blood vessel were still controversial. In this study, we evaluated that the effect and the action site of halothane and isoflurane on isolated aortic rings of the rabbit. METHODS: Each of obtained thoracic aorta from rabbits (1.5~2.5 Kg) was divided into 3~5 mm sized rings, and a half of that were denuded. All of the aortic rings were preconstricted with phenylephrine 1.5 10-7 Mole in warm organ bath filled with modified Krebs' solution, and then LNAME (inhibitor of nitric oxide synthase, 3 10-4Mole) was administered to one group of aortic rings. MB (inhibitor of soluble guanylate cyclase, 2 10-5Mole) was administered to another one group and neither of LNAME nor MB was administered to the other group. And then isoflurane or halothane was administered (1~4%) to all of aortic rings. The polygraph recorded the changes of tension of aortic ring which was transmitted through the force transducer. RESULTS: It was proved that basal EDRF was released from endothelium by the fact that intact aortic rings were more constricted after LNAME or MB administration. The intact aortic rings were constricted in all concentration of isoflurane and both intact and denuded rings were relaxed in 4% concentration of halothane. CONCLUSION: It is concluded that isoflurane in all concentrations has an endothelium -mediated vasoconstriction and 4% halothane produced vascular relaxation directly independent of existence of the endothelium of vessel.

Malignant Hyperthermia Syndrome: A case report / 대한구급학회지

Malignant hyperthermia (MH) is an inherited skeletal muscle disorder characterized by hypermetabolism, muscle rigidity, rhabdomyolysis, fever, metabolic acidosis and death if untreated. The syndrome is believed to result from abnormal control of intracellular calcium ions in the skeletal muscle: on exposure to certain anesthetics, calcium level is increased, and then it activates contractile processes and biochemical events that support muscle contraction. We experienced a MH of 2 years-old male who had release of sternocleidomastoid muscle due to torticolis under general anesthesia. Anesthesia was induced with thiopental and succinylcholine, maintained with enflurane, nitrous oxide and oxygen (2 volume%: 2 L/min: 2 L/min). After induction of anesthesia, his heart rate, end-tidal CO2 tension and body temperature had been gradually increased and then those were reached to maximal value of heart rate (160~170 BPM), end-tidal CO2 tension (60~70 mmHg) and body temperature (41degrees C) 55 minutes later. He was immediately managed with symptomatic treatment such as hyperventilation with oxygen, cooling, beta-blocker, sodium bicarbonate and diuretics, so he was survived without any sequelae.

Combination Therapy of Verapamil and Esmolol for the Paroxysmal Supraventricular Tachycardia Recurred during the Central Venous Catheterization: A case report / 대한구급학회지

Combination therapy of beta-blocker and a calcium channel blocker is not recommened because their additive effect on the myocardium and the atrioventricular node may precipitate heart block in susceptible patients. We experienced a 68 years old female patient who had paroxysmal supraventricular tachycardia that was treated with verapamil and esmolol. She had been taking verapamil for 2 years because of her paroxysmal supraventricular tachycardia. She was planned for left ureteronephrectomy due to left ureteral tumor. After epidural catheterization for the postoperative pain control, she was anesthetized with isoflurane and vecuronium. During central venous catheterization, SVT (H.R. from 98 beats per minute to 190 BPM) was suddenly developed with hypotension (B.P. from 120/65 mmHg to 75/42 mmHg) when guide wire was introduced. We treated her with combination therapy of verapamil 7.5 mg and esmolol 18 mg under the monitoring of blood pressure, electrocardiogram, end-tidal CO2 tension, central venous pressure and pulse oximeter. After 20 minutes of vigorous treatment, her heart rate and blood pressure returned to a normal range.

Carbon Monoxide Production by Electrocautery during Laparoscopic Cholecystectomy and Carboxyhemoglobin Concentrations in Patients and Operators / 대한마취과학회지

Pyrolysis of tissue in a hypoxic environment can produce carbon monoxide. Peritoneal cavity is hypoxic during laparoscopic cholecystectomy by insufflation with 100% carbon dioxide, then, carbon monoxide is produced by electrocautery of tissue. To determine whether carbon monoxide was being absorbed in dangerous amounts to patients and operating room workers, blood was analyzed for carboxyhemoglobin in patients and their operators. Twenty-one patients undergoing this procedure, sampling the insufflation gas before, after use of electrocautery analyzed for carbon monoxide. Carbon monoxide was present in the peritoneal cavity, 5 min after use of electrocautery at a median concentration of 430 ppm(range 20~1000 ppm), and at the end of surgery at a median concentration of 174 ppm(range 10~720 ppm). This is well in excess of the 35 ppm upper limit for a 1-hr exposure set by the Environmental Protection Agency in U.S.A.. The patients carboxyhemoglobin concentrations(mean +/- SD) at the beginning, at the end and 3 hrs after surgery were 0.51+/-0.30%, 0.41%+/-0.28%, and 0.45%+/-0.74%, respectively. The operator's carboxyhemoglobin concentrations before and at the end of surgery were 1.12%+/-1.09% and 1.03%+/-1.03%, respectively. Although there was no evidence of significant absorption of carbon monoxide in these patients and operators, care should be taken to scavenge the gases produced by electrocautery of tissues to avoid operating room contamination during laparoscopic cholecystectomy.