The State of Anesthetic Services in Korea: A National Survey of the Status of Anesthesia Provider in the 2011-2013 Period

Active involvement of anesthesiologists in perioperative management is important to ensure the patients' safety. This study aimed to investigate the state of anesthetic services in Korea by identifying anesthetic service providers. From the insurance claims data of National Health Insurance for 3 yr, the Korean state of anesthetic services was analyzed. The claims for anesthesia from the medical institutions which hire their own anesthesiologist or with an anesthesiologist invitation fee are assumed to be the anesthesia performed by anesthesiologists. The annual anesthetic data were similar during the study period. In 2013, total counts of 2,129,871 were composed with general anesthesia (55%), regional anesthesia (36%) and procedural sedation with intravenous anesthetics (9%). About 80% of total cases of general anesthesia were performed in general hospitals, while more than 60% of the regional anesthesia and sedation were performed in the clinics and hospitals under 100 beds. Non-anesthesiologists performed 273,006 cases of anesthesia (13% of total) including 36,008 of general anesthesia, 143,134 of regional anesthesia, and 93,864 of sedation, mainly in the clinics and hospitals under 100 beds. All procedural sedations in the institutions without direct employed anesthesiologist were performed by non-anesthesiologists. Significant numbers of anesthesia are performed by non-anesthesiologist in Korea. To promote anesthetic services that prioritize the safety of patients, the standard to qualify anesthetic service is required. Surgeons and patients need to enhance their perception of anesthesia, and the payment system should be revised in a way that advocates anesthesiologist-performed anesthetic services.

Intensive Care Unit Delirium / 대한중환자의학회지

Delirium is described as a manifestation of acute brain injury and recognized as one of the most common complications in intensive care unit (ICU) patients. Although the causes of delirium vary widely among patients, delirium increases the risk of longer ICU and hospital length of stay, death, cost of care, and post-ICU cognitive impairment. Prevention and early detection are therefore crucial. However, the clinical approach toward delirium is not sufficiently aggressive, despite the condition's high incidence and prevalence in the ICU setting. While the underlying pathophysiology of delirium is not fully understood, many risk factors have been suggested. As a way to improve delirium-related clinical outcome, high-risk patients can be identified. A valid and reliable bedside screening tool is also needed to detect the symptoms of delirium early. Delirium is commonly treated with medications, and haloperidol and atypical antipsychotics are commonly used as standard treatment options for ICU patients although their efficacy and safety have not been established. The approaches for the treatment of delirium should focus on identifying the underlying causes and reducing modifiable risk factors to promote early mobilization.

Intensive Care Unit Delirium / 대한구급학회지

Delirium is described as a manifestation of acute brain injury and recognized as one of the most common complications in intensive care unit (ICU) patients. Although the causes of delirium vary widely among patients, delirium increases the risk of longer ICU and hospital length of stay, death, cost of care, and post-ICU cognitive impairment. Prevention and early detection are therefore crucial. However, the clinical approach toward delirium is not sufficiently aggressive, despite the condition's high incidence and prevalence in the ICU setting. While the underlying pathophysiology of delirium is not fully understood, many risk factors have been suggested. As a way to improve delirium-related clinical outcome, high-risk patients can be identified. A valid and reliable bedside screening tool is also needed to detect the symptoms of delirium early. Delirium is commonly treated with medications, and haloperidol and atypical antipsychotics are commonly used as standard treatment options for ICU patients although their efficacy and safety have not been established. The approaches for the treatment of delirium should focus on identifying the underlying causes and reducing modifiable risk factors to promote early mobilization.

Recent knowledge of preoperative evaluation and preanesthetic management in infants

Preoperative assessment and optimization of a patient's condition are important components of anesthesia practice. Improvements in evaluation and management can potentially reduce adverse events, improve patient and caregiver satisfaction, and reduce costs. Although routine preoperative laboratory tests are ordered in many institutions, history taking and physical examination provide more information about patients than laboratory tests do. Therefore, history taking and physical examination should be used to direct test ordering, and a test should be ordered only if the results will impact the decision to proceed with the planned procedure or alter the care plans. Preoperative laboratory tests without specific indications lack clinical usefulness and may actually lead to patient injury because of unnecessary interventions, delay of surgery, anxiety, and even inappropriate therapies. After sufficient discussion between anesthesiologists and surgeons in each institution, diagnostic testing guidelines for the preoperative evaluation should be developed to improve patient care, standardize clinical practice, improve efficiency, and reduce costs. For preoperative management for infants, preoperative evaluation is similar to that for the adult, but reducing anxiety of patients and their parents is especially important. Although many nonpharmacologic methods are used to reduce anxiety, the pharmacologic methods are more effective than nonparmacologic methods. The administration of sedative premedication to infants who are about to undergo anesthesia and surgery can result in beneficial effects during the preoperative and postoperative periods by decreasing anxiety, increasing cooperation during anesthesia induction, and reducing negative postoperative behavioral responses.

Videothoracoscopic management of a perforated central vein and pleura after ultrasound-guided internal jugular vein cannulation: a case report / 대한마취과학회지

A 23-year-old male underwent a left internal jugular vein catheterization during extended surgery for treatment of multiple fractures due to a traffic accident. Although the catheterization was performed under ultrasound (US) guidance, iatrogenic perforation of the central vein and pleura occurred. The catheter was removed, and the perforated site was addressed under thoracoscopy rather than an open thoracotomy. This case suggests that using US does not completely guarantee a complication-free outcome, and that catheter placement should be carefully confirmed. In addition, this case suggests that thoracoscopy may be an ideal method of resolving a perforation of the central vein and pleura.

Combined use of a McGrath(R) MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome: a case report / 대한마취과학회지

Patients with Pierre Robin syndrome are characterized by micrognathia, retrognathia, glossoptosis, and respiratory obstruction and are prone to have a difficult-to-intubate airway. The McGrath(R) MAC video laryngoscope provides a better view of the glottis than a Macintosh laryngoscope, but it is not easy to insert an endotracheal tube through the vocal cords because a video laryngoscope has a much greater curvature than that of a conventional direct laryngoscope and an endotracheal tube has a different curvature. The Frova Intubating Introducer is used as a railroad for an endotracheal tube in cases of a difficult airway. We thought that a combination of these two devices would make it easy to insert an endotracheal tube through the vocal cords, as a McGrath(R) MAC video laryngoscope provides a better glottic view and the Frova Intubating Introducer is a useful device for placing an endotracheal tube through the glottis. We report a successful endotracheal intubation with use of the McGrath(R) MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome.

Effectiveness of the Smart Care Service for Diabetes Management / 대한의료정보학회지

OBJECTIVES: The aim of this study was to assess the effectiveness of the Smart Care service for the diabetes management. METHODS: Fifty-six patients with diabetes mellitus were recruited in Daegu, Korea. All participants completed a diabetes management education course (diet, exercise, and complications) for their self-care and received access to a care management website through a netbook and smartphone. The website accepts uploads of glucose level, body weight, HbA1c, low-density lipoprotein cholesterol level, and blood pressure. Participants communicated with the care manager through the internal management system of the website. The intervention was applied for 6 months. RESULTS: Participants receiving the Smart Care service had lower blood glucose and HbA1c during 6 months follow-up when 1-month values (p < 0.001) were compared. There was no significant difference in body weight and body mass index between 1 month and 6 months. The average number of remote consultation with the Smart Care service per person was 10.4 by nurses, 3.0 by nutritionists, and 1.6 by sports curers. Regression analysis indicated that the number of times counseling was offered by nurses influences body weight and that the number of minutes of telephone counseling influences both body weight and body mass index. CONCLUSIONS: We have confirmed that the Smart Care service might be an effective system for reduction in blood glucose and HbA1c. We expect that the Smart Care service will contribute to delaying diabetes complications and improving the quality of life of patients with diabetes.

Diabetes and Cognitive Function in Community-Dwelling Older Adults

PURPOSE: This study was to examine the relation between diabetes and cognitive function in older adults. METHODS: Eighty community-dwelling patients with diabetes and 506 subjects without diabetes were studied with cognitive function test. Cognitive function was measured by Full-scale IQ, Basic IQ, Executive IQ, Attention Function Index, Working Memory Index, Language Function Index, Visuospatial Function Index, Memory Function Index, and MMSE-K1. RESULTS: In model controlling for education, the diabetic group showed significantly lower scores than the non-diabetic group in in Full-scale IQ (p=.012), Basic IQ (p=.034), Executive IQ (p=.014), Attention Function Index (p=.002), Working Memory Index (p=.037), and Memory Function Index (p=.043). The diabetic and non-diabetic groups that were matched for gender, age, and education showed similar differences in 7 out of 9 cognitive measures. The impairments of Full-scale IQ and Memory Function Index in the diabetic group were, respectively, 2.7 and 2.8 times greater than that in the diabetic group. CONCLUSION: These results showed that diabetes should be considered to a factor of cognitive impairment in older adults.

The Validity of a Single Item Scale: Health Related Quality of Life in Heart Failure Patients / 기본간호학회지

PURPOSE: The purpose of this study was to examine the validity of a single item scale by comparing a single item scale of health related quality of life to subscopes of the multi-item scales in the Medical Outcome Study Short Form-36 (SF-36), and Minnesota Living with Heart Failure Questionnaire (MLHFQ). METHOD: The data from 103 patients with heart failure were analyzed. The statistics program SPSS 12.0 used for descriptive statistics. RESULTS: Significant correlations were found between the single item scale and subscopes of SF-36, for physical functioning (r= .42), role physical (r= .22), general health perception (r= .46), vitality (r= .40), social functioning (r= .20) and mental health (r= .51), but not for body pain (r= .12) and role emotional (r= .06). Physical (r= -.41), emotional (r= -.49) and total scores (r= -.49) of MLHFQ were significantly related to the single item scale. CONCLUSION: The single item scale of health related quality of life showed low to moderate correlation with multi-item scales. Even though the single item scale was correlated with several subscopes of multi-item scales, the correlation was not high, so we have to use caution when using the single item scale instead of multi-item scales.

Predictors of Vascular Complications among Patients with Type 2 Diabetes / 기본간호학회지

PURPOSE: The purpose of this study was to predict the risk factors for vascular complications among patients with type 2 diabetes. METHOD: The data were collected from August to September, 2007 using clinical examination and questionnaires. Patients (N=101) were recruited from the endocrinology department of P University hospital in D city. Descriptive statistics, Pearson correlation coefficients and multiple linear regression were used to analyze the data. RESULTS: The cardiovascular risk of patients with diabetes was significantly related to self care behavior, family history, and smoking status. The risk of peripheral vascular complications was not related to predictors included in the study. With multivariate analyses, significant predictors of cardiovascular risk for these patients were self care behavior, family history, and smoking status (R2=.40, p<.0001). CONCLUSION: The findings of this study indicate that smoking cessation and improving self-care behavior are essential to reduce the risk of cardiovascular complications among patients with diabetes. To enhance self-care practices for the patients with diabetes, nursing interventions, such as telephone counseling, problem focused nursing counseling, and peer group activities should be considered.