Analysis of the Proportion of Patients Who Were Admitted to the Emergency Department of the Tertiary Care Hospital for Primary Care

BACKGROUND: The medical service delivery system in Korea works inefficiently and patients tend to visit tertiary hospitals by means of the emergency department (ED). Overcrowding of the ED threatens the health and life of emergency patients as a result of the inability to effectively distribute emergency medical resources in the community. To solve this problem, improvement in the medical delivery system and dispersion of patients by strengthening primary care may be helpful. In order to make policy decisions for this, it is necessary to estimate the scale of patients who can be distributed to primary care.METHODS: From January 1 to December 31, 2016, we analyzed the National Emergency Department Information System (NEDIS) data of patients who visited a tertiary ED to examine the proportion of patients eligible for primary medical care. The inclusion and exclusion criteria for primary care were made through the consensus of three physicians.RESULTS: A total of 65,061 NEDIS records were analyzed. Among them, by inclusion criteria, 29,818 cases were Korean Triage and Acuity Scale level 4 and 5, and 11,791 patients visited the ED during the day. After considering the exclusion criteria, there were 6,468 cases who may be suitable for primary medical care.CONCLUSION: Of the patients who visited the ED of tertiary hospitals, approximately 10% of them may be suitable for primary care. There should be a discussion and social consensus to reduce overcrowding in EDs and deliver better medical services.

Margin of Safety in Positioning Double-lumen Endotracheal Tubes Using a Fiberoptic Bronchoscope in Korean Adult / 대한마취과학회지

BACKGROUND: The margin of safety is the length of the mainstem bronchi, over which double-lumen endotracheal tubes (DLTs) can be moved and still be correctly positioned. A negative value of margin of safety means that DLTs may not be safe. We measured the length of the left and right mainstem bronchi and margin of safety in Korean adults. METHODS: One hundred and fifty-six ASA I or II adult patients undergoing an elective surgery were examined. After nduction of general anesthesia, we measured the lengths from the upper incisor to the tracheal carina, to the proximal margin of the left and right upper lobe bronchial opening using a fiberoptic bronchoscope. We calculated the lengths of the left and right mainstem bronchi and margin of safety using the measured lengths. RESULTS: In Korean adults, the average margin of safety of left-sided DLTs of males and females was 2.4 +/- 1.0 cm and 1.9 0.7 cm and right-sided DLTs of males and females was 1.0 +/- 0.9 cm and 0.8 +/- 0.3 cm, respectively. The percentage of a negative value of the margin of safety in positioning right-sided DLTs was 10.4% in males and 8.6% in females. However, all values of the margin of safety in left-sided DLTs were positive. CONCLUSIONS: Using left-sided DLTs, regardless of the operative side, is better than right-sided DLTs because left-sided DLTs have a greater margin of safety in positioning. If we use right-sided DLTs, we should confirm the proper position of tubes using a fiberoptic bronchoscope.

The Comparison of Characteristics in Emergence between Inhalational Anesthesia Using Isoflurane and Total Intravenous Anesthesia Using Propofol and Ketamine / 대한마취과학회지

BACKGROUND: Total intravenous anesthesia (TIVA) is one of the anesthetic techniques that needs no inhalational agent but only an intravenous agent for induction and maintenance of anesthesia. Among drugs used in TIVA, propofol is the most popular agent. Rapid emergence and antiemetic characteristics of propofol are well known advantages but a dose dependent cardiovascular depressant effect is one of the disadvantages of this drug. Otherwise, ketamine, a dissociative agent, has been restricted in its use because of bad dreams, delirium and delayed emergence even though it has profound analgesic characteristics. However, ketamine has a stimulatory effect on the cardiovascular system, so it can raise blood pressure and pulse rate and in the case of TIVA, these properties can be advantageous when used with propofol. This study was aimed to decide whether TIVA using propofol and ketamine would have more stable vital signs during anesthesia and more rapid and smoother emergence in comparison with inhalational anesthesia using isoflurane. METHODS: Thirty two patients scheduled for elective general anesthesia were randomly allocated into two groups; I (inhalational anesthesia using isoflurane) group and PK (TIVA using propofol and ketamine) group. I group was controlled with isoflurane 1 - 1.5 vol% and the PK group was controlled with propofol 3 - 12 mg/kg/hr and ketamine 0.5 - 1.0 mg/kg/hr. Arriving at the recovery room, a single observer recorded the time to spontaneous movement, responses to painful pinch and verbal command, and orientation to age, name, place, date and time. At 5, 10, and 30 minutes after anesthesia, a PARS (postanesthesia recovery score), count-down test, and VAS (visual analogue scale) were checked. Postoperative events were checked in the recovery room and 24 hours lator. RESULTS: There was no significant difference in demographic data or characteristics of operation. Compared with the I group, the PK group had significantly rapid orientation responses on place, date and time. Restoration in the count-down test was more rapid in the PK group after 10 minutes in the recovery room. The VAS was lower in the PK group after 30 minutes in the recovery room. CONCLUSIONS: TIVA using propofol and ketamine has a more rapid emergence than inhalational anesthesia using isoflurane and better postoperative analgesic effect without respiratory depression.

Inflammatory Reactions after Subdermal Injection of Thiopental and Propofol in Rabbits / 대한마취과학회지

BACKGROUND: Thiopental and propofol are the most widely used intravenous anesthetics as induction agents in general anesthesia. Thiopental is a very strong alkaline drug, and when it is extravasated, it can cause pain and skin necrosis. Propofol also can cause pain on injection in many populations. Therefore, we planed this study to compare inflammatory reactions of skin tissues after subdermal injections of thiopental and propofol in rabbits. METHODS: Four rabbits were divided into 2 groups: Standard dose (S) group and double dose (D) group. In the S group, thiopental 0.4 ml and propofol 0.4 ml were injected subcutaneously on each side of the posterior proximal ear. In the D group, the dose was doubled to 0.8 ml of each drug and injection was done in the same manner. Skin tissue at the injection sites were excised after 1 day, 3 days, and 7 days. Then each skin tissue slide was examined under an optical microsccpe. RESULTS: In the S group, the inflammatory reaction after the subdermal injection of 2.5% thiopental revealed a more progressed and more severe pattern than 1% propofol. In the D group, the inflammatory reaction after a subdermal injection of 2.5% thiopental revealed a more progressed and more severe pattern than 1% propofol at 3 days, but there was no significant difference in the degree of progression and severity between the 2 drugs at 7 days. CONCLUSIONS: When propofol is extravasated during continuous infusion for maintenance of anesthesia, it can cause distinct inflammatory reaction; though the inflammatory reaction is milder and the possibility of complications is lower than with thiopental.

Comparison of the Changes of Liver Function in Patients after Open Versus Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Laparoscopic cholecystectomy is a standard treatment for cholelithiasis and indication is continuously widened to acute and complicated cholecystitis. It has been proved to give advantages such as less postoperative pain, postoperative complications and early recovery. However, postoperative hepatic dysfunction after laparoscopic cholecystectomy has been repeatedly reported and when we evaluate postoperative hepatic dysfunction, laparoscopic surgery has been thought as one of the contributors. So authors planned this study to satisfy the growing need of reevaluation of postoperative hepatic dysfunction because we have had many achivements and improvements in knowledge and operative techniques since a while. METHODS: From January to December in 2000, 182 patients were randomly selected among who had undergone cholecystectomy in one university hospital. The numbers of each group (group OC; open, group LC; laparoscopy) were equal. Demographic data, duration of operation and level of liver enzymes (alanine transferase, alkaline phosphatase, total bilirubin and direct bilirubin) on operation day and one postoperative day were estimated by medical records. RESULTS: Mean operation time was longer in group OC than in group LC. Levels of alanine transferase, total bilirubin and direct bilirubin of postoperative one day were increased significantly in both groups. The degrees of increase of alanine transferase and bilirubin were higher in group OC than group LC in statistically significant manner. CONCLUSIONS: Laparoscopic cholecystectomy has more advantages than open cholecystectomy in many aspects.

The Effect of Endotracheal Tube Cuff Filled with Lidocaine and Sodium Bicarbonate Mixture on Postoperative Sore Throat and Hoarseness Following General Endotracheal Anesthesia / 대한마취과학회지

BACKGROUND: Postintubational sore throat and hoarseness are usually mild symptoms but they are very common complaints among the patients after endotracheal general anesthesia. In addition, some might have severe discomfort and need invasive procedure to relieve these problems. We tried new method of endotracheal tube cuff filling with local anesthetics to reduce postoperative sore throat and hoarseness and evaluated the results. METHODS: Endotracheal cuff filling was done with air 5 ml in healthy 20 patients (ASA I-II, control group). And in another healthy (ASA I-II) 35 patients, the cuffs were filled with 4% lidocaine 3.5 ml and 8.4% sodium bicarbonate 1.5 ml mixture. After 24 hours following general anesthesia, patients were visited and asked whether there were sore throat or hoarseness, if any, how the degree was. RESULTS: In lidocaine-treated group, the incidence of postintubational sore throat was less compared to control group significantly. There was no difference in incidence of hoarseness between two groups. CONCLUSION: Endotracheal cuff filled with lidocaine and sodium bicarbonate mixture is suggested as an effective protective method that reduces the frequency of postintubational sore throat.

The Effect of CO2 Insufflation and Trendelenburg-lithotomy Position on Intraocular Pressure during Laparoscopy / 대한마취과학회지

BACKGROUND: The laparoscopy requires carbon dioxide (CO2) insufflation and Trendelenburg position for operational convenience. However, the above circumstances affect the cardiopulmonary systems significantly and intraocular pressure (IOP) may be also influenced. METHODS: In 27 non-glaucoma patients right and left intraocular pressure (RIOP, LIOP) were measured 5 minutes after induction of general anesthesia (control value), 15 and 30 minutes after CO2 insufflation and endelenburg-lithotomy position. RESULTS: The control values of RIOP and LIOP were 11.3 4.7 mmHg and 11.5 4.7 mmHg respectively. At 15 minutes after CO2 insufflation and Trendelenburg-lithotomy position, they increased to 16.6 5.3 mmHg and 17.0 5.9 mmHg (p<0.05). At 30 minutes, 18.4 3.5 mmHg and 18.2 4.1 mmHg (p<0.05). CONCLUSION: CO2 insufflation and Trendelenburg-lithotomy position increase IOP significantly in non-glaucoma patients during laparoscopy.