Factors Affecting of Long Term Care Hospital Patient's Intention of Transfer to a Nursing Home

PURPOSE: To examine factors affecting long-term care hospital patients' intention of transfer to a nursing home. METHOD: A questionnaire survey was conducted in Aug. 2007 that included 655 patients from 49 long-term care hospitals. The survey aimed to assess the patients' health status, family status, cost and intention of transfer to a nursing home. Institutional characteristics were analyzed from the nationwide database of Health Insurance Review & Assessment Service. The affecting factors were examined by employing chi-square test and logistic regression using SAS 8.2. RESULT: Of the subjects, 32.4% had intention of transfer to a nursing home. The intention of transfer to a nursing home was affected by moderate or severe pain, living together with the primary carer, high cost uncovered by insurance, and recognition of nursing home. CONCLUSION: For appropriate service utilization, a higher level of care is needed to satisfy patients at nursing homes and a balanced fee schedule is needed between long term care hospitals and nursing homes. It is desirable to encourage transfer to a nursing home at which nurses support patients and their families by giving information, coordination, and to make efforts to establish a reference system.

Epidural Anesthesia for Lumbar Spine Surgery / 대한마취과학회지

BACKGROUND: Many anesthesiolosists feel that epidural anesthesia is unsuitable for spinal sugery. However, several articles have been published in which epidural anesthesia is viewed as a good alternative to general anesthesia for spine surgery. The aim of this study was to evaluate effectiveness and complications of epidural anesthesia for spine surgery. METHODS: Eighty-two patients undergoing epidural anesthesia for spine surgery was studied prospectively. Epidural anesthesia was performed using 18-gauge Tuohy needles inserted at the L1-2 interspace. A test dose of lidocaine 3 ml was injected to check for a subarachnoid puncture. After a 2 - 3 minute waiting period, 0.5% bupivacaine 12 ml was slowly injected for 3 minutes. The pain at the operation site and roots, extension of anesthesia, motor blockade and complications were evaluated. RESULTS: Pain at the operation site was minimal in 83% of the patients; however, 44% of the patients complained of moderate to severe root pain. No patient had a new neurologic deficit as a result of the epidural technique. Perioperative complications were minimal and could be easily treated. CONCLUSIONS: We concluded that proper administration of epidural anesthesia for spine surgery is a safe and reliable procedure and a good alternative to general anesthesia.

Comparison of 0.075% Bupivacaine/Fentanyl and 0.125% Ropivacaine/Fentanyl Infusion for Postoperative Epidural Analgesia / 대한마취과학회지

BACKGROUND: The new, long-acting local anesthetic ropivacaine is structurally very similar to bupivacaine, but the motor block is less profound and of shorter duration. The aim of this study was to compare analgesic effectiveness and side effects during postoperative pain control after a Caesarean section with either a bupivacaine/fentanyl or ropivacaine/fentanyl mixture. METHODS: Thirty-nine patients undergoing a Caesarean section were randomized in a double-blinded manner to receive bupivacaine or ropivacaine. Postoperative epidural analgesia was provided using a PCA pump with either bupivacaine/fentanyl 0.075%/3.4 microgram/ml after 10 ml of 0.125% bupivacaine with morphine (n = 18) or ropivacaine/fentanyl 0.125%/3.4 microgram/ml after 10 ml of 0.2% ropivacaine with morphine (n = 21). Verbal rating pain scores (rest and cough), side effects (nausea, vomiting, pruritus, sedation, motor block and hypotention) and time to ambulation were measured for 48 hr after surgery. RESULTS: There were no significant differences between the groups in verbal pain scores, sensory level, motor blockade and other side effects, but time to ambulation was earlier in the ropivacaine group. CONCLUSIONS: 0.125% ropivacaine with 3.4 microgram/ml fentanyl provided similar successful pain relief as 0.075% bupivacaine/fentanyl. However, earlier recovery of ambulation in patients receiving ropivacaine/ fentanyl will improve outcome after surgery.

Extension of Sensory Blockade after Thoracic and Lumbar Epidural Administration of a Test dose of Lidocaine / 대한마취과학회지

BACKGROUND: The distribution of solutions injected into the epidural space has not been well determined. The aim of this study was to compare the difference in extension of sensory blockade between the thoracic and lumbar regions in epidural analgesia. METHODS: Forty-five female patients scheduled for postoperative pain control were enrolled. In group 1 (n = 22), the Tuohy needle was inserted at T6 10 levels and in group 2 (n = 23), it was inserted at T12 L2 levels. The catheter was introduced 3 4 cm into the epidural space and 3 ml of 1.5% lidocaine with epinephrine (1:200,000) was injected. The extension of sensory anesthesia to loss of cold sensation and pinprick test was measured every 5 minute for 15 minutes. RESULTS: Fifteen minutes after epidural injection, the mean sensory block extension in group 1 (7.8 +/- 2.0 dermatomes) was significantly wider than in group 2 (4.7 +/- 2.2 dermatomes) but cranial and caudad spread of sensory blockade in relation to the puncture level was the same in both groups. CONCLUSION: The mean dose of local anesthetic required for analgesia was smaller in the thoracic region than in the lumbar region.

Freeman-Sheldon Syndrome: Difficult Intubation A case report / 대한마취과학회지

The Freeman-Sheldon syndrome (FSS) is a rare congenital myopathy. Main manifestations are "whistling face", camptodactyly with ulnar deviation of the finger and talipes equinovarus. Myopathic fibrotic circumoral musculature result in microstomia with the characteristic protruding pursed "whistling lip" and mandibular and laryngeal development may also be abnormal. Thus the patients with FSS are expected to difficult intubation and the use of muscle relaxant should not be expected to improve intubating condition. We report a children with the Freeman-Sheldon syndrome who was intubated with fiberoptic laryngoscope and discuss anesthetic consideration.