Clinical Characteristics of Intraoperative Cardiac Arrest During Cancer Surgery

Purpose@#Intraoperative cardiac arrest (IOCA) is rare, unpredictable, and may result in a poor outcome. The features of IOCA during cancer surgery and factors related to survival following an IOCA were examined. @*Methods@#This was a retrospective study of patients who had cancer surgery under general anesthesia between March 2009 and March 2021 (n = 84,615) to determine the number of patients who had an IOCA. Patients’ clinical information, cause of IOCA, hypoxemia during anesthesia, and the duration of hypotension and CPR were analyzed. @*Results@#A total of 22 cases of IOCA occurred during cancer surgery (overall incidence: 2.6 per 10,000 surgeries). Return of spontaneous circulation was achieved in 17 patients, but only 13 survived until discharge. There were statistically significant differences between the deceased and the survival cancer patient groups in; (1) duration of hypoxemia (survival group: 5 minutes, range: 2-18 minutes; deceased group: 60 minutes, range, 22.5-120 minutes; p = 0.019); (2) duration of hypotension (survival group: 35 minutes, range, 15-55 minutes; deceased group 160 minutes, range, 140-185 minutes; p = 0.007); and (3) total duration of CPR (survival group: 3 minutes, range: 1-15 minutes; deceased group: 40 minutes, range: 19-149 minutes; p = 0.005). @*Conclusion@#The duration of hypoxemia and hypotension prior to the onset of IOCA, as well as the duration of CPR were associated with the prognosis of IOCA, highlighting the need to reduce multiorgan damage caused by hypoxemia and hypotension during surgery in high-risk patients.

The Effect of Care-Robots on Improving Anxiety/Depression and Drug Compliance among the Elderly in the Community / 생물치료정신의학

Objectives@#：Community managements for elderly are changing due to increased social and economic burdens.The purpose of this study was to find out if there is an effect on depression, anxiety, quality of life, and life management by using a care robot, which is a future technology. @*Methods@#：For 100 elderly patients who visited the hospital with cognitive impairment or type 2 diabetes, we install a care robot between August 20 and November 14, 2019. The self-report questionnaire was used to measure changes in depression, sleep quality, quality of life, and life management among patients. In this study, 77 patients completed the survey were compared before and after the use of a care robot. @*Results@#：It was confirmed that the elderly patients using the care robot improved in terms of depression, sleep quality, anxiety, and life management. When the mean values of the scores before and after the care robot intervention were compared, there was a significant decrease (p≤0.001) in depression scale. In the sleep quality category, there was a significant positive effect (p≤0.001). In quality of life category, anxiety/depression showed a significant decrease (p≤0.001). In the life management category, there was a significant improvement (p=0.004) in the cognitive impairment group, and especially in the drug compliance, patients with the cognitive impairment group had a positive effect (p=0.01). @*Conclusion@#：For elderly patients, the use of care robots as a non- pharmacological intervention can help improve depression, anxiety and sleep quality. In particular, in the cognitive impairment group, it is effective in improving life management.

Evaluation of the Clinical Usefulness of Critical Patient Severity Classification System and Glasgow Coma Scale for Neurological Patients in Intensive Care Units

PURPOSE: The purpose of this study was to evaluate the clinical usefulness of the Critical Patient Severity Classification System (CPSCS) and Glasgow Coma Scale (GCS) for critically ill neurological patients and to determine the applicability of CPSCS and GCS in predicting their mortality. METHODS: Data were collected from the medical records of 187 neurological patients who were admitted to the intensive care unit of C university hospital. The datawere analyzed through chi-square test, t test,Mann-Whitney, Kruskal-Wallis, goodness-of-fit test, and receiver operating characteristic curve. RESULTS: In accordance with patients' general and clinical characteristics, patient mortality turned out to be significantly different depending on intensive care unit stay, endotracheal intubation, central venous catheter, and severity by CPSCS. Hosmer-Lemeshow goodness-of-fit tests were applied to CPSCS and GCS. The results of the discrimination test using the receiver operating characteristic curve were CPSCS0, .743, GCS0 .583, CPSCS24, .734, GCS24 .612, CPSCS48, .591, GCS48 .646, CPSCS72, .622, and GCS72 .623. Logistic regression analysis showed that each point on the CPSCS score signifies a 1.034 higher likelihood of dying. CONCLUSION: Applied to neurologically ill patients, early CPSCS scores can be regarded as a useful tool.

Relationships between Compassion Fatigue, Burnout, and Turnover Intention in Korean Hospital Nurses

PURPOSE: This study aimed to identify relationships between compassion fatigue, burnout, and turnover intention in Korean hospital nurses. METHODS: In total, 142 hospital nurses were surveyed as part of data collection. Data related to compassion fatigue, burnout, and turnover intention were collected using a questionnaire between May 2011 and September 2011. The data analysis was performed using PASW 19.0 program, which included one-way ANOVA, independent t-tests, Pearson's correlation coefficient, and hierarchical regression analysis. RESULTS: This study detected a positive correlation between compassion fatigue and burnout(r=.37, p<.001), and turnover intention(r=.55, p<.001). Compassion fatigue accounted for 29.6% of the variance for turnover intention among Korean hospital nurses. CONCLUSION: The results indicate that it is necessary to reduce compassion fatigue, and turnover intention among Korean hospital nurses.

Evaluation on the Accuracy of Vaccination Card for National Immunization Program in a 2005 Population-Based Survey in Nonsan, Korea / 農村醫學 地域保健

No abstract available.

Idiopathic Hypertrophic Spinal Pachymeningitis : Report of Two Cases and Review of the Literature

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare inflammatory disease characterized by hypertrophic inflammation of the dura mater and various clinical courses that are from myelopathy. Although many associated diseases have been suggested, the etiology of IHSP is not well understood. The ideal treatment is controversial. In the first case, a 55-year-old woman presented back pain, progressive paraparesis, both leg numbness, and voiding difficulty. Initial magnetic resonance imaging (MRI) demonstrated an anterior epidural mass lesion involving from C6 to mid-thoracic spine area with low signal intensity on T1 and T2 weighted images. We performed decompressive laminectomy and lesional biopsy. After operation, she was subsequently treated with steroid and could walk unaided. In the second case, a 45-year-old woman presented with fever and quadriplegia after a spine fusion operation due to lumbar spinal stenosis and degenerative herniated lumbar disc. Initial MRI showed anterior and posterior epidural mass lesion from foramen magnum to C4 level. She underwent decompressive laminectomy and durotomy followed by steroid therapy. However, her conditions deteriorated gradually and medical complications occurred. In our cases, etiology was not found despite through investigations. Initial MRI showed dural thickening with mixed signal intensity on T1- and T2-weighted images. Pathologic examination revealed chronic nonspecific inflammation in both patients. Although one patient developed several complications, the other showed slow improvement of neurological symptoms with decompressive surgery and steroid therapy. In case of chronic compressive myelopathy due to the dural hypertrophic change, decompressive surgery such as laminectomy or laminoplasty may be helpful as well as postoperative steroid therapy.

IS6110-Restriction Fragment Length Polymorphism and Spoligotyping Analysis of Mycobacterium tuberculosis Clinical Isolates for Investigating Epidemiologic Distribution in Korea

The Beijing family of Mycobacterium tuberculosis has been emerging in the world. However, there are few nationwide data of genotypic distribution in Korea. This study aimed to identify the genotypic diversity of clinical isolates of M. tuberculosis and to demonstrate the population of Beijing family in Korea. We collected 96 clinical M. tuberculosis isolates from 11 university hospitals nationwide in Korea from 2008 to 2009. We observed 24 clusters in IS6110-RFLP analysis and 19 patterns in spoligotyping. Seventy-five isolates were confirmed to be Beijing family. Two isolates of the K strain and 12 isolates of the K family strain were also found. We found that drug resistance phenotypes were more strongly associated with Beijing family than non-Beijing family (P=0.003). This study gives an overview of the distribution of genotypes of M. tuberculosis in Korea. These findings indicate that we have to pay more attention to control of M. tuberculosis strains associated with the Beijing family.

Development and Application of E-Learning Human Anatomy Content for Undergraduate Students in Health Allied Science / 체질인류학회지

This study aimed to develop and implement a progressive e-learning teaching method in the teaching of human anatomy. For analysis of the effect of new teaching methods, we made a survey of user satisfaction, content difficulty, and course management. The e-learning content was developed by the authors and implemented to class, practice, and tests, for 16 weeks. The survey was conducted on sophomores of nursing science (NS, n=42) and sports science (SS, n=26), at Kangwon National University. These two groups of students filled out a questionnaire related to effectiveness of e-learning content and tool in learning human anatomy. The results were compared between two groups. The majority of the students were satisfied with the content, difficulty level, and management of the e-learning course. Through the board of virtual classroom, all of the students played positive manners in communication and activity. Students pointed out 'reinforcement of multimedia data', 'improvement of technical service' and 'addition of broad information' as the most notable improvements of content. Therefore, we conclude that an e-learning course for undergraduate nursing science and sports science students can provide an effective learning model.

Law and Ethics in Emergency Medicine

Ethical problems in an emergency department (ED) are much more common than is usually recognized. But these difficult ethical dilemmas have not been dealt with by general medical ethicists. Most medical ethics guidelines tend to concentrate on chronic or at least relatively stable situations rather than on the acute, episodic cases that are typical in the ED. most ethical problems such as abortion, euthanasia, and professionalism can be solved after reflection and deliberation, and after a process of communication that reveals the values and interests of the patient or the patient's family. In contrast, when health care professionals in the ED recognize ethical problems, they often don't have enough time for an ethical consultation such as a Hospital Ethics Committee. Ethical principles such as autonomy, beneficence, nonmaleficence, and justice need to be applied to the unique setting of emergency medicine. Hence, it is necessary to develop ethics guidelines in emergency medicine and ethics education for health care professionals in emergency departments. At first, we collected cases involving ethical problems and reviewed the ethical and legal aspects of those cases. In this article, we summarize the ethical issues in emergency medicine, deal with actions in emergency medical services, and also consider the relationships between ethical issues and act on emergency medical services. We want to present the important factors that should be considered in ethical decision making within an emergency medicine department including patient decision making capacity, legal custody, and ethical principles.

Education of Bioterrorism Preparedness and Response in Healthcare-associated Colleges - Current Status and Learning Objectives Development / 예방의학회지

OBJECTIVES: Bioterrorism (BT) preparedness and response plans are particularly important among healthcare workers who will be among the first involved in the outbreak situations. This study was conducted to evaluate the current status of education for BT preparedness and response in healthcare-related colleges/junior colleges and to develop learning objectives for use in their regular curricula. METHODS: We surveyed all medical colleges/schools, colleges/junior colleges that train nurses, emergency medical technicians or clinical pathologists, and 10% (randomly selected) of them that train general hygienists in Korea. The survey was conducted via mail from March to July of 2007. We surveyed 35 experts to determine if there was a consensus of learning objectives among healthcare workers. RESULTS: Only 31.3% of medical colleges/schools and 13.3% of nursing colleges/junior colleges had education programs that included BT preparedness and responses in their curricula. The most common reason given for the lack of BT educational programs was 'There is not much need for education regarding BT preparedness and response in Korea'. None of the colleges/junior colleges that train clinical pathologists, or general hygienists had an education program for BT response. After evaluating the expert opinions, we developed individual learning objectives designed specifically for educational institutions. CONCLUSIONS: There were only a few colleges/junior colleges that enforce the requirement to provide education for BT preparedness and response in curricula. It is necessary to raise the perception of BT preparedness and response to induce the schools to provide such programs.

A case of Addison's disease due to tuberculosis: pathologic confirmation by laparoscopic biopsy / 대한내과학회지

Addison's disease is a rare disorder that is characterized by primary adrenal hypofunction and the underlying causes are various according to geographic regions. In order to establish an appropriate therapeutic regimen to treat adrenal insufficiency associated with Addison's disease, knowledge of the underlying adrenal abnormality is essential. We report a case of a 37-year-old man who showed biochemical evidence of adrenocortical insufficiency without signs of tuberculosis. Computed tomography showed bilateral adrenal enlargement and definitive diagnosis of adrenal tuberculosis was established by laparoscopic biopsy.

Utility of CT colonography in detecting colon polyps as a colon cancer screen / 대한내과학회지

BACKGROUND/AIMS: CT colonography is a rapid and safe imaging method for detecting polyps in the colon and rectum. We assessed the efficacy of CT colonography in colorectal polyp detection. METHODS: We prospectively studied 84 subjects (mean age 55.7+/-11.1 years; 52 men, 32 women) undergoing CT colonography followed by colonoscopy. Based on the results of CT colonography, all polyps were classified by size (any size, and those larger than 5, 7, and 10 mm) and were checked for location, morphology, and histological characteristics. We determined the sensitivity and specificity of CT colonography using colonoscopy as a reference standard with a segmental unblinding method. RESULTS: A total of 56 lesions were identified in 26 of 79 subjects undergoing both CT colonography and conventional colonoscopy. The sensitivities of CT colonography for polyps of any size, and larger than 5, 7, and 10 mm were 60.7%, 70.5%, 75.9%, and 81.8%, respectively. The per-subject sensitivities of CT colonography for the polyps of any size, and larger than 5, 7, and 10 mm, were 80.7%, 95.0%, 93.3%, and 90.9%, respectively. The per-subject specificities of CT colonography for polyps were 86.8%, 89.8%, 95.3%, and 100.0%, respectively. The sensitivities of CT colonography for flat, sessile, and pedunculated polyps were 30.8%, 85.0%, and 90.0%, respectively. CONCLUSIONS: CT colonography is a useful diagnostic method for screening colorectal neoplasias larger than 7 mm diameter, showing 75.9% sensitivity and 71.0% positive predictive value.

Application of Integrative Lecturing to Basic Medicine Courses for Undergraduate Health Allied Sciences Students / 한국의학교육

PURPOSE: In spite of the rapidly expanding importance of the basic sciences, the number of professors teaching basic sciences in medicine has not changed in the last decade. Thus, the need for new methods of teaching and learning has increased. The purpose of this study was to develop and assess integrative lecturing in the basic sciences for undergraduate allied health sciences students. METHODS: We developed an alternate form of lecturing in anatomy, physiology, microbiology, and pathology, focusing on the gastrointestinal system. We tested several teaching strategies including E-learning, face-to-face, and practice. Students majoring in nursing (n=43), sports science (n=26), and emergency medical technology (n=35) participated and were asked to complete an anonymous survey. RESULTS: The majority of the students were satisfied with the new lecture style (86.6%). They preferred integrative lectures to traditional lectures. The degree of satisfaction with E-learning and practice were much higher than with face-to-face. Most of the students identified the knowledge of interdisciplinary relationship and participating in cadaveric dissections as the important effects of this lecture style. CONCLUSION: From this study, it can be suggested that integrative lecturing in basic sciences for public health- / medicine- related courses is effective in teaching and learning. Further studies for the development of integrative contents and system are needed.

Effects of Protein Kinase C on Hypoxic Pulmonary Vasoconstriction in Isolated Rat Lungs / 대한마취과학회지

BACKGROUND: Protein kinase C represents an important component of a signal transduction pathway that regulates vascular smooth muscle contraction. This study was performed with an inhibitor and activators of protein kinase C to determine their effects on hypoxic pulmonary vasoconstriction (HPV) in isolated rat lung model. METHODS: Isolated lungs from Sprague-Dawley rats were ventilated with a normoxic gas (21%O2-5%CO2-balanced N2) and a hypoxic gas (3%O2-5%CO2-balanced N2) alternatively, and then perfused with constant pulmonary blood flow. Baseline hypoxic pressor responses (delta PAP) were measured as the difference of pulmonary artery pressure between normoxic ventilation and hypoxic ventilation. After baseline delta PAP had obtained, rats were randomly divided into a chelerythrine group, an phorbol 12, 13-dibutyrate (PDBu) group, and a farnesylthiotriazole (FTT) group. The different concentrations of each drug were added into the perfusate sequentially. delta PAP in the different concentrations of each drug were calculated as a percentage of the delta PAP in each concentration of drug to the baseline delta PAP in the absence of drug (%delta PAP). RESULTS: The %delta PAP of chelerythrine were 83.7 +/- 19.2%, 71.5 +/- 24.1% and 68.4 +/- 28.3% at 0.1, 1, and 10micrometer, respectively (P < 0.05). The %delta PAP of PDBu were 111.3 +/- 10.1%, 144.4 +/- 37.8% and 168.4 +/- 89.1% at 20, 100, and 300 nM, respectively (P < 0.05). The %delta PAP of FTT were 80.1 +/- 25.1%, 61.0 +/- 17.2% and 30.1 +/- 18.4% at 1, 10, and 30micrometer, respectively (P < 0.05). CONCLUSIONS: The results of this study suggest that regulator of protein kinase C influence HPV.

Outbreak of Measles among School Ages in Yeongju in 2000 / 한국역학회지

BACKGROUND: The outbreak of measles from 2000 to 2001 was the biggest epidemic since measles vaccination was introduced in Korea. Outbreak of measles in Yeongju was one of the earliest milestones of the nationwide outbreak in the year 2000. The authors investigated epidemiologic characteristics of the outbreak in this area. METHODS: The authors estimated attack rate through the investigation of all the school age cases of measles reported to local health authority between March and May, 2000. Case investigation was done to trace the source of the outbreak. One hundred seventy two cases were examined with medical examination, with interview on their clinical manifestations, and with serologic examination on the anti-measles IgM and IgG antibody. RESULTS: Overall attack rate among the school children was 4.3%, with highest attack rate in middle school students (8.5%). The outbreak began in March in middle schools, which spread to elementary and high schools. IgG was positive in 160(93.0%) cases and IgM was positive in 94(54.6%) cases, among which 90 cases (95.7%) were also positive for IgG. IgM positive cases had higher prevalence of rash (91.5%) compared to those without IgM (70.5%). Diagnostic criteria based on the clinical manifestation and contact history showed the highest sensitivity (92.6%) compared to conventional diagnostic criteria in outbreak (40.4-44.7%) CONCLUSIONS: High proportion of susceptible children in the population due to primary or secondary vaccine failure played a key role in this outbreak. Clinical manifestation was milder than classical measles and adjustment of diagnostic criteria can be helpful in the management of outbreak.

Seroepidemiologic Study of Measles Outbreak in a Primary School, Youngduk

BACKGROUND: Nation-wide measles outbreaks occurred from 2000 to 2001 in Korea. Since, mass vaccination campaign for measles eradication among children and adolescents was implemented in May-August of 2001. Even in a highly vaccinated community, measles cases occur among vaccinees and there might be different serological responses among unvaccinees. In addition, the primary and secondary vaccine failures are not rare in the mass-vaccination era. Therefore, this study was undertaken to evaluate the effectiveness of serologic method for diagnosis of measles among the vaccinees and to estimate the vaccine failure rate among students with relatively high vaccination rate during the measles outbreak in a primary school. METHODS: In March 2000, the measles outbreak occurred in a primary school in Youngduk county, Kyung-sang-buk Do. Questionnaires about clinical manifestations of measles and history of measles vaccination were given out to in 209 3rd and 5th grade students among whom many measles cases occurred. The paired sera, which were taken from all students during March and May 2000, were tested for IgM and IgG measles antibody by using Enzygnost Anti-Measles IgG and IgM (Dade Behring, Germany). RESULTS: The questionnaires and serum samples were obtained from 145(69.4%) out of 209 cases. The immunization rate of measles vaccine was 80.7% (117/145). During the measles outbreak, 25 (17.2%) out of 145 cases with previous history of measles vaccination were diagnosed as measles, based on clinical definition. Among 17 cases (17/25, 68.0%) with paired samples out of 25 measles cases, 4 cases (4/17, 23.5%) were diagnosed by seroconversion of IgG, but negative IgM antibody, and they all had received measles vaccination previously. Among 117 cases with previous history of measles vaccination, 47 (40.2%) cases without measles symptoms showed four-fold increment of IgG titer. The primary and secondary failure rates of measles vaccine were 6.0% (7/117) and 1.7% (2/117), respectively. CONCLUSION: Among symptomatic measles cases with previous history of measles vaccination, 23.5% were diagnosed only by seroconversion of IgG measles antibody. In a highly vaccinated country, the accuracy of measles serodiagnosis can be increased with the IgG test of convalescent serum sample in addition to IgM antibody test. Among vaccinees, secondary immune response was 40.2%, suggesting that non-specific measles symptoms might occur among them. Therefore, further studies on the clinical definition of measles cases, vaccine failure rate and protective antibody titers should be continued in order to effectively conduct measles eradication campaign.

Seroepidemiologic Study of Measles Outbreak in a Primary School, Youngduk

BACKGROUND: Nation-wide measles outbreaks occurred from 2000 to 2001 in Korea. Since, mass vaccination campaign for measles eradication among children and adolescents was implemented in May-August of 2001. Even in a highly vaccinated community, measles cases occur among vaccinees and there might be different serological responses among unvaccinees. In addition, the primary and secondary vaccine failures are not rare in the mass-vaccination era. Therefore, this study was undertaken to evaluate the effectiveness of serologic method for diagnosis of measles among the vaccinees and to estimate the vaccine failure rate among students with relatively high vaccination rate during the measles outbreak in a primary school. METHODS: In March 2000, the measles outbreak occurred in a primary school in Youngduk county, Kyung-sang-buk Do. Questionnaires about clinical manifestations of measles and history of measles vaccination were given out to in 209 3rd and 5th grade students among whom many measles cases occurred. The paired sera, which were taken from all students during March and May 2000, were tested for IgM and IgG measles antibody by using Enzygnost Anti-Measles IgG and IgM (Dade Behring, Germany). RESULTS: The questionnaires and serum samples were obtained from 145(69.4%) out of 209 cases. The immunization rate of measles vaccine was 80.7% (117/145). During the measles outbreak, 25 (17.2%) out of 145 cases with previous history of measles vaccination were diagnosed as measles, based on clinical definition. Among 17 cases (17/25, 68.0%) with paired samples out of 25 measles cases, 4 cases (4/17, 23.5%) were diagnosed by seroconversion of IgG, but negative IgM antibody, and they all had received measles vaccination previously. Among 117 cases with previous history of measles vaccination, 47 (40.2%) cases without measles symptoms showed four-fold increment of IgG titer. The primary and secondary failure rates of measles vaccine were 6.0% (7/117) and 1.7% (2/117), respectively. CONCLUSION: Among symptomatic measles cases with previous history of measles vaccination, 23.5% were diagnosed only by seroconversion of IgG measles antibody. In a highly vaccinated country, the accuracy of measles serodiagnosis can be increased with the IgG test of convalescent serum sample in addition to IgM antibody test. Among vaccinees, secondary immune response was 40.2%, suggesting that non-specific measles symptoms might occur among them. Therefore, further studies on the clinical definition of measles cases, vaccine failure rate and protective antibody titers should be continued in order to effectively conduct measles eradication campaign.

Genetic Characterization of Haemagglutinin 1 Domain of Influenza B Viruses Isolated in Korea during 1988~1999

Although Korean influenza virus isolates have been genetically associated with the vaccine strains of the corresponding year, influenza B viruses have prevailed almost every year in Korea during the past decades. We have analyzed the genetic characteristics and evolutionary patterns of the haemagglutinin (HA) 1 domains of influenza B viruses isolated during 1988-1999 using direct RT-PCR and sequencing. Phylogenetic analysis of influenza B viruses isolated in Korea indicated that antigenically and genetically distinguishable strains of the lineage II and lineage III variants had been cocirculated. Variants prevailed in early 1990s are represented in 1996/97 and 1998/99 and some different variants have been cocirculated geographically and prevailed concurrently in Korea. All HA1s of Korean isolates have amino acid substitutions mainly in the region between position 124 and 310, which was previously proposed an immunodominant region. Insertion-deletion patterns of the HA gene revealed that Korean influenza B viruses were evolved from Lee40 with different manner between lineage II and III viruses. Lineage III viruses were also divided into two groups as conserved group and inserted group, in relation to Lee40. But lineage II viruses had evolved with directional pattern. Antigenic index proposed that influenza B isolates prevailed since 1996/97 seasons might had emerged from the antigenic variants of a Seo1697-like virus and that new variants might appear from the lineage II viruses resulting in persistent prevalence in Korea.

An Analysis of Overtransfusion in Total Hip Replacement Surgery / 대한마취과학회지

BACKGROUND: This study was designed to identify overtransfusion- triggering clinical factors in patients undergoing total hip replacement surgery. METHODS: The discharge hematocrit was chosen for evaluation. Estimated red cell loss for each patient during the admission was calculated by the differences between admission and discharge hematocrit, multiplied by patient whole blood volume. Total RBC lost was then determined by the sum of RBC volume lost plus the RBC volume transfused. RBC transfusion was considered appropriate if given to replace RBC volume lost in excess of 15% of the RBC volume in each patient at admission. Comparison of transfusion practice was done on the basis of sex, age, preoperative hematocrit, surgical procedure and anesthetic method. RESULTS: Forty-six (37.7%) of 122 patients were identified to have been transfused with red cell volumes in excess of red cell volumes lost. Significant differences for patients transfused in excess of needs were found by sex (52.4% of women vs. 22.0% of men, P = 0.001) and by preoperative hematocrit (71.4% of patients with lower hematocrit vs. 24.1% of patients with higher hematocrit, P = 0.001). CONCLUSIONS: Preoperative hematocrit and sex can be a overtransfusion-triggering index.

A Comparison of Femoral and Radial Artery Pressure during an Adult Liver Transplantation / 대한마취과학회지

BACKGROUND: The radial artery pressure is known to differ from central arterial pressure in normal patients (distal pulse amplification) and in the early postcardiopulmonary bypass period. We assumed that there may be a change in the normal relationship between central and peripheral arterial pressure in patients with hepatic failure due to an arterio-venous shunt caused by vasodilation and a complex surgical procedure with major vessel clamping. This study was done to examine the adequacy of the radial artery as a site for blood pressure monitoring in liver transplantation (TPL). METHODS: We investigated when the pressure gradient developed and what mechanism could be responsible by comparing femoral to radial artery pressure in 11 patients undergoing liver transplantation. Radial and femoral artery pressures, systemic vascular resistance, cardiac output and temperature were compared during surgery in all 11 patients. Additionally measurements included pH, PaO2, PaCO2, central venous pressure, pulmonary artery pressure and mixed venous oxygen saturation. RESULTS: The femoral artery systolic pressure was higher than the corresponding radial artery pressures during the operation. Although not statistically significant, the radial mean and diastolic artery pressures were lower than corresponding the femoral artery pressure. CONCLUSIONS: Radial artery systolic pressures underestimate the femoral artery pressure when undergoing a liver TPL. Failure to recognize these effects on pressure recordings can lead to inappropriate patient management decisions.