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1.
Yonsei Medical Journal ; : 1098-1106, 2021.
Article in English | WPRIM | ID: wpr-919592

ABSTRACT

Purpose@#Intensive care unit (ICU) bed availability is key to critical patient care. In many countries, older patients generally account for a significant proportion of hospitalizations and ICU admissions. Therefore, considering the rapidly increasing aging population in South Korea, it is important to establish whether the demand for critical care is currently met by available ICU beds. @*Materials and Methods@#We evaluated a 9-year trend in ICU bed supply and ICU length of stay in South Korea between 2011 and 2019 in a population-based cross-sectional analysis, using data from the Korean Health Insurance Review & Assessment Service and Statistics database. We described the changes in ICU bed rates in adult (≥20 years) and older adult (≥65 years) populations. ICU length of stay was categorized similarly and was used to predict future ICU bed demands. @*Results@#The ICU bed rate per 100000 adults increased from 18.5 in 2011 to 19.5 in 2019. In contrast, the ICU bed rate per 100000 older adults decreased from 127.6 in 2011 to 104.0 in 2019. ICU length of stay increased by 43.8% for adults and 55.6% for older adults. In 2019, the regional differences in the ICU bed rate nearly doubled, and the ICU length of stay increased six-fold. The ICU bed occupancy rate in South Korea is expected to rise to 102.7% in 2030. @*Conclusion@#The discrepancy between the demand and supply of ICU beds in South Korea requires urgent action to anticipate future ICU demands.

4.
Article in Korean | WPRIM | ID: wpr-52840

ABSTRACT

OBJECTIVES: The purpose of this study was to make empirical evidence for a community based case management program for the first episode of psychosis. METHODS: We provided a case management program for first episode psychosis patients and assessed their symptoms, function, insight, and satisfaction using Positive and Negative Syndrome Scale (PANSS), the Health of Nation Outcomes Scales (HoNOS), Scale to assess Unawareness of Mental Disorder (SUMD), Global Assessment of Functioning Scales (GAF), and Quality of Life scales (QOL) at baseline and after the program. We also evaluated the treatment maintenance rate and the changes of their developmental task achievement. RESULTS: Significant improvement was observed in all sub-domains of PANSS and significant changes were also observed in the areas of symptoms and function of HoNOS. Significant improvement was observed in awareness of mental illness itself and its outcomes. The treatment maintenance rate was 87.5%, including three patients who stopped their medication with the doctor's order. The rate of participation in meaningful social activities, such as school or job showed an increase, from 25% at baseline to 81% after the program. CONCLUSION: Results of this study demonstrate the possibility of community programs for prevention of relapse, improvement of symptoms and function, and facilitation of return to meaningful social activities of first episode psychosis patients.


Subject(s)
Case Management , Humans , Mental Disorders , Psychotic Disorders , Quality of Life , Recurrence , Weights and Measures
5.
Article in Korean | WPRIM | ID: wpr-135277

ABSTRACT

Lymphangioleiomyomatosis (LAM) is a rare, progressive cystic lung disease, characterized by a proliferation of immature smooth muscle cell (LAM cell) in the airway, parenchyma, lymph nodes and pulmonary vessels. It mainly affects women in their reproductive years. It is clinically manifested by recurrent pneumothorax, progressive dyspnea on exertion and chylothorax; it can also ultimately lead to respiratory failure. However, no curative treatment for LAM is currently available. We report an anesthetic management for cesarean delivery in a parturient newly diagnosed with LAM.


Subject(s)
Anesthesia , Chylothorax , Dyspnea , Female , Humans , Lipopolysaccharides , Lung Diseases , Lymph Nodes , Lymphangioleiomyomatosis , Myocytes, Smooth Muscle , Pneumothorax , Respiratory Insufficiency
6.
Article in Korean | WPRIM | ID: wpr-135276

ABSTRACT

Lymphangioleiomyomatosis (LAM) is a rare, progressive cystic lung disease, characterized by a proliferation of immature smooth muscle cell (LAM cell) in the airway, parenchyma, lymph nodes and pulmonary vessels. It mainly affects women in their reproductive years. It is clinically manifested by recurrent pneumothorax, progressive dyspnea on exertion and chylothorax; it can also ultimately lead to respiratory failure. However, no curative treatment for LAM is currently available. We report an anesthetic management for cesarean delivery in a parturient newly diagnosed with LAM.


Subject(s)
Anesthesia , Chylothorax , Dyspnea , Female , Humans , Lipopolysaccharides , Lung Diseases , Lymph Nodes , Lymphangioleiomyomatosis , Myocytes, Smooth Muscle , Pneumothorax , Respiratory Insufficiency
7.
Article in English | WPRIM | ID: wpr-123656

ABSTRACT

BACKGROUND: The administration of short-acting opioids before emergence is useful for preventing emergence cough induced by an endotracheal tube. This study examined the clinically effective dose of alfentanil for suppressing cough during emergence from desflurane anesthesia. METHODS: Twenty-nine adult patients undergoing elective oral surgery were enrolled in this study. During emergence from anesthesia, the patients received alfentanil diluted in 10 ml normal saline when the end-tidal vol% of desflurane decreased to 3%. The initial alfentanil dose was 16 microg/kg. The alfentanil dose for consecutive patients, determined by Dixon's up-and-down method, increased or decreased by 2 microg/kg according to a previous patient's result. RESULTS: The 50% effective dose (ED50) of alfentanil for suppressing cough during emergence from desflurane anaesthesia was 9.3 +/- 1.5 microg/kg according to Dixon's up-and-down method. Isotonic regression revealed an ED50 and ED95 (95% confidence interval) of alfentanil 10.0 microg/kg (6.8-13.2 microg/kg) and 14.0 microg/kg (7.7-19.4 microg/kg), respectively. CONCLUSIONS: The ED95 of alfentanil for suppressing emergence cough was 14.0 microg/kg. A single bolus administration of alfentanil during emergence from anesthesia was useful for suppressing emergence cough.


Subject(s)
Adult , Alfentanil , Analgesics, Opioid , Anesthesia , Cough , Humans , Isoflurane , Surgery, Oral
8.
Article in Korean | WPRIM | ID: wpr-113127

ABSTRACT

Eisenmenger syndrome is defined as pulmonary hypertension at or close to systemic values, with an intracardiac or aortopulmonary communication resulting a bidirectional or right-to-left shunt.Patients with Eisenmenger syndrome require a close monitoring while undergoing non-cardiac surgery because these patients are very vulnerable to alteration in hemodynamics induced by anesthetics or surgery.Therefore we report the successful management of a patient with Eisenmenger syndrome undergoing a dacryocystorhinostomy under desflurane and ketamine based general anesthesia.


Subject(s)
Anesthesia, General , Anesthetics , Dacryocystorhinostomy , Eisenmenger Complex , Hemodynamics , Humans , Hypertension, Pulmonary , Isoflurane , Ketamine
9.
Article in English | WPRIM | ID: wpr-165952

ABSTRACT

BACKGROUND: The aim of this study was to determine the clinical effective dose of rocuronium for tracheal intubation using a lightwand after induction with propofol, alfentanil, and a low concentration of sevoflurane. METHODS: Twenty-eight adults scheduled to undergo elective surgery lasting less than one hour were enrolled in this study. All patients received alfentanil (10 microgram/kg) and propofol (1.5 mg/kg) for the induction of anesthesia. Tracheal intubation using a lightwand was attempted 3 minutes after administering rocuronium and mask ventilation with 2 vol% of sevoflurane. The initial rocuronium dose was 0.5 mg/kg. The rocuronium dose for consecutive patients, determined by Dixon's up-and-down method, was increased or decreased by 0.05 mg/kg according to the result of the previous patient. The mean arterial pressure and heart rate were recorded before induction, 1 min before intubation, 1 and 2 min after intubation. RESULTS: The 50% clinical effective dose (cED(50)) of rocuronium for tracheal intubation using a lightwand was 0.20 +/- 0.05 mg/kg according to Dixon's up and down method. Isotonic regression revealed the cED(50) and cED(95) (95% confidence intervals) to be 0.20 mg/kg (0.10-0.3 mg/kg) and 0.35 mg/kg (0.16-0.49 mg/kg), respectively. CONCLUSIONS: The cED(50) and cED(95) of rocuronium for tracheal intubation using the lightwand were 0.20 mg/kg and 0.35 mg/kg, respectively, after induction with alfentanil, propofol, and a low concentration of sevoflurane.


Subject(s)
Adult , Alfentanil , Androstanols , Anesthesia , Arterial Pressure , Heart Rate , Humans , Intubation , Masks , Methyl Ethers , Propofol , Ventilation
10.
Article in Korean | WPRIM | ID: wpr-26545

ABSTRACT

BACKGROUND: Cardiopulmonary bypass produces a state of functional hypothyroidism characterized by low levels of circulating tri-iodothyronine (T3). Theoretically, supplementing T3 should result in improved hemodynamics as well as patients' outcome. The aim of the present study was to determine whether pretreatment with single oral T3 could prevent serum T3 reduction, and improve hemodynamics and clinical outcome. METHODS: Forty-seven patients undergoing valvular heart surgery were included in the study. Patients were randomly assigned into two groups (T = T group; C = control group) the day before surgery and received single oral T3 40 microg or placebo before operation. Blood samples were collected for determination of serum levels of total T3, T4 and TSH before administration of oral T3 or placebo (baseline), 1, 6 and 18 hour after weaning of cardiopulmonary bypass. Hemodynamic parameters and medication were recorded during the intraoperative period and throughout the first 24 h after arrival at the intensive care unit. RESULTS: T3 levels were significantly higher in the T group 1 hr after weaning of cardiopulmonary bypass. T3 levels in the T group were all maintained within the normal range throughout the study period, whereas it was decreased to below normal level in the C group at 18 hr after weaning of cardiopulmonary bypass. In the T group, vasoactive agent requirements were reduced during and after cardiopulmonary bypass. CONCLUSIONS: Pretreatment with single oral T3 prevented the reduction in T3 level after valvular heart surgery, with subsequent reduction in vasoactive agent requirement.


Subject(s)
Cardiopulmonary Bypass , Hemodynamics , Humans , Hypothyroidism , Intensive Care Units , Intraoperative Period , Reference Values , Thoracic Surgery , Weaning
11.
Article in Korean | WPRIM | ID: wpr-648947

ABSTRACT

We report on a 45-year-old patient who sustained an intra-operative pulmonary thromboembolism during elective mastoidectomy under general anesthesia. At the end of surgery, the patient developed hemodynamic compromise and exhibited T wave inversion on electrocardiogram. Echocardiography showed an echogenic mass in the right pulmonary artery and pulmonary hypertension. Pulmonary thromboembolism is rare in the field of otolaryngology and head and neck surgery; however, it may develop, resulting in a fatal outcome. It is thus important to establish the diagnosis early and prevent such serious complications.


Subject(s)
Anesthesia, General , Echocardiography , Electrocardiography , Fatal Outcome , Head , Hemodynamics , Humans , Hypertension, Pulmonary , Middle Aged , Neck , Otolaryngology , Pulmonary Artery , Pulmonary Embolism
12.
Article in English | WPRIM | ID: wpr-98892

ABSTRACT

BACKGROUND: In the case of bilateral total knee replacement arthroplasty (TKA), surgery is performed either simultaneously or in a staged manner. We tried to investigate the differences of blood loss and transfusion practice between the use of simultaneous and staged operations. METHODS: We analyzed retrospectively the medical records of 20 patients undergoing simultaneous TKA (simultaneous group), who received autologous blood via a reinfusion system, and 20 patients undergoing staged TKA (staged group), of which the interval is about three weeks. We compared the amount of blood loss, and the number of transfusions and transfusion-related complications between the two groups of patients. RESULTS: Postoperative total blood loss was 2,174 +/- 460 ml in the simultaneous group and 1,850 +/- 461 ml in the staged group. There was no significant difference for transfusion (simultaneous group 3.5 +/- 1.1 units, staged group 3.9 +/- 1.4 units; P > 0.05). In the simultaneous group, the volume of autologous transfusion was 985 +/- 326 ml, corresponding to 2.5 +/- 0.8 units. The total number of transfused RBC units including autologous blood was 6.1 +/- 1.5 units in the simultaneous group and 3.9 +/- 1.4 units in the staged group. In the staged group, the amount of postoperative drained blood was significantly less in the second knee operation than that in the first knee operation (first knee surgery, 992 +/- 265 ml; second knee surgery, 868 +/- 260 ml: P < 0.05). CONCLUSIONS: Postoperative blood loss and total transfusion were less in the staged TKA group of patients as compared with the simultaneous TKA group of patients. Postoperative blood salvage and reinfusion appear to be safe and effective for patients undergoing simultaneous TKA.


Subject(s)
Arthroplasty , Arthroplasty, Replacement, Knee , Blood Transfusion , Costs and Cost Analysis , Humans , Knee , Medical Records , Operative Blood Salvage , Postoperative Hemorrhage , Retrospective Studies
13.
Article in Korean | WPRIM | ID: wpr-217071

ABSTRACT

BACKGROUND: This study was designed to compare hemodynamic responses and postoperative courses between sevoflurane-remifentanil and sevoflurane-nitrous oxide anesthesia. METHODS: Forty ASA I or II patients undergoing gynecologic surgery were randomly assigned to receive sevoflurane-remifentanil (group R) or sevoflurane-nitrous oxide group (group N). In group R, remifentanil was continuously infused by using target-controlled infusion pump from anesthetic induction (effect-site target concentration: 4 ng/ml) to the end of surgery (1-5 ng/ml). In group N, fentanyl (2microg/kg) was administered before tracheal intubation and 50% N2O was used during anesthesia. In both groups, 2 vol% sevoflurane was used during anesthetic induction and then end-tidal sevoflurane concentrations were controlled between 1 to 3 vol% according to systolic blood pressure. We compared blood pressure (BP) and heart rate (HR) before and after tracheal intubation and frequencies of hemodynamic aberrations between the two groups. Postoperative nausea/vomiting, sedation, pain scores at 2 and 24 hours after operation were also compared. RESULTS: Changes of BP and HR after tracheal intubation were similar in group R and group N, but MAP at 1 and 2 min after intubation was significantly decreased versus baseline MAP in group N. Intraoperative hypertensive episodes (systolic BP > 140 mmHg) were more frequent in group N compared to group R, and hypotensive episodes (SBP < 90 mm Hg) were similar in both groups. There were no differences in postoperative nausea/vomiting, sedation and pain scores. CONCLUSIONS: Sevoflurane/remifentanil anesthesia provided more stable intraoperative hemodynamic status than sevoflurane/N2O and postoperative adverse effects were similar in both groups.


Subject(s)
Anesthesia , Blood Pressure , Female , Fentanyl , Gynecologic Surgical Procedures , Heart Rate , Hemodynamics , Humans , Infusion Pumps , Intubation , Methyl Ethers , Nitrous Oxide , Piperidines
14.
Article in Korean | WPRIM | ID: wpr-223100

ABSTRACT

We report a case of awakening during general anesthesia due to a vaporizer malfunction. The sevoflurane vaporizer had a hole through which approximately 20% of fresh gas escaped. The gas in the common gas outlet contained only 60% of the sevoflurane stated on the vaporizer setting. Moreover, the gas monitor module was out of order, and the heart rate and blood pressure were stable. As a result, we were unaware of the low sevoflurane concentration. The leakage through the hole could not be detected with the commonly used low-pressure system leak checking method. The implication of this case is that unexpected awakening can occur in patients with stable vital signs with an inhalation anesthesia. Therefore, more attention is needed to detect the level of patient awareness.


Subject(s)
Anesthesia, General , Anesthesia, Inhalation , Blood Pressure , Heart Rate , Humans , Nebulizers and Vaporizers , United Nations , Vital Signs
15.
Article in Korean | WPRIM | ID: wpr-223094

ABSTRACT

Peripartum cardiomyopathy (PPCM) is a rare form of cardiomyopathy associated with a significant morbidity and mortality. The anesthetic management of a Cesarean section in patients with PPCM has not been well defined. Herein, our experience of a 31-year-old multipara, with recurrent PPCM and congestive heart failure, who presented for an elective cesarean section, is reported. Combined spinal-epidural anesthesia was successfully employed as the anesthetic technique for the procedure. The intra-arterial blood pressure and central venous pressure were monitored throughout the procedure. In addition, the patient's postoperative pain was markedly reduced with the use of epidural PCA. Combined spinal-epidural anesthesia is suggested to be a reliable technique, which provides minimal hemodynamic changes, and a lower failure rate than epidural anesthesia only, and is also highly effective with a low dose of local anesthetic drug.


Subject(s)
Adult , Anesthesia , Anesthesia, Epidural , Blood Pressure , Cardiomyopathies , Central Venous Pressure , Cesarean Section , Female , Heart Failure , Hemodynamics , Humans , Mortality , Pain, Postoperative , Passive Cutaneous Anaphylaxis , Peripartum Period , Pregnancy
16.
Article in Korean | WPRIM | ID: wpr-193254

ABSTRACT

Acute transient salivary gland swelling is a rare complication of general anesthesia. These swellings usually resolve over a few hours without sequelae. The etiology of the salivary gland swelling is unclear. However, they are considered to be associated with cough or straining on the endotracheal tube and mechanical blockage of salivary gland duct. Anesthesiologists should know the possible causes, lack of clinical significance, and the course of these transient salivary gland swellings in order to reassure the patient. We report bilateral submandibular gland swelling developed after endotracheal anesthesia in a 4-year-old girl.


Subject(s)
Anesthesia , Anesthesia, General , Child, Preschool , Cough , Female , Humans , Salivary Glands , Submandibular Gland
17.
Article in Korean | WPRIM | ID: wpr-648833

ABSTRACT

BACKGROUND: Procedures in medical papers should be described in sufficient detail to allow other researchers to reproduce the results. The apparatus including anesthesia machine should be given, too. Anesthesia machine has dramatically improved as bioengineering has developed. There are several ventilator settings in modern anesthesia machines. However, it seems that only a few ventilator settings are described even though modern ventilators are used in research. The purpose of this study is to investigate that how many ventilator parameters were described in the papers of the Korean Journal of Anesthesiology from 2001 to 2006. METHODS: All of papers with human general anesthesia were reviewed except case reports, and papers regarding only induction or intubation procedures. Recruited articles were grouped into papers with strongly related to respiratory parameters (STP), and into ones with slightly related to them based on the research topics. The description of following categories was counted in each paper; the type of anesthesia machine, tidal volume, respiratory rate, inspiratory:expiratory ratio, mode of ventilation, pressure set in pressure targeted ventilation, positive end expiratory pressure, inspiratory pause, and inspiratory rising rate. RESULTS: The description rate of each parameters in STP were 36% in the type of anesthesia machine, 66% in tidal volume, 54% in respiratory rate, and 24% in inspiratory:expiratory ratio. The other settings were seldomly mentioned. CONCLUSIONS: Description on the ventilator parameters was sometimes missed. We should describe adequate ventilator settings to reproduce the results because the modern anesthesia machine has additional ventilator options.


Subject(s)
Anesthesia , Anesthesia, General , Anesthesiology , Bioengineering , Humans , Intubation , Positive-Pressure Respiration , Respiration, Artificial , Respiratory Rate , Tidal Volume , Ventilation , Ventilators, Mechanical
19.
Article in Korean | WPRIM | ID: wpr-20027

ABSTRACT

BACKGROUND: Dobutamine, isoproterenol, and milrinone are inotropic agents with vasodilatory properties, and are frequently used perioperatively. We undertook to examine the effects of these three drugs on the pulmonary vasculature, excluding cardiovascular effects, by determining their effects on pulmonary artery pressure and hypoxic pulmonary vasoconstriction in an isolated rat lung model. METHODS: Thirty Sprague-Dawley rats were divided into a dobutamine group (n = 10), an isoproterenol group (n = 10) and a milrinone group (n = 10). Dobutamine 50microgram, 500microgram, and 5,000microgram, isoproterenol 0.4microgram, 4microgram, and 40microgram, and milrinone 2.5microgram, 25microgram, and 250microgram were added to perfusate sequentially during normoxic ventilation (21% O2-5% CO2-balanced N2). Baseline pulmonary artery pressure changes and subsequent hypoxic pressor responses during hypoxic ventilation (5% O2-5% CO2-balanced N2) were observed. RESULTS: Dobutamine, isoproterenol, and milrinone all decreased baseline pulmonary artery pressures and hypoxic pressor responses in a dose-dependent manner (P < 0.05). The last dose listed for each of the three drugs reversed hypoxic pulmonary vasoconstriction nearly completely. The calculated dose required to reduce the hypoxic pressor response to 50% of the initial response before drug administration (ED50) was 155microgram (95% CI: 80-263microgram) for dobutamine, 0.23microgram (95% CI: 0.011-0.75 microgram) for isoproterenol and 6.31microgram (95% CI: 3.1-10.8microgram) for milrinone. The relative potency of the drugs on HPV, based on ED50 was dobutamine 10: isoproterenol 0.015: and milrinone 0.41. CONCLUSIONS: Dobutamine, isoproterenol, and milrinone all reduced pulmonary vascular resistance and hypoxic pulmonary vasoconstriction in a dose dependent manner. (Korean J Anesthesiol 2004; 46: 454~461)


Subject(s)
Animals , Dobutamine , Isoproterenol , Lung , Milrinone , Pulmonary Artery , Rats , Rats, Sprague-Dawley , Vascular Resistance , Vasoconstriction , Ventilation
20.
Article in English | WPRIM | ID: wpr-86346

ABSTRACT

Little is known about the prevalence of naturally acquired IgG antibodies to the capsular polysaccharides of Streptococcus pneumoniae (pneumococcal IgG) in Korea. In the present study, we investigated transplacental transfer and age-related levels of pneumococcal IgG to provide background seroepidemiologic data for S. pneumoniae in Korea. One hundred thirty eight sera were assayed by ELISA for IgG to pneumococcal polysaccharide capsular serotypes 14 and 19, the predominant serotypes for under 15 yr of age in Korea. The subjects were divided into 7 subgroups according to age. The cord/maternal geometric mean titer of pneumococcal were 4.47+/-5.88/5.21 +/- 5.88 for serotype 14, and 4.68 +/- 5.55/6.55 +/- 6.92 for serotype 1 9 (mean +/- standard deviation, microg/mL). After birth, the geometric mean titers of pneumococcal IgG for serotypes 14 and 19 expressed in microg/mL were 1.18+/-2.12 and 1.41+/-2.17 in the 0-6 months group, 0.27+/-0.19 and 0.69+/-0.93 in 7-12 months, 0.21+/-0.22 and 0.64+/-1.32 in 1-2 yr, 0.69+/-0.78 and 2.65+/-2.46 in 3-6 yr, 2.52+/-2.72 and 8.29+/-4.24 in 7-10 yr, respectively. In conclusion, reduced transplacental transfer and very low serum concentrations of pneumococcal IgG may contribute to the susceptibility of neonates, infants, and young children to S. pneumoniae infection.


Subject(s)
Age Factors , Antibodies, Bacterial/metabolism , Bacterial Capsules/immunology , Child , Child, Preschool , Enzyme-Linked Immunosorbent Assay , Female , Humans , Immunoglobulin G/metabolism , Immunoglobulin G/blood , Infant , Infant, Newborn , Male , Maternal-Fetal Exchange , Pneumococcal Vaccines/immunology , Pregnancy , Streptococcus pneumoniae/immunology , Vaccines, Conjugate/immunology
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