Undesirable Symptoms of Patients in the Postanesthesia Recovery Situation / 대한마취과학회지

BACKGROUND: Healthcare quality can be improved by avoiding patient discomforts and customizing care to meet the needs of the patient. Therefore, the goal of this study was to quantify patients' discomfort for postoperative anesthesia outcomes for healthcare quality improvement. METHODS: One hundred orthopedic surgical patients were asked to tell possible undesirable postoperative outcomes preoperatively. In addition, they were also asked to tell undesirable postoperative outcomes from their most undesirable to least undesirable outcomes that they have experienced postoperatively. RESULTS: Patients expressed the following undesirable outcomes from most frequent to least frequent (in order); incisional pain, nausea/vomiting, shivering, headache, dizziness, sore throat, residual weakness, generalized myalgia, and somnolence. However, the severity of the symptoms were in the following order; nausea/vomiting, incisional pain, headache, dizziness, shivering, generalized myalgia residual weakness, sore throat, and somnolence. CONCLUSIONS: Although there is variability in how patients expressed postoperative outcomes, anesthesiologists can improve the quality of anesthesia by designing anesthesia regimens and methods that most closely meet each individual patient's preferences.

A Comparison of the Effects on Postoperative Course of Hypothermic Circulatory Arrest Versus Continuous Cardiopulmonary Bypass in Infants Arterial Switch Operation / 대한마취과학회지

BACKGROUND: Hypothermic circulatory arrest is a widely used support technique during heart surgery in neonate and infants, but the difference in the effects of perfusion methods, total arrest versus continuous flow, on postoperative course has been controversial. METHODS: This study was retrospectively designed to examine the difference in effects of deep hypothermic circulatory arrest or continuous flow perfusion on postoperative courses including mortality and neurologic morbidity after arterial switch operation through chart review. We also examined the relationship between intraoperative data and postoperative outcomes. RESULTS: Of 72 patients, 44 patients (Total Circulatory Arrest (TCA) group; 26 patients had intact ventricular septum, 18 patients had ventricular septal defect) were treated with total arrest, and 28 patients (Continuous Perfusion Flow (CPF) group; 13 patients had intact ventricular septum, and 15 patients had ventricular septal defect) were treated with continuous flow. Hospital course, postoperative hemodynamic profiles, incidence of complications excluding neurology and mortality were not different between two groups. The incidence of neurologic abnormalities was higher two times in TCA group than in CPF group but was not significantly different. CONCLUSIONS: We could not confirm the differences in postoperative outcomes between both techniques, total circulatory arrest and continuous flow perfusion during arterial switch operation in neonates and infants.

Emergence from Anesthesia is Dependent on Age and Physical Status, but not on Operation Site and Operation Time / 대한마취과학회지

BACKGROUND: For most patients, recovery from anesthesia is a smooth uneventful. But for some, recovery can be life threatening. To prevent this, adequate and prompt evaluation of patients on recovery state is essential. Activity, respiration, circulation, awareness, and color are comprehensively assessed by PAR score. So we performed this clinical study to compare ongoing changes in PAR score and the effects of age, physical status, operation site and operation time on PAR score were evaluated. METHODS: Two hundred and fifty-four patients (ASA 1, 2) undergoing elective surgery under general anesthesia were evaluated in our recovery room. They were anesthetized with enflurane or isoflurane, and nitrous oxide, and were transferred to the recovery room when SpO2 was more than 97% and there was no supplemental oxygen during transport. Once there, O2 5 l/min was administered via a face mask to all the patients. Assessment of each patient's PAR score was made at ten-minute intervals by the same anesthesiologist. RESULTS: Emergence from anesthesia was significantly dependent on patient's age, preoperative physical status but not on operation site and time. PAR score was significantly increased according to PAR-stay time regardless of age, physical status, operation site or time. CONCLUSION: In evaluating the postanesthetic recovery state, it seems to be important to consider patient's age and physical status.

The Relationship between Periadmission Blood Pressure and Periinduction Blood Pressure / 대한마취과학회지

BACKGROUND: There has been a study reporting those cases with elevated blood pressure (BP) above 140/90 mmHg on admission and normotension on ward showed more increase in mean arterial pressure(MAP) and pressure-pulse product than the normotensive or hypertensive patients in both situations. But the mean ages of the groups were different each other. This study was done to see if the same results would come without age differences. METHODS: One hundred and sixty-two patients between the age of 45 and 64 were divided into three groups. The patients with BP below 140/90 mmHg on admission and on ward were included in group 1(N=66) and those with BP above 140/90 mmHg on admission and below 140/90 mmHg on ward, in group 2(N=42) and those with BP above 140/90 mmHg in both situations were included in group 3(N=54). Preiinduction BP, PR, the changes of BP, PR during operation, incidence of hypertension at post-anesthesia room(PAR), and the number of cases who needed the use of inotropics or antihypertensives perioperatively were checked. RESULTS: As for the increase of BP just before induction the group 2 showed the greatest, group 1 was the next, and group 3 showed the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next, and group 3 the least amount increase. As for the increase of preinduction pressure-pulse product(PPP) group 2 showed the greatest, group 3 the next, and group 1 the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next,and group 3 the least amount increase. CONCLUSIONS: Intensive anesthetic care is needed also at periinduction period for the patients who showed hypertensive BP on admission and normotension on ward thereafter.