Comparison of Safety Profiles between Non-operating Room Anesthesia and Operating Room Anesthesia: a Study of 199,764 Cases at a Korean Tertiary Hospital

BACKGROUND: Despite expanding demands for non-operating room anesthesia (NORA) worldwide, studies in this field are scarce. We compared the overall characteristics and the nature of deaths occurring within 48 hours after surgery between NORA and operating room anesthesia (ORA) cases at a Korean tertiary hospital. METHODS: We retrospectively analyzed the medical records of patients who underwent surgical procedures under anesthesia services in and outside the operating room from January 2013 to November 2017. All of the mortalities were categorized by principal cause into groups such as patient disease or condition, surgery, anesthesia, and others. RESULTS: Overall, 16,383 NORA cases and 183,381 ORA cases were analyzed. Eighty-six deaths were identified. The mortality rate of NORA cases was similar to that of ORA cases (4.9 per 10,000 cases [95% confidence interval (CI), 2.1–9.6] vs. 4.3 per 10,000 cases [95% CI, 3.4–5.3], respectively). Similar to ORA cases, higher American Society of Anesthesiologists physical status and very young age (< 2 years) were significantly associated with mortality in NORA cases. A patient's disease or condition was the most important cause of mortality (65/86, 75.6%), followed by surgery-related causes (16/86, 18.6%). Two cases of anesthesia-related mortality were only identified in the ORA cases, resulting in an overall anesthesia-related mortality of 0.1 per 10,000 cases (95% CI, 0.0–0.4). CONCLUSION: Although NORA cases showed an equivalent perioperative mortality rate compared to ORA cases, there may be more room for improving patient safety when considering their favorable characteristics (healthier patients, less invasive and shorter procedures). Trial registry at Clinical Research Information Service, KCT0002719.

Severe respiratory depression precipitated by unrecognized gastric perforation during endoscopic submucosal dissection under deep sedation: A case report

Endoscopic submucosal dissection (ESD) is widely performed these days as the standard procedure for the treatment of early gastric cancer. During ESD, insertion and rotation of the scope, air insufflation, incision and hemostasis may provoke pain, which commonly requires either general anesthesia or moderate to deep sedation. Deep sedation precludes the need for general anesthesia, and can help endoscopists speed up the procedure compared to light sedation. But, there are risks of respiratory complication. We report a case of respiratory compromise caused by pneumoperitoneum from unrecognized gastric perforation during ESD under deep sedation.

Severe respiratory depression precipitated by unrecognized gastric perforation during endoscopic submucosal dissection under deep sedation: A case report

Endoscopic submucosal dissection (ESD) is widely performed these days as the standard procedure for the treatment of early gastric cancer. During ESD, insertion and rotation of the scope, air insufflation, incision and hemostasis may provoke pain, which commonly requires either general anesthesia or moderate to deep sedation. Deep sedation precludes the need for general anesthesia, and can help endoscopists speed up the procedure compared to light sedation. But, there are risks of respiratory complication. We report a case of respiratory compromise caused by pneumoperitoneum from unrecognized gastric perforation during ESD under deep sedation.

Prevalence of Anti-HCV in Hemodialysis Patients in Taegu and Kyeongbuk, Korea / 대한내과학회지

To determine the prevalence and risk factor of anti-HCV in ESRD patients under chronic maitenance hemodialysis, the prevalence of serum antibodies to hepatitis C Virus(Anti-HCV) was assessed by an enzyme immunoassay (Abbott HCV EIA) in 253 patients with long-term Hemodialysis in Daegu & Kyoungbuk. 15 patients(5.9%) were anti-HCV positive. All dialysis patients had the history of transfusion. The number of transfusion units was not significant in anti-HCV positive patients(mean 17+/-20 pints) in comparison with the number in anti-HCV negative patients (mean 16+/-17 pints). The frequency of hemodialysis was also not significant in anti-HCV positive patients(mean 477+/-618 ) compared with anti-HCV negative patients (mean 462+/-616). The mean duration of hemodialysis was significantly higher(P<0.001) in the anti-HCV positive patients (74+/-42 months) in comparison with anti-HCV negative patients (45+/-41 months). We concluded that the prevalence of anti-HCV in hemodialysis patients is 5.9% and that HCV infection is significantly related with the duration of hemodialysis rather than the number of transfusion units and the frequency of hemodialysis