Risk factors of emergency reoperations

Background@#Emergency reoperation is considered to be a quality indicator in surgery. We analyzed the risk factors for emergency reoperations. @*Methods@#Patients who underwent emergency operations from January 1, 2017, to December 31, 2017, at our hospital were reviewed in this retrospective study. Multivariate logistic regression was performed for the perioperative risk factors for emergency reoperation. @*Results@#A total of 1,481 patients underwent emergency operations during the study period. Among them, 79 patients received emergency reoperations. The variables related to emergency reoperation included surgeries involving intracranial and intraoral lesions, highest mean arterial pressure ≥ 110 mmHg, highest heart rate ≥ 100 /min, anemia, duration of operation ＞120 min, and arrival from the intensive care unit (ICU). @*Conclusions@#The type of surgery, hemodynamics, hemoglobin values, the duration of surgery, and arrival from ICU were associated with emergency reoperations.

Retrospective investigation of anesthetic management and outcome in patients with deep neck infections

BACKGROUND: Although incidence of deep neck infection has decreased after the introduction of antibiotics and improvement of oral hygiene, the disease may remain serious to anesthesiologists and patients, especially relative to postoperative prognosis and airway management. The objective of this study is to clarify clinical characteristics and consider anesthetic implications. METHODS: This study reviews the experience of 116 patients that received operations for deep neck infections 1997–2017 in a university hospital. Variables included in data were age, sex, lesion, etiology, underlying disease, result of culture, anesthetic techniques, C-reactive protein level, and a variety of scores including ASA physical status, APACHE II, and SOFA. Scores were analyzed statistically to elucidate prognostic ability, and influences on intubation. RESULTS: The following background variables were associated postoperative complication; age, presence of diabetes, hypertension, and infectious disease, extended space and use of N2O. APACHE II ≥ 7 and SOFA ≥ 3 were revealed to be associated with postoperative complication. The following background variables were associated with difficult intubation: date of surgery ≤ 2009, non-otolaryngology department, and submental space. CONCLUSIONS: This study revealed the possibility that the preoperative evaluation, including the determination of scoring system, may be useful in predicting outcome and making a clinical decision of airway management in deep neck infections.

Retrospective anesthetic evaluation of non-obstetric surgery during pregnancy: single center experience

BACKGROUND: Laparoscopic procedures and ultrasonography are now commonly used in the obstetric field, and more non-obstetric procedures are being performed. However, little domestic data has been published on the topic. This present retrospective study investigated the clinical information and the effect on perinatal outcomes of non-obstetric surgery during pregnancy. METHODS: This retrospective study was performed using data of all adult pregnant women that underwent non-obstetric surgery at our institute between from July 2009 to December 2016. Data was collected from the institutional computerized database. The causes, types, and the gestational ages at surgery were collected as our primary outcomes. Basic characteristics of patients, operation times, anesthesia times, anesthetic methods, anesthetic agents, and adverse perinatal outcomes such as abortion or preterm delivery were evaluated as secondary outcomes. RESULTS: During the study period, there were 2,421 deliveries and 60 cases of non-obstetric surgery, an operation rate of 2.48%. The most common cause of non-obstetric surgery was abdominal surgery, followed by orthopedic surgery and neurosurgery. Most of abdominal surgeries were performed laparoscopically during the first trimester. The incidence of adverse perinatal outcomes was increased in the first trimester, was not related with anesthesia. CONCLUSIONS: The rate of non-obstetric surgery was found to be 2.48%, which was higher than those reported in previous domestic studies. This increase seems to have resulted from early diagnosis by ultrasonography and non-invasive surgery using laparoscopy. Adverse perinatal outcomes are not related with age, surgery and anesthetic-related factors but seem to be associated with surgery exposure stage, especially the first trimester.

Preliminary study of anesthetic risk factors in surgery for pathologic fractures secondary to metastatic tumors

BACKGROUND: Despite advances in the treatment of primary cancer, metastatic pathologic fractures still affect the survival of cancer patients. The goals of surgery, such as those with terminal cancer, are to maintain a maximum level of independence and improve the quality of life. A patient may be a poor surgical candidate because of a short life expectancy or illness that is too severe to benefit from surgical fixation. Moreover, this surgery is an operation accompanied with significant morbidity and mortality. This retrospective study investigated the characteristics of these patients and assessed the influence of anesthetic risk factors on the outcome. METHODS: The records of 45 patients with pathologic fractures who underwent surgical stabilization for metastatic factors from 1 January 1995 to 31 December 2013 at our hospital were reviewed. Demographic data, various severity scores, anesthetic factors, and survival were reviewed. RESULTS: The most common sites of primary tumors were lung, liver and stomach. The predominant sites of pathologic fractures were the femur (71.1%); six lesions were in the humerus and four in the spine. Univariate and multivariate analyses identified several prognostic factors with a significantly worse influence on survival, including lung tumor and Acute Physiology and Chronic Health Evaluation (APACHE) II score. CONCLUSIONS: Although the number of patients was too small to result in a satisfactory appraisal, the most important step is to select candidates to gain the benefits of palliative surgery. We suggest the possibility of APACHE II scoring and the recognition of lung cancer in making the clinical decision of performing the palliative osteosyntheses for patients with pathologic fractures.

An analysis of consultations requested to a pain clinic

BACKGROUND: The study investigated in detail the current status of the consultations requested in a pain clinic. We evaluated the characteristics of the consultations to determine the kind of contents requested, referring departments and factors including demographics, co-morbidities, previous medical problems, and the descriptions of the reasons for the consultation to the pain clinic. METHODS: Clinical data were collected in the authors' institution between 1 January 2009 and 31 December 2013. The medical records were reviewed and compared. Characteristics of both outpatients and inpatients were analysed. RESULTS: Data from 1,140 patients was available for this study. Seven hundred thirteen individuals belonged to the outpatient group and 427 individuals belonged to the inpatient group. Orthopedic surgery, neurosurgery, and otolaryngology were the main departments that requested consultations to the pain clinic. The most frequent requested lesion and diagnostic term were low back and lumbar spinal stenosis, respectively, and the most common reason for consulting was for "control of pain not controlled by medications." Factors that were significantly different between the two groups were gender, questions about other illnesses apart from the main diagnoses, history of specific diseases, acute onset, cancer, operation within 3 months, and physical system abnormalities. CONCLUSIONS: The medical problems addressed by a pain clinic consultation service were diverse. It is rational to develop standardized guidelines for pain consultations, and treatment strategies aimed at alleviating pain per se as well as caring for comorbid conditions.

Anesthetic experience of patients with Fournier's syndrome / 대한마취과학회지

No abstract available.

Rhabdomyolysis after laparoscopic radical nephrectomy: A case report / 대한마취과학회지

Rhabdomyolysis is a rare but potentially lethal clinical syndrome that results from acute muscle fiber necrosis with leakage of muscle constituents into blood. This devastating disease could be due to muscle compression caused by urologic positioning for a lengthy nephrectomy. In this regard, laparoscopic renal surgery may be a risk for the development of rhabdomyolysis. This phenomenon of massive muscle necrosis can produce secondary acute renal failure. The risk factors have to be managed carefully during anesthetic management. Here, we report a case of a patient with rhabdomyolysis that developed in the flexed lateral decubitus position during laparoscopic nephrectomy.

Comparison of the neuroendocrine and inflammatory responses after laparoscopic and abdominal hysterectomy / 대한마취과학회지

BACKGROUND: Laparoscopic surgery is associated with a more favorable clinical outcome than that of conventional open surgery. This might be related to the magnitude of the tissue trauma. The aim of the present study was to examine the differences of the neuroendocrine and inflammatory responses between the two surgical techniques. METHODS: Twenty-four patients with no major medical disease were randomly assigned to undergo laparoscopic (n = 13) or abdominal hysterectomy (n = 11). Venous blood samples were collected and we measured the levels of interleukin-6 (IL-6), CRP and cortisol at the time before and after skin incision, at the end of peritoneum closure and at 1 h and 24 h after operation. RESULTS: The laparoscopic hysterectomy group demonstrated less of an inflammatory response in terms of the serum IL-6 and CRP responses than did the abdominal hysterectomy group, and the laparoscopic hysterectomy group had a shorter hospital stay (P < 0.05). The peak serum IL-6 (P < 0.05) and CRP concentrations were significantly less increased in the laparoscopic group as compared with that of the abdominal hysterectomy group (P < 0.05), while the serum cortisol concentration showed a similar time course and changes and there were no significant difference between the groups. The response of interleukin-6 showed a significant correlation with the response of CRP (r = 0.796; P < 0.05). CONCLUSIONS: The laparoscopic surgical procedure leaves the endocrine metabolic response largely unaltered as compared with that of open abdominal hysterectomy, but it reduces the inflammatory response as measured by the IL-6 and CRP levels.

Anesthetic management in an angiographic suite: a retrospective review of 88 cases / 대한마취과학회지

BACKGROUND: Advances in the field of interventional and diagnostic radiology have resulted in anesthesiologists becoming involved in angiographic suites. In the present study, we evaluated the characteristics of patients and the anesthetic management in an angiographic suite, to determine what factors influenced the patient outcome. METHODS: Data pertaining to patients that were anesthetized at an angiographic suite in a university hospital between 1 January 2007 and 31 December 2007 were evaluated retrospectively. Specifically, we evaluated the patient characteristics and the types of anesthesia administered, to determine which factors were related to patient outcome. RESULTS: Sixty-four percent of the patients enrolled in this study were women. Cases involving coiling for unruptured and ruptured aneurysm, embolization for intracranial arteriovenous malformation and fistula, pediatric diagnostic angiography, embolization for extracranial arteriovenous malformation, and implantable cardioverter-defibrillator (ICD) implantation all required the involvement of anesthesiologists. Major postoperatve complications included pneumonia, atelectasis, and hydrocephalus. In addition, GCS, net fluid balance, and anesthesia time had influence on patient outcome. CONCLUSIONS: We evaluated the characteristics of patient groups, procedures, and postoperative complications in an angiographic suite. The results of our analysis revealed that a through understanding of nervous and vascular pathology, as well as knowledge of current interventional radiology, neuroanesthesia and vascular anesthesia techniques is essential for development of safe and effective care.

Anesthetic experience of a patient with hereditary factor XI deficiency (Hemophilia C) : A case report / 대한마취과학회지

Factor XI deficiency (also called Hemophilia C) rarely occurs among ethnicities other than Ashkenazi Jews. A boy was scheduled for frontoethmoidectomy due to bilateral chronic rhinosinusitis. He was incidentally found to have factor XI deficiency due to prolonged aPTT on preoperative laboratory finding. His medical history reveals frequent epistaxis 2 or 3 times per day and his factor XI and XII activity were 17% (normal; 60-140%) and 34% (normal; 60-140%), respectively on furthermore laboratory evaluation. He was diagnosed as hereditary factor XI deficiency. He underwent the operation with administration of the fresh frozen plasma without complication.

Retrospective Analysis of the Postoperative Patients Admitted to General Surgical-Medical Intensive Care Unit / 대한구급학회지

BACKGROUND: The present study was designed to examine the purpose of intensive care unit (ICU) admission and the prevalence of disease in postoperative patients admitted to general surgical-medical ICU. METHODS: Between 1 January 2007 and 31 December 2007, 646 cases of 612 patients admitted to a general postoperative patients admitted to general surgical-medical ICU were examined. The patients were classified into two groups, ICU treatment and ICU monitoring groups according to Knaus' suggestion which defines the kinds of treatment done exclusively in ICU. Patients' demographics, preoperative American Society of Anesthesiologists physical status classification (ASA) grade, prevalence of disease and emergent operation rate were analyzed. RESULTS: 255 patients (39.5%) were included in the ICU treatment group and 391 cases (60.5%) in the ICU monitoring group. The prevalence of respiratory, gastrointestinal, and central nervous diseases was higher significantly in the ICU treatment group. In addition, the average of ASA grade and the duration of operation were higher significantly in the ICU treatment group. CONCLUSION: Admission rate only for monitoring was higher than one for intensive treatment. An alternative strategy should be considered to care for postoperative patients who need just close monitoring.

Ketamine potentiates neurotoxicity in obese mice / 대한마취과학회지

BACKGROUND: Obesity exacerbates chemically-induced neurodegeneration. N-methyl-D-aspartate (NMDA) antagonists such as ketamine prevent excitotoxicity and are neuroprotective against acute brain injury, but can also be toxic. In low doses they induce reversible neuronal injury, but in higher doses they cause irreversible degeneration of cerebrocortical neurons. This study was designed to evaluate the neurotoxic effect of ketamine on obesity-induced neurotoxicity in the young mouse brain. METHODS: Five-week-old female wild and obese type (C57BL6) mice were randomly allocated into three groups (n=6 each) receiving a single intraperitoneal injection of (i) saline (control); (ii) ketamine (50 mg/kg); (iii) or ketamine (100 mg/kg). Three hours after ketamine administration, their brains were prepared histologically for quantitative assessment of the number of posterior cingulate/retrosplenial (PC/RS) neurons with vacuolation at a specific rostrocaudal level. RESULTS: Pyramidal neurons containing cytoplasmic vacuoles in layers III and IV of the PC/RS cortex were observed in all groups of mice, except wild-type mice that received saline injections. Ketamine produced a dose-dependent vacuolization in both types of mice, which was more prominent in obese mice (P < 0.05). CONCLUSIONS: Administration of ketamine in young obese mice can exacerbate neurotoxicity.

Clinical Experience of the Lower Extremity Nerve Block for a Neurocritically Ill Patient Who is Not Able to Communicate:A Case Report / 대한구급학회지

A 73-year-old man was scheduled for the surgical reduction of fractured femur which occurred ar 3 months ago by the accident. The mental status of the patient was stuporous (Glasgow coma scale: 5) due to the complication of the head trauma. We performed nerve blocks (femoral, sciatic, lateral femoral cutaneous, and illiohypogastric nerve blocks) for the surgical reduction of left femur with 55 ml of 0.25% ropivacaine. The electroencephalography was monitored continuously during the 4 hour operation as well as monitoring the hemodynamic and respiratory parameters. The operation was performed successfully and the patient recovered uneventfully.

Pulmonary Edema Caused by Massive Intraarterial Infusion and Flushing of Heparinized Saline during the Endovascular Embolization in a Patient with a Cerebral Aneurysm: A case report / 대한마취과학회지

Here we report, along with a review of the literature, our experience with a patient suffering from a cerebral aneurysm and developed volume overloading pulmonary edema during endovascular coiling. A 51-year-old female patient who had an aneurysm in the basilar artery tip and subarachnoid hemorrhage was scheduled for endovascular embolization under general anesthesia. She developed pulmonary edema during the procedure. Coiling failed so neurosurgeon performed aneurysmal clipping under general anesthesia. The massive intraarterial infusion and flushing with heparinized saline may have triggered the pulmonary edema. We monitored diuresis and hemodynamics following surgery, as a high degree of vigilance, including monitoring of arterial blood gas and electrolyte evaluation, of patients undergoing prolonged endovascular embolization and receiving many intra-arterial fluids may help recovery.

Severe Postoperative Delirium Lasting for Three Weeks: A Case Report / 대한구급학회지

Postoperative delirium in the intensive care unit is a serious problem that has recently attracted much attention. We present a 73-year-old female patient who was admitted by multiple fractures induced by an accident. We started general anesthesia for the operation of open reduction and internal fixation. After the discontinuation of general anesthesia, the patient was transported to the intensive care unit. The symptoms of delirium were developed and controlled with medications including haloperidols, benzodiazepines, and vitamins. The patient was recovered three weeks after the management and received two other operations, but delirium did not be developed again. She was discharged from the hospital without complications.

Clinical Experience of General Anesthesia in a Child with Status Epilepticus Induced by Febrile Convulsion: A case report / 대한마취과학회지

When continuous seizures are refractory to conventional intravenous anticonvulsant drugs, general anesthesia has been recommended to control status epilepticus. We present the case of a 6-year-old male patient who was admitted for generalized tonic-clonic status epilepticus secondary to febrile convulsion due to an upper respiratory infection. The tonic-clonic status epilepticus was refractory to all anticonvulsant measures and drugs including, phenytoin, phenobarbital, diazepam and lorazepam. After about 32 hours of unsatisfactory seizure activity control, we started general anesthesia for the management of his status epilepticus. After discontinuing general anesthesia, the patient developed a small number of episodes of epilepsia partialis, but seizure activity was well controlled by conventional anticonvulsants. The patient was extubated after three days and was discharged from hospital as cured 12 days after general anesthesia management.

Clinical Experience of General Anesthesia in a Child with Status Epilepticus Induced by Febrile Convulsion: A case report / 대한마취과학회지

When continuous seizures are refractory to conventional intravenous anticonvulsant drugs, general anesthesia has been recommended to control status epilepticus. We present the case of a 6-year-old male patient who was admitted for generalized tonic-clonic status epilepticus secondary to febrile convulsion due to an upper respiratory infection. The tonic-clonic status epilepticus was refractory to all anticonvulsant measures and drugs including, phenytoin, phenobarbital, diazepam and lorazepam. After about 32 hours of unsatisfactory seizure activity control, we started general anesthesia for the management of his status epilepticus. After discontinuing general anesthesia, the patient developed a small number of episodes of epilepsia partialis, but seizure activity was well controlled by conventional anticonvulsants. The patient was extubated after three days and was discharged from hospital as cured 12 days after general anesthesia management.