Development of an Evaluation Baseline Module for Clinical Clerkship: Gachon Medical School Experience / 한국의학교육

PURPOSE: The aims of this paper are to develop a student evaluation format as a part of core clinical clerkship (student internship) program at Gachon Medical School, and to identify its impeding factors in implementation. METHODS: Both rating scale of Likert type and check list for student's clerkship assessment were designed; the rating scale format was developed into two parts, namely attendance and the clinical competence demonstrated during the clerkship in which 3 domains of knowledge, skills and attitude were included in balance; the professional competence was made of 9 items, each being designed to accommodate 3 degrees by learner's performance. The clinical instructors in charge were requested to sit a short feedback session on the evaluation results with students who were signed at the end. Nursing staff was also asked to participate in evaluation of the student attitude in a limited area. RESULTS: Despite the full acceptance of the evaluation approach theoretically, its practical implementation was not successful because of difficulties related to adjustment of their department-based scoring system to the comprehensive assessment, or unfamiliarity with face-to-face feedback system. CONCLUSION: The authors assume that this Likert type of the rating scale is a simple, more comprehensive and strong tool to meet the learning objectives, and easy to enhance the feedback effect. It is, however, advised that the formative reporting system is crucial to transform the traditional evaluation approach into the pass/fail format so that unnecessary conversion risk is eliminated.

Inflammatory Reactions after Subdermal Injection of Thiopental and Propofol in Rabbits / 대한마취과학회지

BACKGROUND: Thiopental and propofol are the most widely used intravenous anesthetics as induction agents in general anesthesia. Thiopental is a very strong alkaline drug, and when it is extravasated, it can cause pain and skin necrosis. Propofol also can cause pain on injection in many populations. Therefore, we planed this study to compare inflammatory reactions of skin tissues after subdermal injections of thiopental and propofol in rabbits. METHODS: Four rabbits were divided into 2 groups: Standard dose (S) group and double dose (D) group. In the S group, thiopental 0.4 ml and propofol 0.4 ml were injected subcutaneously on each side of the posterior proximal ear. In the D group, the dose was doubled to 0.8 ml of each drug and injection was done in the same manner. Skin tissue at the injection sites were excised after 1 day, 3 days, and 7 days. Then each skin tissue slide was examined under an optical microsccpe. RESULTS: In the S group, the inflammatory reaction after the subdermal injection of 2.5% thiopental revealed a more progressed and more severe pattern than 1% propofol. In the D group, the inflammatory reaction after a subdermal injection of 2.5% thiopental revealed a more progressed and more severe pattern than 1% propofol at 3 days, but there was no significant difference in the degree of progression and severity between the 2 drugs at 7 days. CONCLUSIONS: When propofol is extravasated during continuous infusion for maintenance of anesthesia, it can cause distinct inflammatory reaction; though the inflammatory reaction is milder and the possibility of complications is lower than with thiopental.

Comparison of Amrinone and Dopamine-Nitroglycerin on Hemodynamic Parameters in Dogs with Postinfarct Heart Failure / 대한마취과학회지

BACKGROUND: Left ventricular failure (LVF) after an acute myocardial infarction occurs during the perioperative period, and since this condition can lead to severe complications, intensive care is required for the patient. LVF is characterized hemodynamically by a raised left heart filling pressure and volume and global depression of the hearts pumping performance. Several effective drugs for patients with heart failure are catecholamines such as dopamine and dobutamine, vasodilators such as nitroglycerin and nitroprusside, and noncatecholamine inotropes such as amrinone, which are either infused alone or in combination. However, as of now, there has been no study as to clarifying either the exact dosage, drug combination, or how they affect the heart. METHODS: By inducing a state of experimental acute left ventricular failure in 20 dogs through ligation of the left anterior descending coronary artery, this study compared the hemodynamic parameters of two treatment groups-one group using amrinone alone (bolus 1 mg/kg, continuous infusion 15micro gram/kg/min), and another group using a combination of dopamine (10micro gram/kg/min) and nitroglycerin (2micro gram/kg/min). RESULTS: Cardiac output of dogs with postinfarct heart failure increased in both treatment groups. But, there was a significant decrease in systemic vascular resistance, pulmonary vascular resistance and left ventricular end diastolic pressure in the group treated with amrinone than dopamine-nitroglycerin. Amrinone also revealed a favorable effect on oxygen utility. CONCLUSIONS: These results showed that amrinone might be more effective than the combination of dopamine and nitroglycerin for acute left ventricular failure in terms of myocardial function, hemodynamic stability and oxygen utility.

Comparison of Amrinone and Dopamine-Nitroglycerin on Hemodynamic Parameters in Dogs with Postinfarct Heart Failure / 대한마취과학회지

BACKGROUND: Left ventricular failure (LVF) after an acute myocardial infarction occurs during the perioperative period, and since this condition can lead to severe complications, intensive care is required for the patient. LVF is characterized hemodynamically by a raised left heart filling pressure and volume and global depression of the hearts pumping performance. Several effective drugs for patients with heart failure are catecholamines such as dopamine and dobutamine, vasodilators such as nitroglycerin and nitroprusside, and noncatecholamine inotropes such as amrinone, which are either infused alone or in combination. However, as of now, there has been no study as to clarifying either the exact dosage, drug combination, or how they affect the heart. METHODS: By inducing a state of experimental acute left ventricular failure in 20 dogs through ligation of the left anterior descending coronary artery, this study compared the hemodynamic parameters of two treatment groups-one group using amrinone alone (bolus 1 mg/kg, continuous infusion 15micro gram/kg/min), and another group using a combination of dopamine (10micro gram/kg/min) and nitroglycerin (2micro gram/kg/min). RESULTS: Cardiac output of dogs with postinfarct heart failure increased in both treatment groups. But, there was a significant decrease in systemic vascular resistance, pulmonary vascular resistance and left ventricular end diastolic pressure in the group treated with amrinone than dopamine-nitroglycerin. Amrinone also revealed a favorable effect on oxygen utility. CONCLUSIONS: These results showed that amrinone might be more effective than the combination of dopamine and nitroglycerin for acute left ventricular failure in terms of myocardial function, hemodynamic stability and oxygen utility.

Partial Obstruction of an Armored Endotracheal Tube / 대한마취과학회지

An 47-year-old woman presented for a microscopic vascular decompression with facial nerve palsy. Past medical history was noncontributory. There were not abnormal physical or laboratory findings. Oral tracheal intubation with an armored tube was performed without any problems. Anesthesia was maintained uneventfully in spite of a high peak inspiratory airway pressure (28 30 cmH2O). After surgery, she had symptoms of airway obstruction and the endotracheal tube was removed. The removed tube was found to have a protrusion through almost all the length of tube which reduced its internal diameter a half. Finally, in any case of "airway obstruction" in an intubated patient, we should consider mechanical problems. We should keep in mind the presence of an armored endotracheal tube cannot be regarded as a guarantee of a patent airway. We must test not only leakage of the cuff but also passage of the tube prior to usage.

The Effects of Propranolol and Esmolol on Blood Flow of Common Carotid Artery and Vital Signs in Rabbits / 대한마취과학회지

BACKGROUND: This study was planned to evaluate the influence of propranolol and esmolol on cerebral circulation and to estimate clinical implications and usefulness. METHODS: This study was designed to measure vital signs, cerebrospinal fluid pressure, cerebral perfusion pressure and blood flow velocity of common carotid artery. This was measured by Doppler Flowmeter after intravenous administration of propranolol 12.5, 25, 50 microgram/kg (P-12.5, P-25, P-50, respectively), and esmolol 0.5, 1.0, 2.0 mg/kg (E-0.5, E-1.0, E-2.0 group, respectively) at 1 or 2 minute intervals for 14 minutes. RESULTS: In the propranolol group (P-12.5, P-25 and P-50), the systolic blood pressure (SBP) significantly decreased since postinjection 1 minute and this decreased pressure continued throughout the entire experiment. But in esmolol group (E-0.5, E-1.0 and E-2.0), the SBP decreased significantly and rapidly recovered within 4 minutes. Heart rate significantly decreased in the propranolol group and continued throughout the experiment, but in the esmolol group the heart rate decreased and rapidly recovered within 10 minutes. The duration of the decreased heart rate in the esmolol group was shortened by decreasing the dosage. The blood flow velocity of the common carotid artery significantly decreased at 1 to 14 minutes after the injection of propranolol, but in group E-1.0, it was significantly decreased at 1 to 2 minutes, and in group E-2.0 at 1 to 3 minutes. CONCLUSIONS: The esmolol group showed less changes of SBP, heart rate and common carotid artery flow, and shorter duration of effect than the propranolol group. Mean blood pressure, cerebrospinal fluid pressure and cerebral perfusion pressure had no significant differences between propranolol and esmolol groups.