Using the Korean Society of Anesthesiologists database of anesthesia-related medical disputes (July 2009-June 2014), causative mechanisms and injury patterns were analyzed. In total, 105 cases were analyzed. Most patients were aged < 60 yr (82.9%) and were classified as American Society of Anesthesiologists physical status < or = II (90.5%). In 42.9% of all cases, the injuries were determined to be 'avoidable' if the appropriate standard of care had been applied. Sedation was the sec most common type of anesthesia (37.1% of all cases), following by general anesthesia. Most sedation cases (27/39, 69.2%) showed a common lack of vigilance: no pre-procedural testing (82.1%), absence of anesthesia record (89.7%), and non-use of intra-procedural monitoring (15.4%). Most sedation (92.3%) was provided simultaneously by the non-anesthesiologists who performed the procedures. After the resulting injuries were grouped into four categories (temporary, permanent/minor, permanent/major, and death), their causative mechanisms were analyzed in cases with permanent injuries (n=20) and death (n=82). A 'respiratory events' was the leading causative mechanism (56/102, 54.9%). Of these, the most common specific mechanism was hypoxia secondary to airway obstruction or respiratory depression (n=31). The sec most common damaging event was a 'cardiovascular events' (26/102, 25.5%), in which myocardial infarction was the most common specific mechanism (n=12). Our database analysis demonstrated several typical injury profiles (a lack of vigilance in seemingly safe procedures or sedation, non-compliance with the airway management guidelines, and the prevalence of myocardial infarction) and can be helpful to improve patient safety.
Adult ; Anesthesia, General/*adverse effects ; Anoxia/epidemiology ; Female ; Humans ; Male ; *Malpractice ; *Medical Errors ; Middle Aged ; Myocardial Infarction/epidemiology ; Republic of Korea/epidemiology

Using the Korean Society of Anesthesiologists database of anesthesia-related medical disputes (July 2009-June 2014), causative mechanisms and injury patterns were analyzed. In total, 105 cases were analyzed. Most patients were aged < 60 yr (82.9%) and were classified as American Society of Anesthesiologists physical status < or = II (90.5%). In 42.9% of all cases, the injuries were determined to be 'avoidable' if the appropriate standard of care had been applied. Sedation was the sec most common type of anesthesia (37.1% of all cases), following by general anesthesia. Most sedation cases (27/39, 69.2%) showed a common lack of vigilance: no pre-procedural testing (82.1%), absence of anesthesia record (89.7%), and non-use of intra-procedural monitoring (15.4%). Most sedation (92.3%) was provided simultaneously by the non-anesthesiologists who performed the procedures. After the resulting injuries were grouped into four categories (temporary, permanent/minor, permanent/major, and death), their causative mechanisms were analyzed in cases with permanent injuries (n=20) and death (n=82). A 'respiratory events' was the leading causative mechanism (56/102, 54.9%). Of these, the most common specific mechanism was hypoxia secondary to airway obstruction or respiratory depression (n=31). The sec most common damaging event was a 'cardiovascular events' (26/102, 25.5%), in which myocardial infarction was the most common specific mechanism (n=12). Our database analysis demonstrated several typical injury profiles (a lack of vigilance in seemingly safe procedures or sedation, non-compliance with the airway management guidelines, and the prevalence of myocardial infarction) and can be helpful to improve patient safety.
Adult ; Anesthesia, General/*adverse effects ; Anoxia/epidemiology ; Female ; Humans ; Male ; *Malpractice ; *Medical Errors ; Middle Aged ; Myocardial Infarction/epidemiology ; Republic of Korea/epidemiology

Obstructive sleep apnea (OSA) is one of common sleep disorders in western countries, affecting 4% of males and 2% of females. It is characterized by repeated obstruction of the upper airway during sleep, leading to intermittent hypoxemia, sympathetic activation, and sleep fragmentation. OSA is an independent risk factor for a range of medical problems, including cardiovascular disease, diabetes, depression, and cognitive dysfunctions. The etiology of OSA is complex and incompletely understood, but recent studies have shown that the development of OSA depends on the structure of the airway anatomy, the responsiveness of the upper airway dilator muscle to stimulation, and the stability of the respiratory control system. This review details the epidemiological and experimental evidence surrounding the associations between OSA and chronic diseases. Recent findings on the etiology of OSA will also be discussed.
Anoxia ; Cardiovascular Diseases ; Chronic Disease ; Depression ; Epidemiology* ; Female ; Humans ; Male ; Risk Factors ; Sleep Apnea, Obstructive* ; Sleep Deprivation ; Sleep Wake Disorders

Because central venous O2 saturation (superior vena cava, ScvO2) can be monitored with less risk of the patients than mixed venous O2 saturation (pulmonary artery, SvO2), there have been studies to see if ScvO2 could replace SvO2. But previous studies showed that these two measurements were correlated but "not interchangeable. Therefore the authors compared right atrial C#b saturation (SraO2) with S vO2 over a wide range of cardiorespiratory status including control, hemorrhage, resuscitation, and hypoxia in anesthetized cats. We performed thoracotomy and inserted cannulae directly into the right atrium and the pulmonary artery. Blood sampling were obtained synchronously through the cannulae and tested immediately. The correlation coefficients in control, hemorrhage, resuscitation, and hypoxia groups were 0.876, 0.794, 0.946, 0.948 respectively and the two measurements in each group showed statistically significant correlations (p<0.05). But the biases of the two measurements in each group were 0.11+/-2.9, 0.35+/-4.2, -0.55+/-3.2, 0.23+/-4.2 respectively and the limits of agreement ( 2 standard deviation) in all groups exceeded permissible (5%) to conclude that the two measurements were in agreement. Thus, we reached the conclusion that the absolute values of SraO2, though not being sufficiently identical to S vO2 to calculate O2 uptake or pulmonary shunt precisely, can reflect the S vO2 trend following the O2 supply / demand change. Further clinical studies are needed.
Animals ; Anoxia* ; Arteries ; Bias (Epidemiology) ; Catheters ; Cats* ; Heart Atria* ; Hemorrhage ; Humans ; Oxygen* ; Pulmonary Artery* ; Resuscitation* ; Shock, Hemorrhagic* ; Thoracotomy

BACKGROUND: Pulmonary embolism is a relatively common disease but may also be manifestated as a lethal disease. Most previous studies on pulmonary embolism included hemodynamically stable patients who were able to tolerate a confirmative diagnostic workup, including ventilation-perfusion lung scan or pulmonary angiography. However, in most cases of acute massive pulmonary embolism, patients are unstable to tolerate a confirmative diagnostic workup. Studies of only stable patients with pulmonary embolism may have a bias on evaluating the clinical course and prognosis of pulmonary embolism. Therefore, we designed a study to observe the clinical manifestations, diagnostic methods, treatment modality, and to investigate the prognostic factors of patients with acute pulmonary embolism who present with overt or impending right heart failure using the diagnostic criteria suggested by MAPPET study. METHODS: Among 103 patients diagnosed as pulmonary embolism from 1990 to 1997, 63 patients(male/female : 21/42, mean age : 56 15) were enrolled as acute major pulmonary embolism by MAPPET's diagnostic criteria. Patients were included in the study if they showed clinical, echocardiographic and cardiac catheterization findings signifying acute right heart failure or pulmonary hypertension due to pulmonary embolism, together with: 1) a diagnostic pulmonary angiogram, or 2) a lung scan indicating high probability of pulmonary embolism, or 3) at least 3 of the followings: 1) syncope; 2) tachycardia (heart rate > 100 beats /min); 3) dyspnea or tachypnea (> 24 breaths/min or need for mechanical ventilation); 4) arterial hypoxemia (partial arterial pressure of oxygen < 70mmHg while breathing room air) in the absence of pulmonary infiltrates on chest x-ray; 5) ECG signs of right heart strain. RESULTS: Among the 63 patients, 15 patients(23.8%) did not have an underlying disease. Eleven patients(17.5%) had malignancy, 8 patients had an operation in the recent 20 days, 6 patients had chronic pulmonary disease, 5 patients had a history of congestive heart failure and cerebrovascular accident respectively, 4 patients had a previous history of pulmonary embolism, 3 patients had vasculitis such as Behcets' disease and systemic lupus erythematosus and a history of venous thrombosis, respectively. The main clinical manifestation on the time of diagnosis was dypnea in 55 patients(87.3%), which was the most frequent, and chest pain in 18 patients(28.6%), syncope in 10 patients(15.9%), and tachycardia in 2 patients(3.2%). The diagnostic methods were echocardiography(43 patients, 68.3%), lung perfusion scan(39 patients, 61.9%), chest computed tomography(16 patients, 26.4%), pulmonary angiography(4 patients, 6.3%) and right heart catherization (2 patients, 3.2%). In order to examine deep vein thrombosis, lower extremity Duplex ultrusonography and venography were performed in 11 patients(17.5%) and 7 patients(11.1%) respectively. The overall in-hospital mortality was 38.1%(24 patients). The factors influencing in-hospital mortality were associated malignancy(p< 0.01) and unstable vital sign(systolic blood pressure of less than 90mmHg)(p< 0.05). CONCLUSION: Acute pulmonary embolism with overt or impending right heart failure is a significant lethal disease with a high in-hospital mortality. The predictors of mortality were associated malignancy and unstable vital sign.
Angiography ; Anoxia ; Arterial Pressure ; Bias (Epidemiology) ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography ; Heart ; Heart Failure ; Hospital Mortality* ; Humans ; Hypertension, Pulmonary ; Lower Extremity ; Lung ; Lung Diseases ; Lupus Erythematosus, Systemic ; Mortality ; Oxygen ; Perfusion ; Phlebography ; Prognosis ; Pulmonary Embolism* ; Respiration ; Stroke ; Syncope ; Tachycardia ; Tachypnea ; Thorax ; Vasculitis ; Venous Thrombosis ; Vital Signs