BACKGROUND: A retrospective study was performed to evaluate postoperative mortality within 30 days following surgery. METHODS: The records of 31,806 patients who received operation under general anesthesia were reviewed. RESULTS: 1) Postoperative deaths were 184 cases, the ratio of which was comprising 0.57% of all surgical operative cases. 2) The highest ratio of the mortality in age group was 51~60 years group which was 24.5%, and in physical status it was ASA class III which was 36.4%. The highest ratio to the mortality rate in postoperative days was 8~30 days which was 45.1%. 3) The most common causes of death was low cardiac output due to heart failure on operating theater, and hypovolemic shock within postoperative 2 days, and intracranial problem within postoperative 7 days, and pulmonary complication within postoperative 30 days. CONCLUSION: We conclude that fatality rate could be decreased by intensive and multidisciplinary care for postoperaive complications as respiratory and renal failure.
Anesthesia, General ; Cardiac Output, Low ; Cause of Death ; Heart Failure ; Humans ; Mortality ; Renal Insufficiency ; Retrospective Studies ; Shock

BACKGROUND: The purpose of this study was to evaluate the effects of lung disease on the difference between arterial and end-tidal carbon dioxide tension by placing patients from the supine to the lateral decubitus position and by the changes from two lung ventilation (TLV) to one lung ventilation (OLV) during thoracic surgery. METHOD: Fifteen patients who had no parenchymal lung disease were selected for control group and 15 patients who had parenchymal lung disease on non-dependent lung were selected for disease group. All patients had been intubated with double lumen endobronchial tubes and respiration was controlled with a rate of 14-15 breaths per minute and tidal volume 8 ml/kg. End-tidal and arterial carbon dioxide tension were measured at three different measurement periods (supine plus TLV, lateral decubitus plus TLV, lateral decubitus plus OLV). RESULTS: The arterial to end-tidal carbon dioxide tension difference was more increased in disease group than control group. But there was no significant difference in arterial to end-tidal carbon dioxide tension with position change, ventilation method change in each groups. CONCLUSION: We conclude that the arterial to end-tidal carbon dioxide tension difference is increased in lung disease, but it does not changed with position and ventilation method change.
Carbon Dioxide* ; Carbon* ; Humans ; Lung Diseases* ; Lung* ; One-Lung Ventilation ; Respiration ; Thoracic Surgery ; Tidal Volume ; Ventilation

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.
Demography ; Humans ; Critical Care ; Intensive Care Units ; Prevalence ; Retrospective Studies

BACKGROUND: Pain is a common side-effect of propofol injection. A remifentanil pretreatment has been reported to decrease the incidence and intensity of pain during a propofol injection and has been suggested to act through a central or peripheral effect. This trial was designed to explore the action site of remifentanil on reducing propofol injection pain, using the venous occlusion technique and a time interval between the applications of remifentanil and propofol. METHODS: This randomized, double-blind study was designed to explore the action site of remifentanil on reducing propofol injection pain in 200 patients scheduled for elective surgery. The peripheral properties were examined using the venous occlusion technique for 30 s while a 1 min time interval between remifentanil and propofol injections was allowed for the central effect. Before the propofol injection, group A was pretreated with remifentanil (0.5 microg/ kg) with a venous occlusion, group B with remifentanil and a 1 min interval, and group C with remifentanil with a venous occlusion and a 1 min interval. Pain severity was assessed using a four-point scale. RESULTS: 40 patients (80%) complained of pain in the placebo group compared with 35 (70%) in group A, 20 (40%) in group B (p < 0.05) and 17 (34%) in group C (p < 0.05). The incidence and severity of propofol injection pain were lower in groups B and C than in group A (p < 0.05). However, there was no significant difference between groups B and C. CONCLUSIONS: The remifentanil mediated analgesic effect occurs mainly through the central effect.
Double-Blind Method ; Humans ; Incidence ; Piperidines ; Propofol

The Korean Medical Association opposes the illegal attempt to implement the physician assistant (PA) system in Korea. The exact meaning of ‘PA’ in Korea at present time is ’Unlicensed Assistant (UA)’ since it is not legally established in our healthcare system. Thus, PA in Korea refers to unlawful, unqualified, auxiliary personnel for medical practitioners. There have been several issues with the illegal PA system in Korea facing medicosocial conflicts and crisis. Patients want to be diagnosed and treated by medically-educated, licensed and professionally trained physicians not PAs. In clinical settings, PAs deprive the training and educational opportunities of trainees such as interns and residents. Recently, there have been several attempts, by CEO or directors of major hospitals in Korea, to adopt and legalize this system without general consensus from medical professional associations and societies. Without such consensus, this illegal implementation of PA system will create new and additional very serious medical crises due to unlawful medical, educational, professional conflicts and safety issues in medical practice. Before considering the implementation of the PA system, there needs to be a convincing justification by solving the fundamental problems beforehand, such as the collapsed medical delivery system, protection and provision of optimal education program and training environment of trainees, burnout from excessive workloads of physicians with very low compensational system and poor conditions for working and education, etc.

The Korean Medical Association opposes the illegal attempt to implement the physician assistant (PA) system in Korea. The exact meaning of ‘PA’ in Korea at present time is ’Unlicensed Assistant (UA)’ since it is not legally established in our healthcare system. Thus, PA in Korea refers to unlawful, unqualified, auxiliary personnel for medical practitioners. There have been several issues with the illegal PA system in Korea facing medicosocial conflicts and crisis. Patients want to be diagnosed and treated by medically-educated, licensed and professionally trained physicians not PAs. In clinical settings, PAs deprive the training and educational opportunities of trainees such as interns and residents. Recently, there have been several attempts, by CEO or directors of major hospitals in Korea, to adopt and legalize this system without general consensus from medical professional associations and societies. Without such consensus, this illegal implementation of PA system will create new and additional very serious medical crises due to unlawful medical, educational, professional conflicts and safety issues in medical practice. Before considering the implementation of the PA system, there needs to be a convincing justification by solving the fundamental problems beforehand, such as the collapsed medical delivery system, protection and provision of optimal education program and training environment of trainees, burnout from excessive workloads of physicians with very low compensational system and poor conditions for working and education, etc.

BACKGROUND: The aim of this study was to investigate the influence of epidural clonidine on the BIS, and its potential dose-sparing effect on the sevoflurane requirement for maintaining the BIS 50. METHODS: Forty ASA I or II patients aged 20 to 65, undergoing lower abdominal, gynecologic surgery under general anesthesia, were randomly allocated to either a 10 ml epidural normal saline injection group (n = 20) or a 10 ml epidural clonidine 3microgram/kg mixed with normal saline injection group (n = 20). They received 5 mg/kg thiopental sodium and 0.1 mg/kg vecuronium bromide for induction, with no premedication. After surgical incision, the sevoflurane concentration was controlled to maintain the BIS 50. Epidural saline or clonidine was then injected and end-tidal sevoflurane concentration to maintain the BIS 50, the heart rate (HR) and mean arterial pressure (MBP) were measured every 5 min over a 20 minute period. RESULTS: The end-tidal sevoflurane concentration in the clonidine group decreased by 27.5% after the epidural clonidine injection (1.49 +/- 0.23 vol% vs. 1.08 +/- 0.27 vol%; P<0.05) compared with the saline group (1.36 +/- 0.18 vol% vs. 1.33 +/- 0.21 vol%; P>0.05). There were no changes in the heart rate and mean blood pressure in either group. CONCLUSIONS: Epidural clonidine causes a significant decrease in the BIS, and lowers the end-tidal sevoflurane concentration required for maintaining the BIS 50.
Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Clonidine* ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Humans ; Premedication ; Thiopental ; Vecuronium Bromide

BACKGROUND: Ischemic preconditioning (IPC) and propofol has been demonstrated to inhibit postischemic adhesion of PMNs on coronary vascular endothelium, respectively. The purpose of this study is to investigate whether IPC and propofol inhibit postischemic coronary vascular adhesion of PMNs synergistically. METHODS: Twenty-eight isolated rat hearts were subjected to stabilization for 15 min, perfusion for 15 min, global ischemia for 15 min and reperfusion for 60 min serially. The isolated hearts were divided into 4 groups as follows: control group, PMNs were infused for 1 min on 1 min after reperfusion following global ischemia; IPC group, IPC was performed before global ischemia and PMNs were infused as the same manner; PPF group, Propofol (0.3microgram/ml) was infused from perfusion until 5 min after reperfusion and PMNs were infused as the same manner; IPC/PPF group, IPC was performed before global ischemia and propofol was infused from perfusion until 5 min after reperfusion and PMNs were infused as the same manner. PMNs adhesion, heart rate, left ventricular developed pressure, dP/dt, coronary flow and creatinine kinase enzyme were measured. RESULTS: Postischemic PMNs adhesion was reduced in IPC, propofol, and IPC/PPF group compared to the control group (30.8 +/- 7.3%, 32.0 +/- 3.9%, 20.9 +/- 6.1% vs 75.7 +/- 6.3%, P <0.05, respectively). There were no significant differences in PMNs postischemic adhesion between IPC group and PPF group, respectively and IPC/PPF group. There were no significant differences in changes in HR, LVDP, dP/dt, CF and CK among the four group. CONCLUSIONS: These results suggest that IPC and propofol have no synergistic effect on reducing postischemic adhesion of PMNs.
Animals ; Creatinine ; Endothelium, Vascular ; Heart ; Heart Rate ; Ischemia ; Ischemic Preconditioning* ; Neutrophils* ; Perfusion ; Phosphotransferases ; Propofol* ; Rats ; Reperfusion ; Reperfusion Injury

BACKGROUND: We have hypothesized that, if a low resistant gravity-flow membrane oxygenator is used, then the twin blood sacs of TPLS can be located at downstream of the membrane oxyenator, which may double the pulse rate at a given pump rate and increase the pump output. The purpose of this study was to determine the optimal configuration for the ECLS circuits by using the concept of pulse energy and pump output. MATERIAL AND METHOD: Animals were randomly assigned to 2 groups in a total cardiopulmonary bypass model. In the serial group, a conventional membrane oxygenator was located between the twin blood sacs. In the parallel group, the twin blood sacs were placed downstream of the gravity-flow membrane oxygenator. Energy equivalent pressure (EEP) and pump output were collected at pump-setting rates of 30, 40, and 50 BPM. RESULT: At the given pump-setting rate, the pulse rate was doubled in the parallel group. Percent changes of mean arterial pressure to EEP were 13.0+/-1.7, 12.0+/-1.9 and 7.6+/-0.9% in the parallel group, and 22.5+/-2.4, 23.2+/-1.9, and 21.8+/-1.4% in the serial group at 30, 40, and 50 BPM of pump-setting rates. Pump output was higher in the parallel circuit at 40 and 50 BPM of pump-setting rates (3.1+/-0.2, 3.7+/-0.2 L/min vs. 2.2+/-0.1 and 2.5+/-0.1 L/min, respectively, p=0.01). CONCLUSION: Either parallel or serial circuit configuration of the ECLS generates effective pulsatility. As for the pump out, the parallel circuit configuration provides higher flow than the serial circuit configuration.
Animals ; Arterial Pressure ; Cardiopulmonary Bypass ; Heart Rate ; Humans ; Life Support Systems* ; Membranes ; Oxygenators, Membrane

No abstract available.
Airway Management* ; Humans ; Mandibulofacial Dysostosis*