For the purpose of effective utilization of donated blood with limited shelf life, the author investigated the transfusion data which were used for 778 patients who received 2,556 units of blood during the period from Jan. to Dec., 1988 in Pusan National University Hospital. The data were statistically studied and optimal guide line in elective surgery was established. The results were as follows. 1) In the period under study, transfusion ratio of each surgical department were from 37.6% to 83.6%. 2) Average CT ratio of elective surgical procedure was 1. 4 3) Number of crossmatched and transfused blood were about 4.7 units and 3.3 units by operating procedure in elective surgery, respectively. 4) The ratio of usage of blood component was 14.0%, and 120 of 778 transfused patients (15.4%) received a single unit transfusion. On the basis of these results and overviewed literature, it is summarized that established MSBOS & T & S order would be of value for decreasing in rate of outdating blood, overusage of blood, excessive crossmatching and laboratory costs.
Busan ; Humans ; Surgical Procedures, Elective

BACKGROUND: Ordering an excessive quantity of blood for elective surgery beyond the actual need causes unnecessary cross-matching and wastage or shortage of blood products. To prevent this problem, a maximum surgical blood order schedule (MSBOS) is beneficial. However, the application of a MSBOS is limited due to the complexity of accurate classification based on the name of the operation alone. In this study, we introduced an automatic cancellation program, in which the assigned blood is automatically cancelled after a certain period of time, andevaluated the practicality of a revised MSBOS. METHODS: We analyzed our hospital data involving transfused RBCs for each elective surgical procedure performed between January and June 2007. The MSBOS was organized based on the average number of units of RBCs transfused for the types of surgeries that had been performed >50 times during a certain period of time. The blood cancellation ratio, blood wastage ratio, and the causes of blood wastage were compared before and after adopting the automatic cancellation program and the revised MSBOS. RESULTS: After adopting the automatic cancellation program, the blood cancellation ratio decreased from 18.3% to 17.6% and the blood wastage ratio decreased from 2.67% to 2.00%. There was no significant change with respect to the causes of blood wastage before and after adoption of the automatic cancellation program. CONCLUSION: The implementation of an automatic cancellation program facilitates the efficient use of blood products during elective surgery. It would be useful to apply a revised MSBOS continuously, which is easily applicable and practical in order to decrease the blood wastage rate.
Adoption ; Appointments and Schedules ; Surgical Procedures, Elective

Preoperative mechanical bowel preparation (MBP) has been established as a standard procedure for elective colorectal surgery in most surgical centers since 1950s. However, the routine use of MBP for elective colorectal surgery is still in debate, as the researches on the evaluation of MBP have been carried out in recent 20 years. By searching and analyzing the existing evidence, we conclude that MBP should be routinely abandoned for elective open colorectal surgery, but should be routinely used for elective laparoscopic rectal surgery, and it still awaits large-scale RCTs for further evaluation of MBP for elective laparoscopic colonic surgery.
Colon ; Colorectal Surgery ; Elective Surgical Procedures ; Humans ; Laparoscopy ; Preoperative Care

COVID-19 ; Elective Surgical Procedures ; Humans ; Orthopedic Procedures ; Pandemics ; SARS-CoV-2

The changes in serum electrolytes that follow the administration of succinylcholine have been reported in numerous publications since the first description of hyperkalemia by Klupp et al in 1954. The changes in serum K+, Ca++ and Na+ after administration of succinylcholine, 2mg/kg, were compared in 3groups of 20 patients each to determine the effect of diasepam and d-Tubocurarine pretreatment on the elctrolyte level. Group l received succinylcholine 2mg/kg only; group ll diazepam 0.2mg/kg 3 minutes before succinylcholine; group lll 3mg d-Tubocurarine 3 minutes before succinylcholine. This investigation was limited to the first 10 minutes after induction on sixty, ASA class 1 patients undergoing elective surgical procedure. The results were as follows: 1) A significant increase of serum potassium concentration was observed at 4 minutes and 6 minutes in group l compared to baseline value(p<0.05). 2) Mean peak change ratio in serum potassium was significantly lower in group lll than group l (p<0.05). 3) There was no significant changes in serum concentration in 3 groups. 4) There was no significant changes in serum sodium concentration except for a decrease at 10 minutes in group l(p<0.05).
Diazepam* ; Electrolytes ; Humans ; Hyperkalemia ; Potassium ; Sodium ; Succinylcholine ; Surgical Procedures, Elective ; Tubocurarine*

BACKGROUND: This study is aimed to investigate the effect of tramadol on the bispectral index (BIS) during anesthesia with desflurane. METHODS: One hundred fifty adults, ASA class 1 and 2 patients, scheduled for general anesthesia for elective surgical procedures were included in this study. None of the patients were premedicated and anesthesia was induced with propofol 2 mg/kg and maintained with air-oxygen (FiO2 0.5) and desflurane, adjusted to keep the BIS between from 50 and 60. Forty minutes before completing surgery, the subjects were randomly allocated into 3 groups to receive saline (control group), tramadol 1.5 mg/kg (T1 group) or 3.0 mg/kg (T2 group) intravenously. Hemodynamics and BIS values were then recorded every 5 minutes until completion of the operation, during which time the concentrations of desflurane were not modified. RESULTS: The mean BIS values after tramadol administration weren't significantly different from the control group throughout the period of observation. No significant changes in the hemodynamics were noted, except systolic and diastolic arterial blood pressure in the T1 and T2 groups significantly increased in the first 5 minutes after the tramadol injection. CONCLUSIONS: The results indicate that the administration of tramadol while maintaining anesthesia with desflurane, adjusted to keep the BIS between 50 and 60, does not modified BIS values. So, we propose that tramadol can be safely administered as an immediate postoperative analgesia without concern about intra-operative awareness.
Adult ; Analgesia ; Anesthesia ; Anesthesia, General ; Arterial Pressure ; Hemodynamics ; Humans ; Isoflurane ; Propofol ; Surgical Procedures, Elective ; Tramadol

Central to the question of anesthetic risk is the definition of an anesthetic death. This has yet to be defined within any reasonable limits. A number of factual and philosophical considerations have complicated attempts to derive a precise definition. Anesthetic risk is largely confused with surgical risk, involving a second set of persons and procedures. Only events between induction of anesthesia and onset of operation clearly relate the risk of anesthesia to patient diseases and the causes of deaths during and after operation are usually speculative. Among those factors which relate to anesthetic risk; age, physical status, surgical area, anesthetic method, selection of anesthetic agent, inadequate preoperative preparation, improper decision and skill of anesthesiologist himself, and elective vs emergency operations are most important in minimizing the anesthetic risk. Furthermore, elective vs emergency operations relate more to anesthetic mortality than to other factors. Many emergency operations were practiced in our hospital, more than in other institutions. Thus, our anesthesiologists are faced with a higher incidence of anesthetic risks. Evaluated results were as follows; 1) The percentage of emergency operations was 57.4% of the total performed operations. 2) The mortality rate is significantly higher in emergency surgical procedures than in elective surgical procedures, 3) Frequent changing of the operation schedule may cause confusion in the anesthesiologist's decision on preparation and selection of the anesthetic agent and technique, and may also cause an increased workload.
Anesthesia ; Appointments and Schedules* ; Cause of Death ; Elective Surgical Procedures ; Emergencies ; Humans ; Incidence ; Methods ; Mortality

BACKGROUND: The image and status of anesthesiology as a medical specialty in the eyes of the general public has been a problem. This study assessed the patients' thoughts on anesthesiologists and their preoperative concerns and examined the influence of any previous anesthetic experience on their apprehension. METHODS: One hundred thirty-nine patients undergoing elective surgical procedures were surveyed with a questionnaire regarding their thoughts on anesthesiologists and their preoperative concerns at preoperative visits. The results were analyzed in terms of a previous experience with anesthesia. RESULTS: Sixty-five patients had previous experience with anesthesia (Group 1), and 74 patients had none (Group 2). Seventy-one percent of patients in Group 1 and 80% in Group 2 reported that a physician-anesthesiologist was in charge of their anesthesia. Regarding the responsibility for the patients' safety during the surgical procedures, 83% of patients in Group 1 and 82% in Group 2 reported that the anesthesiologists were responsible for the patients' well-being. Fifty-seven percent of patients in Group 1 and 58% in Group 2 reported that the anesthesiologists were responsible for their safe recovery from the anesthesia. The most frequent preoperative apprehensions were postoperative pain (57% in Group 1 and 62% in Group 2) and the risk of not waking up from the anesthesia (60% in Group 1 and 57% in Group 2). There were no significant differences between the two groups. CONCLUSIONS: Passive learning from previous anesthetic experience does not affect the patients' thoughts on the anesthesiologists and their preoperative concerns.
Anesthesia* ; Anesthesiology ; Humans ; Learning ; Pain, Postoperative ; Surveys and Questionnaires ; Surgical Procedures, Elective

OBJECTIVETo identify the incidence and risk factors of perioperative major adverse cardiac events (MACE) in elderly patients with coronary heart disease (CHD) undergoing non-cardiac surgery.

METHODSWe prospectively analyzed the clinical data of 360 CHD patients who aged 75 years or older undergoing elective intermediate-to high-risk surgery in five medical centers across China from January 2008 to January 2010. The clinical variables included the 12-lead ECG and Troponin I levels after surgery. The combined outcome was defined as all the perioperative MACE in hospital. The risk factors of MACE and their indexes were analyzed with univariate analysis and multivariable logistic regression in SPSS software,together with a risk scoring and stratification system established.

RESULTSPerioperative MACE occurred in 11.94% of elderly CHD patients undergoing non-cardiac surgery. Seven independent risk factors of perioperative MACE for this population were identified,which included angina within 6 months (P=0.001), hypertension(P=0.014), preoperative haematocrit (HCT) <40% (P=0.050), serum creatinine (Scr)>150 mmol/L (P=0.014), ejection fraction(EF) <50% (P=0.019), intraoperative hyoxemia (P=0.019), and operative time>150 min (P=0.001). The risk indexes of these factors were 4,3,3,6,4,5, and 4, respectively. The rate of perioperative MACE increased significantly as the level of risk stratification elevated.

CONCLUSIONSElderly CHD patients undergoing non-cardiac surgery are at high risk of perioperative MACE. Angina within 6 months,hypertension, preoperative HCT<40%, Scr>150 mmol/L, EF<50%, intraoperative hyoxemia, and operative time>150 min can increase the risk of MACE. The risk scoring and stratification system based on the risk factor index can be a valuable parameter for assessing the perioperative cardiac risk of noncardiac surgery for elderly CHD patients.

Aged ; China ; Coronary Disease ; Elective Surgical Procedures ; Electrocardiography ; Humans ; Incidence ; Logistic Models ; Perioperative Care ; Risk Factors

Arterial blood pressure, pulse rate and rate pressure product changes following tracheal intubation were studied in 50 patients undergoing elective surgical procedures who received a thiopental-succinylcholine anesthetic intubation sequence. Three treatment groups and a control group were observed. Intravenous labetalol doses of 0.25 mg/kg, 0.5 mg/kg and 1.0 mg/kg, injected prior to anesthesia, were compared with respect to their effect on the cardiovascular sequences to direct laryngoscopy followed by the passage of an endotraeheal tube. The increases in heart rate and rate-pressure product associated with tracheal intubation were significantly prevented in labetalol treated patients, significantly. The increase in arterial pressure was prevented, insignificantly. However, it was dose-dependent. From the above result, a pre-induction dose of labetalol was effective in attenuating the pressure response to laryngoscopy and intubation.
Anesthesia ; Arterial Pressure ; Heart Rate ; Humans ; Intubation ; Intubation, Intratracheal* ; Labetalol* ; Laryngoscopy* ; Surgical Procedures, Elective