PURPOSE: The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and its Portsmouth modification (P-POSSUM) are comprehensive assessment methods for evaluating patient and surgical factors widely used to predict 30-day mortality rates. In this retrospective study, we evaluated the usefulness of POSSUM and P-POSSUM in predicting 30-day mortality after intraoperative cardiac arrests in adult patients undergoing non-cardiac surgery. MATERIALS AND METHODS: Among 190486 patients who underwent anesthesia, 51 experienced intraoperative cardiac arrest as defined in our study protocol. Predicted mortality rates were calculated using POSSUM and P-POSSUM equations and were compared with actual outcomes using exponential and linear analyses. In addition, a receiver operating characteristic curve analysis was undertaken, and area-under-the-curve (AUC) values with confidence intervals (CIs) were calculated for POSSUM and P-POSSUM. RESULTS: Among the 51 patients with intraoperative cardiac arrest, 32 (62.7%) died within 30 days postoperatively. The overall predicted 30-day mortality rates using POSSUM and P-POSSUM were 65.5% and 57.5%, respectively. The observed-to-predicted (O:E) ratio for the POSSUM 30-day mortality was 1.07, with no significant difference between the observed and predicted values (chi2=4.794; p=0.779). P-POSSUM predicted mortality equally well, with an O:E ratio of 1.10 (chi2=8.905; p=0.350). AUC values (95% CI) were 0.771 (0.634-0.908) and 0.785 (0.651-0.918) for POSSUM and P-POSSUM, respectively. CONCLUSION: Both POSSUM and P-POSSUM performed well to predict overall 30-day mortality following intraoperative cardiac arrest in adults undergoing non-cardiac surgery at a university teaching hospital in Korea.
Adult ; Aged ; Female ; Heart Arrest/*complications/mortality ; Humans ; Incidence ; Intraoperative Complications/*mortality ; Male ; Middle Aged ; Morbidity ; Postoperative Period ; ROC Curve ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Assessment/*methods ; *Severity of Illness Index ; Surgical Procedures, Operative/*mortality

PURPOSE: Dexmedetomidine, a potent selective alpha2-adrenergic agonist, produces sedation and analgesia. This study was conducted to assess the effect of dexmedetomidine infusion on sevoflurane requirements, recovery profiles, and emergence agitation in children undergoing ambulatory surgery. MATERIALS AND METHODS: Forty children undergoing ambulatory hernioplasty or orchiopexy were randomized into two groups. The dexmedetomidine group (Group D, n=20) received dexmedetomidine 1 microg/kg, followed by 0.1 microg/kg/h until the end of surgery, whereas the saline group (Group S, n=20) received volume-matched normal saline. Sevoflurane was used for induction and maintenance of anesthesia and caudal block was performed in all children. End-tidal sevoflurane concentration (ET-sevo), the incidence of emergence agitation, pain scores, and sedation scores were recorded. Hemodynamic changes and other adverse effects were assessed in the perioperative period. RESULTS: ET-sevo of Group D was significantly reduced in 23.8-67% compared to Group S during surgery. The incidence of emergence agitation was lower in Group D than in Group S (5% vs. 55%, p=0.001). Postoperative pain was comparable, and discharge time was not different between the groups. Mean arterial pressure and heart rate were significantly lower in Group D during surgery. CONCLUSION: Intraoperative infusion of dexmedetomidine reduced sevoflurane requirements and decreased emergence agitation without delaying discharge in children undergoing ambulatory surgery. However, caution should be taken in regard to bradycardia and hypotension.
Adolescent ; Adult ; Ambulatory Surgical Procedures/*methods ; Child ; Dexmedetomidine/*therapeutic use ; Female ; Hemodynamics/drug effects ; Humans ; Male ; Methyl Ethers/*therapeutic use ; Psychomotor Agitation/drug therapy ; Young Adult

Although single-shot caudal blockade is known as a relatively safe procedure, it is not always without complications. We present a case of accidental bladder puncture that was identified with fluoroscopy by chance after single-shot caudal blockade in a 17-months-old, 12 kg boy who underwent inguinal hernioplasty.
Child ; Fluoroscopy ; Herniorrhaphy ; Humans ; Punctures ; Urinary Bladder

BACKGROUND AND OBJECTIVES: Pain control is one of the most important factors for the patients that underwent the snoring surgery. This study was performed to investigate the effectiveness of intravenous patient-controlled analgesia (PCA) for postoperative pain control after tonsillectomy with laser resection of palatopharynx. MATERIALS AND METHODS: In this double-blind randomized study, 44 patient were randomly allocated to 2 groups. In the PCA group comprising 32 patients, fentanyl citrate, ketorolac tromethamine and zofran in normal saline solution were administered by PCA equipment. In the control group comprising 12 patients, normal saline solution was given without analgesic drug by PCA equipment. Visual analogue pain score (VAS) was recorded right after surgery and 2, 4, 6, 12, 18, and 24 hours after surgery and satisfaction score was recorded just before discharge from the hospital. RESULTS: VAS was significantly higher in the control group of all time points. Overall satisfaction score was also higher in PCA group than control group. CONCLUSION: The results of this study suggest that intravenous PCA is an effective method for postoperative pain control after tonsillectomy with laser resection of palatopharynx.
Analgesia, Patient-Controlled* ; Fentanyl ; Humans ; Ketorolac Tromethamine ; Ondansetron ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Snoring ; Sodium Chloride ; Tonsillectomy*

BACKGROUND: The aim of this study was to compare the accuracy of the position of the epidural catheter inserted from three different lumbar intervertebral spaces, L2-3, L3-4, and L4-5, in infants and children. METHODS: Seventy-five children were randomly allocated to 3 groups according to the epidural catheter insertion site (L2-3, L3-4, and L4-5). The epidural catheter tip was identified using 50% diluted Iohexol and fluoroscopy. The incidence of correct position was compared among the groups and between infants and children. RESULTS: The incidence of correct position was significantly higher in the L2-3 group as compared to the L3-4 and L4-5 groups (P = 0.023 and P = 0.046 respectively). The incidence of correct position was higher in infants compared to children (P = 0.017). CONCLUSIONS: The L2-3 intervertebral space is preferable during epidural catheter insertion in children older than 1 year, but a low lumbar level should be considered in infants because they have a higher risk of neural damage.
Analgesia, Epidural ; Catheters ; Child ; Fluoroscopy ; Humans ; Incidence ; Infant ; Iohexol ; Pediatrics

BACKGROUND: As the frequency of colonoscopic approaches increases, we need a less painful premedication for colonoscopy. We used midazolam as a premedication agent. It has more rapid onset of action than that of diazepam and its duration is shorter. The purpose of this study was to examine the clinical application of midazolam. METHODS: Fifty patients underwent colonoscopies. An average dose of midazolam, 0.07 mg/kg, was given to patients intravenously as premedication. We measured systolic and diastolic blood pressures, pulse rates, respiratory rates, and oxygen saturation (SaO2) using pulse oxymetry before and after the injection. A Trieger test was accomplished before and after the procedures. We examined the levels of consciousness with verbal and physical stimulation during the colonoscopy. The examiners noted the degree of amnesia and pain after colono-scopy. We examined the patients' satisfaction and endoscopists' assessments. RESULTS: 1) Systolic, diastolic blood pressures and respiratory rates showed no significant changes. But, pulse rates increased meaningfully at 15 minutes after the injection of midazolam (p <0.05). 2) The Trieger test showed meaningfully increased numbers of missed dots after the injection of midazolam. 3) The levels of consciousness during the test showed alertness in 22 patients (44%), drowsy mentality in 22 patients (44%) and stuporous mentality in 6 patient (12%). 4) The degree of amnesia after examination showed recall in 26 patients (52%), partial recall in 10 patients (20%) and total amnesia in 14 patients (28%). 5) Forty-five patients (90%) acknowledged this procedures to be more comfortable than previous procedures. CONCLUSIONS: Midazolam stabilized vital signs and oxygen saturation, therefore midazolam can be used safely as premedication for colonoscopy. Thirty-six patients (72%) recalled the procedures totally or partially. But, the relief of pain compared favorably to the degree of amnesia. We concluded that mida-zolam (0.07 mg/kg) was the safe and effective premedication for colonoscopy.
Amnesia ; Colonoscopy* ; Consciousness ; Diazepam ; Heart Rate ; Humans ; Midazolam* ; Oxygen ; Physical Stimulation ; Premedication* ; Respiratory Rate ; Stupor ; Vital Signs

BACKGROUND/AIMS: Colonoscopic surveillance is currently recommended after polypectomy owing to the risk of newly developed colonic neoplasia. However, few studies have investigated colonoscopy surveillance in Asia. This multicenter and prospective study was undertaken to assess the incidence of advanced adenoma based on baseline adenoma findings at 3 years after colonoscopic polypectomy. METHODS: A total of 1,323 patients undergoing colonoscopic polypectomy were prospectively assigned to 3-year colonoscopy surveillance at 11 tertiary endoscopic centers. Relative risks for advanced adenoma after 3 years were calculated according to baseline adenoma characteristics. RESULTS: Among 1,323 patients enrolled, 387 patients (29.3%) were followed up, and the mean follow-up interval was 31.0±9.8 months. The percentage of patients with advanced adenoma on baseline colonoscopy was higher in the surveillance group compared to the non-surveillance group (34.4% vs. 25.7%). Advanced adenoma recurrence was observed in 17 patients (4.4%) at follow-up. The risk of advanced adenoma recurrence was 2 times greater in patients with baseline advanced adenoma than in those with baseline non-advanced adenoma, though the difference was not statistically significant (6.8% [9/133] vs. 3.1% [8/254], P=0.09). Advanced adenoma recurrence was observed only in males and in subjects aged ≥50 years. In contrast, adenoma recurrence was observed in 187 patients (48.3%) at follow-up. Male sex, older age (≥50 years), and multiple adenomas (≥3) at baseline were independent risk factors for adenoma recurrence. CONCLUSIONS: A colonoscopy surveillance interval of 3 years in patients with baseline advanced adenoma can be considered appropriate.
Adenoma ; Asia ; Colon ; Colonic Polyps ; Colonoscopy ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Male ; Prospective Studies ; Recurrence ; Risk Factors