In the Dept. of Thoracic Surgery, Korea University Hospital, Preoperative diagnosis as Ebstein anomaly was made on the 11-year old female through the preoperative examination including right cardioangiography and the Glenn Operation was performed to this patients as palliative treatment. During closure of the thoracic wall just after the anastomosis of S.V.C. and right pulmonary artery, sudden cardiac arrest developed. One day later after death, autopsy was performed in order to confirm the pathologic anatomy of the cardiac anomaly and to clarify the cause of death. Pathologic anatomy of the heart revealed the huge dilatation of right atrium, Patent Foramin Ovale, and the deformed and descended posterior and the septal leaflets of tricuspid value by which right ventricle was devided into the atrialized and the functional portion. The diagnosis of the autopsy showed (1) Ebstein Anomaly (2) bilateral total atelectasis of the lung, (3) multiple petechial hemorrhage and edema of the myocardium, brain and liver due to acute hypoxia, (4) fibrocaseous tuberculosis of the liver and tuberculous pericholangitis.
Anoxia ; Autopsy ; Brain ; Cause of Death ; Child ; Death, Sudden, Cardiac ; Diagnosis ; Dilatation ; Ebstein Anomaly* ; Edema ; Female ; Heart ; Heart Atria ; Heart Ventricles ; Hemorrhage ; Humans ; Korea ; Liver ; Lung ; Myocardium ; Palliative Care ; Pulmonary Artery ; Pulmonary Atelectasis ; Thoracic Surgery ; Thoracic Wall ; Tuberculosis

PURPOSE: This study was done to examine perioperative nurses' perception of the definitions and causes of nursing errors; the relationships among emotional distress, coping strategies, and changes in practice as a result of errors. METHODS: A descriptive, correlative design was used with a sample of 146 nurses working in the operating room of a university hospital. Data were collected using a self-report questionnaire with 4 point Likert scales. For the analysis, t-test, ANOVA, Scheffe's post hoc test and multiple regression analysis were used. RESULTS: Most nurses recognized themajority of the items as perioperative nursing errors. Job overload was perceived as the cause of errors. Emotional distress was significantly related with nurses' age, position and years of work experience. The coping strategies used most frequently were 'accepting responsibility' and 'planful problem solving'. The coping strategies of 'accepting responsibility', 'planful problem solving', 'seeking social support', and 'using self-control' were significant predictors in constructive practice change. Defensive changes were related to the strategy of escape/avoidance and emotional distress. CONCLUSION: The results of this study suggest that intervention strategies should be developed to decrease perioperative nurses'distress and improve their coping strategies resulting in constructive change in practice after committing an error.
Medical Errors ; Nursing* ; Operating Rooms ; Perioperative Nursing ; Surveys and Questionnaires ; Weights and Measures

Disseminated intravascular coagulation (DIC) is a pathological syndrome in which activation of coagulation cascade leads to fibrin clot formation, consumption of platelets and coagulation factors, and secondary fibrinolysis. We report a case of severe postoperative hemorrhagic diathesis due to DIC. A 59-year-old man was scheduled for reduction of tibia fracture and anatrophic nephrolithotomy of staghorn calculi. On the fifth postoperative day, second operation was performed for nephrectomy due to perirenal hematoma. Two days later, third operation was performed for hemostasis because of the continuous bleeding. Coagulation tests showed positive DIC profiles of thrombocytopenia, hypofibrinogenemia, increased fibrin degradation products, and prolonged prothrombin time and thrombin time. The patient recovered uneventfully and discharged on the 59th postoperative day.
Blood Coagulation Factors ; Calculi ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Fibrin ; Fibrin Fibrinogen Degradation Products ; Fibrinolysis ; Hematoma ; Hemorrhage* ; Hemorrhagic Disorders ; Hemostasis ; Humans ; Middle Aged ; Nephrectomy ; Postoperative Complications ; Prothrombin Time ; Thrombin Time ; Thrombocytopenia ; Tibia

BACKGROUND: The purpose of this study was to compare prospectively two different anesthetic techniques with isoflurane or propofol for postoperative nausea, vomiting and recovery after tonsillectomy in children. METHODS: Sixty children, ASA physical status I, were assigned randomly to one of two groups. In group I, anesthesia was induced with thiopental 5 mg/kg and maintained with isoflurane 1~1.5 vol%. In group P, anesthesia was induced with fentanyl 1 mcg/kg, propofol 2 mg/kg and maintained with propofol infusion 5~10 mg/kg/hr. Both group received vecuronium 0.1 mg/kg for tracheal intubation and were ventilated with 33% O2 in N2O. The time to extubation, time to eye opening, PACU time, incidence and numbers of postoperative nausea and vomiting, and degree of sedation were recorded as well as perioperative complications. RESULTS: There were no significant difference in the duration of anesthesia and PACU time between two groups. The time to extubation and eye opening of group P were significantly shorter than group I (p<0.05). The degree of sedation and incidence of postoperative nausea and vomiting of group P were significantly lower than group I (p<0.05). But the frequency of intraoperative bradycardia was significantly higher in group P than group I (p<0.05). CONCLUSIONS: Propofol-fentanyl anesthesia results in less nausea and vomiting during postoperative period and more rapid recovery compared to isoflurane anesthesia and may be recommended in children undergoing tonsillectomy and adenoidectomy.
Adenoidectomy ; Anesthesia* ; Bradycardia ; Child* ; Fentanyl ; Humans ; Incidence ; Intubation ; Isoflurane* ; Nausea ; Postoperative Nausea and Vomiting* ; Postoperative Period ; Propofol* ; Prospective Studies ; Thiopental ; Tonsillectomy* ; Vecuronium Bromide ; Vomiting*

Postoperative hypertension occurs often in hypertensive patients due to pain, hypercapnia, hypoxemia, or excessive intravascular fluid volume. In addition, tracheal extubation exacerbates hypertension and tachycardia, which leads to left ventricular failure, myocardial infarction, or cerebral hemorrhage. We experienced a case of recurrent intracerebral hemorrhage after extubation in the postanesthetic care unit. The patient was 50-year old female who underwent total abdominal hysterectomy. Three months ago, she suffered a hypertensive cerebral hemorrhage with conservative treatment. Anesthesia induction and intraoperative course were relatively uneventful. In the postanesthetic care unit, she had voluntary movement of all limbs to command and fully awake consciousness. Immediately after tracheal extubation, the blood pressure was increased sharply to 200/110 mmHg. After then, the patient's mental status was deteriorated and the motor weakness of left extremities was developed. Brain CT showed a hypertensive hemorrhage at the right putamen and emergency stereotaxic aspiration was performed. After rehabilitative treatment, the patient was discharged with alert mental status and moderate improvement of motor weakness.
Airway Extubation ; Anesthesia ; Anoxia ; Blood Pressure ; Brain ; Cerebral Hemorrhage* ; Consciousness ; Emergencies ; Extremities ; Female ; Hemorrhage ; Humans ; Hypercapnia ; Hypertension ; Hysterectomy ; Intracranial Hemorrhage, Hypertensive ; Middle Aged ; Myocardial Infarction ; Putamen ; Tachycardia

Nowdays the number of geriatric patients has increased gradually and the risk for anesthesia and surgery is poor compared with younger patients because of chronic systemic diseases and aging of physiologic function. We analyzed 982 cases of geriatric anesthesia patients aged over 65 years performed at Presbyterian Medical Center from January 1992 to December 1993. The patients were evaluated according to age, sex, preoperative physical status, preoperative laborative findings, concurrent illness, anesthetic consult, department, operation site, anesthesia type, duration of anesthesia, intraoperative events, postoperative complications and mortality. The results were as follows; 1) The number of the cases older than 65 years was 982 cases(8.4%) out of total 11,629 cases. There were 548 cases(55.8%) of male and 434 cases(44.2%) of female. 2) By the classification of physical status of American Society of Anesthesiologist, the most common evidence was class 2 in 587 cases(59.8%) and emergency operation was performed in 237 cases(24.1%). 3) 520 cases(53.0%) had concurrent illness and hypertension was most common in 129 cases(24.8%). 4) Preoperative anesthetic consult was performed in 421 cases(42.9%) and the frequent consult problem was cardiovascular in 155 cases(36.8%). 5) The most common department and operation site was general surgery in 461 cases(47.0%), lower abdominal region in 265 cases(27.0%) respectively. 6) The anesthetic technique employed was usually general anesthesia; 710 cases(72.3%). 7) The intraoperative events and postoperative complications were revealed in 244 cases(24.8%), 225 cases (22.9%) respectively and hypertension was leading problem. 8) Overall mortality rate was 1.9%(19 cases). The mortality rate was 0.7% in elective cases and 5.9% in emergency cases. In conclusion, anesthesiologists should attention to perioperative management of geriatric patients to decrease the morbidity and mortality.
Aging ; Anesthesia* ; Anesthesia, General ; Classification ; Emergencies ; Female ; Humans ; Hypertension ; Male ; Mortality ; Postoperative Complications ; Protestantism

Patients with severe hypertension present the anesthesiologist with considerable difficulty. Without adequate treatment, serious problems may develop including myocardial ischemia or infarction, cerebral thrombosis or hemorrhage and renal damage during perioperative periods. However, drug interactions between antihypertensives and anesthetics may also be severe enough to produce synergistic bradycardia and hypotension. We have experienced managing a case with severe bradycardia and hypotension following halothane induction in a patient receiving beta-adrenergic blocker. This case illustrates the drug interaction between beta-adrenergic blocker and halothane.
Adrenergic Antagonists* ; Anesthetics ; Antihypertensive Agents ; Bradycardia* ; Cerebral Infarction ; Drug Interactions ; Halothane* ; Hemorrhage ; Humans ; Hypertension ; Hypotension* ; Myocardial Ischemia ; Perioperative Period ; Thrombosis

Postoperative nausea and vomiting is a troublesome problem in pediatric patients undergo- ing strabismus surgery. We compared the effects of ondansetron with those of droperidol and placebo within the 24hrs postoperative period. 54 children, who admitted to Presbyteri- an Medical Center to receive strabismus operations, with ASA physical status 1, were as- signed to one of three groups according to uncontrolled parallel comparative study design. A standard anesthetic technique consisting of thiopental-vecuronium for induction and N2O-O2-enflurane for maintenance of anesthesia was used. The data showed that ondansetron 0. 067mg/kg i.v. before induction was significantly more effective in preventing emesis (n=19, 100%) than placebo(n=17, 58.8%). But, there was no significant difference between droperidol group and placebo group. In conclusion, ondansetron(0.067mg/kg) given intravenously before induction to prevent postoperative nausea and vomiting in patients undergoing elective strabismus surgery in children was effective.
Anesthesia ; Child* ; Droperidol* ; Humans ; Nausea ; Ondansetron* ; Postoperative Nausea and Vomiting* ; Postoperative Period ; Strabismus* ; Vomiting

BACKGROUND: We assessed the effectiveness of arthroscopic capsular release for the treatment of adhesive capsulitis. Further, we tried to ascertain the clinical benefits, if any, of pancapsular release over selective capsular release, where the two differ by performing or not performing a posterior capsular release, respectively. METHODS: Thirty-five consecutive patients with either primary or secondary adhesive capsulitis who failed conservative treatment for more than 6 months were enrolled in the study. A total of 16 patients allocated in group 1 received a pancapsular release that comprises the release of the rotator interval, anteroinferior capsular, and the posterior capsular release, whereas 19 patients in group 2 received a selective capsular release that comprises only the release of the rotator interval release and anteroinferior capsular release. The clinical outcomes, visual analogue scale (VAS) score, Constant score, and range of motion, were assessed preoperative and postoperatively. RESULTS: In both groups, the preoperative VAS score, Constant score, and ROM showed a significant improvement by the 6-month follow-up. We found that the immediate postoperative internal rotation was significantly higher in group 1 than group 2. Despite significant differences seen between the two groups at the initial postoperative period, there were no significant differences in Constant score, VAS score, and the ROM at all the subsequent follow-ups between the two groups. CONCLUSIONS: Arthroscopic capsular release for the treatment of adhesive capsulitis is very effective. However, pancapsular release did not show any advantage over selective capsular release in terms of overall clinical outcome.
Bursitis* ; Follow-Up Studies ; Humans ; Joint Capsule Release* ; Postoperative Period ; Range of Motion, Articular

Primary germ cell tumor of the testis is rare, which occupies 1 to 2% of all reported malignant male neoplasms. Combined primary germ cell tumor of the testis composed of embryonal carcinoma and seminoma is more rare tumor. The authors experienced a case of 50-year old male who presented with painless enlargement of right testicle. He has had radical orchiectomy and diagnosed by pathologically as combined germ cell tumor of testis. The testicle is measuring 180 gm in weight and 9×6×5 cm in dimension, and almostly replaced by tumor mass. Grossly the tumor is rubbery solid smooth tumor mass, with variegated cut surface with geographically outlined diffuse necrotic area. Histologically the tumor is composed of two components of tumor, which are solid growth pattern of large round to polyhedral cells with clear or granular cytoplasm and distinct cell border, and anastomosing glandular and papillary arrangement of anaplastic epithelial cells. The former corresponds to seminoma, and the latter to embryonal carcinoma. Each tumor lobule is separated by abundant fibrous stroma.
Carcinoma, Embryonal ; Cytoplasm ; Epithelial Cells ; Germ Cells* ; Humans ; Male ; Neoplasms, Germ Cell and Embryonal* ; Orchiectomy ; Seminoma ; Testis*