BACKGROUND: The purpose of this study was to evaluate the historical anesthetic trends for last 35 years at Chonnam National University Hospital (CNUH). METHODS: The anesthetic records of total 101,637 anesthetic cases performed at CNUH from January 1961 to December 1996 were reviewed and analyzed according to age, sex, department, operation site, physical status, preoperative findings, anesthetic methods and agents, duration of operation, etc. RESULTS: Annual anesthetic cases was increased remarkably year by year; annual surgical patients increased 19 times for 35 years. The ratio of male to female was 1.18:1. The percent of geriatric anesthesia was increased year by year. In preoperative physical status from ASA definitions, 83.6 % of total patients was assigned class I and II. The average departmental distributions in descending order were surgery, orthopedic surgery, obstetrics and gynecology, neurosurgery, urology, ENT, thoracic surgery, ophthalmology, plastic surgery, oral and maxillofacial surgery, and others. The distributions of operation site in descending order were lower abdomen, neck, upper abdomen, lower extremities, head, chest, spine, upper extremities, and breast. Inhalational anesthesia was the most frequent used methods. Ether was abandoned from 1983, and major volatile anesthetics was halothane from 1981 to 1991. The use of enflurane has steadily increased and isoflurane has also been used with increasing frequency since 1992. CONCLUSIONS: Anesthetic cases are markedly increased year by year, and major volatile anesthetics and neuromuscular blocker were changed from halothane to enflurane and from pancuronium to vecuronium, respectively.
Abdomen ; Anesthesia ; Anesthetics ; Breast ; Enflurane ; Ether ; Female ; Gynecology ; Halothane ; Head ; Humans ; Isoflurane ; Jeollanam-do* ; Lower Extremity ; Male ; Neck ; Neuromuscular Blockade ; Neurosurgery ; Obstetrics ; Ophthalmology ; Orthopedics ; Pancuronium ; Retrospective Studies* ; Spine ; Surgery, Oral ; Surgery, Plastic ; Thoracic Surgery ; Thorax ; Upper Extremity ; Urology ; Vecuronium Bromide

A retrospective analyis was performed on 12,212 pediatric patients who had received operations from 1986 to 1988 in eight operating rooms, Seoul National University Childrens Hospital (SNUCH). The average distribution of the patient by department in descending order was pediatric surgery 24%, cardiothoracic surgery 17%, orthopedic surgery 16%, otolaryngology 13%, plastic surgery 11%, ophthalmology 10%, urology 8%, neurosurgery 3% and others 0.2%. Ophthalmology and urology share one operating room each other, why they have some limitations in performing operations. Total number of operations showed increasing tendency; 3,285 in 1986, 4,185 in 1987 and 4,742 in 1988, which were 27.4% increase in 1987 and 13.3% increase in 1988, compared with the previous year. The average age distribution in descending order was 42% in group between 2 and 5 years, 29% in group between 6 and 10 years, 13% in group between 1 month and 1 year, and over 10 years respectively and 3% in group under 1 month. The male to female ratio was 62% to 38%. Elective and emergency surgeries comprised 92.6% and 7.4%, respectively. Emergency pediatric surgery was the highest in number (16.4% of all surgeries and 48.9% of all emergency surgeries performed in the pediatric operating rooms). Pediatric operating room utility ratios for each departments increased year by year, especially utility ratios for ophthalmology and orthopedic surgery were 118% and 115%, respectively. The number of patients supported by medical insurance showed also increasing tendency; 72.5% in 1986, 74.1% in 1987 and 80.8% in 1988.
Age Distribution ; Child ; Emergencies ; Female ; Humans ; Insurance ; Male ; Neurosurgery ; Operating Rooms ; Ophthalmology ; Orthopedics ; Otolaryngology ; Retrospective Studies ; Seoul ; Surgery, Plastic ; Urology

The contribution of anesthesia has been one of the major factors in developing surgical procedures at present. Now anesthesia is an essential part for surgery. Understanding of anesthesia is necessary for the surgeon to do his uaual job and to solve anesthetic problems where the anesthesiologist is absent. Because of these necessities. several surgical departments have sent their residents for several months for rotation through anesthesiology although it is not long enough to learn and understand anesthesia practices. In 1975 we made a special form to evaluate the residents and have collected these from 1977 until 1985. Now we analyzed and evaluated these protocols. The number of residents rotating through our department in the last nine years were 174. Residents from obstetrics and gynecology were accounted for the greatest number and the decreasing order was general surgery, oral surgery(dental part), plastic surgery, orthopedic surgery, neurosurgery, and the urology department. The distribution of residents by their residential year of training numbered as follows: the 1st residential year numbered 122(70%), the 2nd 45(26%), the 3rd(4%), and there was none from the 4th residential grade. The number of anesthesias performed for the 9 years were 14,632 and the ratio between general and regional anesthesia was 10:l. All residents had thoughts that the rotation was very valuable(59%) and valuable(39%) totaling(98%). They wanted more chances to give regional anesthesia.
Anesthesia ; Anesthesia, Conduction ; Anesthesiology* ; Gynecology ; Neurosurgery ; Obstetrics ; Orthopedics ; Surgery, Plastic ; Urology

A analysis was performed on 1716 pediatric surgical patients, who were supposed to receive elective operations at Seoul National University Childrens Hospital from March 2, 1991 to June 29, 1991. The results can be summarized as follows; 1) Overall cancelled ratio was 19.6%. 2) Departmental distribution of delayed/cancelled elective operations, Plastic surgery 27.0%, pediatric surgery 26.1%, neurosurgery 20.3%, cardiothoracic surgery 18.1%, orthopedic surgery 18.0%, ENT 15.6 ophthalmology 13.9% and urology 13.8%. 3) Major causes of delay/cancellation of elective operatios; Abnormal history and physical examination 54.3 , non-medical 35.0% and abnormal laboratory data only 10.7%. 4) Detailed causative factors of delay/cancellation of elective operations, URI 30.6%, notadmitted 27.9%, heavy schedule 5.9%, abnormal LFT 5.3%, FUO 4.2%, abnormal PTT/PT 2.4%, arrhythmia and cardiac disease 2.4% and further diagnostic evaluation needed 1.8%.
Appointments and Schedules ; Arrhythmias, Cardiac ; Child ; Heart Diseases ; Humans ; Neurosurgery ; Ophthalmology ; Orthopedics ; Physical Examination ; Seoul ; Surgery, Plastic ; Urology

The purpose of a conculation is to seek the opinions and advice of those whom we recognize to be more expert in a particular field of medicine than we are. Most surgeons regard the anesthesiolgist as a conculatant. Thus we analyzed 308 cases of interdepartmental consulatation submitted to our department from June 1991 to Novermber 1991. All case were elective ones and emergent cases were excluded. The analysis were as follow. 1) The overall conculation rate were 11.5%. 2) The highest rate of consultation were requested from orthopedic surgery department(29.9%) followed by ophthalmology department(25.0%), neurosurgery department(24.6%) and urology department(13.4%). 3) Male was 42.8% and female was 57.2%. 4) Most requestered problem was hepatic diseases including elevated transaminase, hepatitis and liver cirrhosis(35.1%) and then cardiovascular problem was 20.5%. 5) Because of our opinion, 22 cases were postponed. 6) Consultation rate increased according to advancing of age.
Female ; Hepatitis ; Humans ; Liver ; Male ; Neurosurgery ; Ophthalmology ; Orthopedics ; Urology

BACKGROUND: Simulation training is becoming an increasingly important component of skills acquisition in surgical specialties, including Plastic Surgery. Non-living simulation models have an established place in Plastic Surgical microsurgery training, and support the principles of replacement, reduction and refinement of animal use. A more sophisticated version of the basic chicken thigh microsurgery model has been developed to include dissection of a type 1-muscle flap and is described and validated here. METHODS: A step-by-step dissection guide on how to perform the chicken thigh adductor profundus free muscle flap is demonstrated. Forty trainees performed the novel simulation muscle flap on the last day of a 5-day microsurgery course. Pre- and post-course microvascular anastomosis assessment, along with micro dissection and end product (anastomosis lapse index) assessment, demonstrated skills acquisition. RESULTS: The average time to dissect the flap by novice trainees was 82±24 minutes, by core trainees 90±24 minutes, and by higher trainees 64±21 minutes (P=0.013). There was a statistically significant difference in the time to complete the anastomosis between the three levels of training (P=0.001) and there was a significant decrease in the time taken to perform the anastomosis following course completion (P<0.001). Anastomosis lapse index scores improved for all cohorts with post-test average anastomosis lapse index score of 3±1.4 (P<0.001). CONCLUSIONS: The novel chicken thigh adductor profundus free muscle flap model demonstrates face and construct validity for the introduction of the principles of free tissue transfer. The low cost, constant, and reproducible anatomy makes this simulation model a recommended addition to any microsurgical training curriculum.
Animals ; Chickens* ; Cohort Studies ; Curriculum ; Education ; Microsurgery* ; Plastics ; Simulation Training* ; Specialties, Surgical ; Surgery, Plastic ; Thigh*

A retrospective analysis was performed on 461 pediatric patients under one year of age who had received operation from 1983 to 1990 in department of anesthesiology of Ewha Womans University Hospital. Total number of operation showed incresing tendency, annually, 37 in 1983, 36 in 1984, 43 in 1985, 41 in 1986, 54 in l987, 89 in 1989, 81 in 1989, and 80 in 1990. The eletive and emergency operation com- prised 79% and 21%, respectively. The distribution of the patients by department was general surgery 217, plastic surgery l09, orthopedic surgery 23, neurosurgery l6, cardiothoracic surgery l6, urology 14, and otolaryngology 6. The average age distribution was 149 in 6.to l2 months, l00 in 1 to 3 months, 81 in 1 week to 1 month, 81 in 3 to 6 months, and 50 under 1 week of age. The male to female ratio was 2.7: l. The distribution of induction agents of general anesthesia was ketamine and succinylcholine (SCC) 317, without induction agent(awake intubation) 84, thiopental or diazepam and SCC 23, ketamine and pancronium or vecuronium l2. The most common technique of maintenence anesthesia was the balaced anesthesia. The distribution of disease entity by department was the following inguinal hernia was the most frequent in general surgery, cleft lip in palstic surgery, and hydrocephalus in neurosurgery. The postoperative complication developed in 31 of 461. The most common complications were the respiratory problems, the others were sepsis, heart failures, and convulsions. The motality rate was 1.73%.
Age Distribution ; Anesthesia ; Anesthesia, General ; Anesthesiology ; Cleft Lip ; Diazepam ; Emergencies ; Female ; Heart ; Hernia, Inguinal ; Humans ; Hydrocephalus ; Ketamine ; Male ; Neurosurgery ; Orthopedics ; Otolaryngology ; Postoperative Complications ; Retrospective Studies ; Seizures ; Sepsis ; Succinylcholine ; Surgery, Plastic ; Thiopental ; Urology ; Vecuronium Bromide

No abstract available.
Vascular Surgical Procedures ; Specialties, Surgical

BACKGROUND: Adequate pre-anesthetic evaluation could improve both patient outcome and hospital management by reducing the rates of operation delay and cancellation. We undertook this study to contribute to the establishment of a pre-anesthetic evaluation system by studying pediatric patients who had preoperatively consulted the anesthesiology department. METHODS: Data were collected using the EMR (Electronic Medical Record) system. 260 pediatric patients, age limitation 15 years, who had consulted our anesthesiology staff, were enrolled. The age distributions, departments consulted and clinical causes were analyzed. RESULTS: The age distributions were as follow; <1 month: 1.5%, 1 month-1 year: 29.2%, 1-4 years: 23.8%, 5-7 years: 18.1% and 8-15 years: 27.3%. The causes of the consultations were mainly pulmonary (27.3%), cardiovascular (21.9%), gastrointestinal (12.3%), airway (9.6%) problems and other causes (26.5%). The most common diseases were congenital heart disease, prematurity and URI. The major departments consulted were general surgery (16.2%), ophthalmology (15.4%), thoracic surgery (15.0%), plastic surgery (15.0%) and orthopedic surgery (14.6%). CONCLUSIONS: The establishment of a communication system with surgeons concerning patient management guidelines about the common causes of consultations would improve hospital management by reducing the incidences of delay and the cancellation of operations.
Age Distribution ; Anesthesiology ; Heart Defects, Congenital ; Humans ; Incidence ; Ophthalmology ; Orthopedics ; Referral and Consultation ; Surgery, Plastic ; Thoracic Surgery

BACKGROUND: Occupational stress and its related psychological strain is a concern among resident doctors that may affect patient care adversely. Residents face many stresses because of their high job demands in delivery of hospital care. They are often subject to work load and pressure due to direct involvement with patients, prolonged working hours, poor job opportunities and low support. Their multiple educational and clinical roles can also affect their performance and quality of personal or professional life. The aim of this study was to evaluate the occupational stress among residents of various medical specialties. We aimed to explore the reasons of occupational stress in residents’ life and determine how we can enhance the stress-coping strategies and create more suitable conditions. METHODS: This cross-sectional analytical-descriptive study was conducted on all medical residents with various specialties in Shiraz University of Medical Sciences. Data was collected using Osipow occupational stress questionnaire and analyzed by SPSS software version 17. RESULTS: The response rate was 88.8%. The average stress score of all residents was 156.35 out of 250. The highest and lowest average stress scores belonged to gynecology and dermatology specialties, respectively. The highest average score of the stress factors was related to the workload with the score of 35.09 of 50 (moderate to severe stress). The total stress score had a significant relationship with age (P = 0.030) and sex (P = 0.009) as well as lack of time to get the needed healthy meals (P = 0.047), high work hours (P < 0.01), surgical specialties (P < 0.01) and on call shift (P < 0.01). CONCLUSION: Since most of the stressors were related to the workload, interventions such workload reduction, education about occupational stress and its management, promoting interpersonal relations and more supportive measures are recommended.
Dermatology ; Education ; Gynecology ; Humans ; Interpersonal Relations ; Meals ; Occupations ; Patient Care ; Specialties, Surgical