BACKGROUND: Maintenance of tracheal intubation is associated with use of sedatives, stress due to mechanical ventilation, or respiratory complications. The aim of this study is to compare the incidence of delirium between early and late extubation groups after liver transplantation (LT). METHODS: Medical records from 247 patients who received LT from January 2010 to July 2017 in a single university hospital were retrospectively reviewed. Patients were divided with 2 groups: Those who underwent early extubation after LT (E group, n = 52) and those who underwent extubation within few hours of intensive care unit (ICU) admission after surgery (C group, n = 195). The patients’ demographic data, perioperative managements and postoperative complications were collected. Early extubation was defined as performing extubation in the operating room after LT. A propensity score matching analysis was performed to reduce the effects of selection bias. RESULTS: Among them, 4/52 (7.69%) in E group and 30/195 (15.38%) in C group occurred postoperative delirium after LT, respectively (P = 0.180). After propensity score matching, there was no difference of the period of hospitalization in ICU (P = 0.961), time to discharge after surgery (P = 0.117) and incidence of delirium between groups (P = 1.000). CONCLUSIONS: Although this study is a retrospective study and limited by the small number of subjects, early extubation does not affect the incidence of delirium after LT. Therefore, further prospective studies on this were needed.
Airway Extubation ; Delirium ; Hospitalization ; Humans ; Hypnotics and Sedatives ; Incidence ; Intensive Care Units ; Intubation ; Liver Transplantation ; Liver ; Medical Records ; Operating Rooms ; Postoperative Complications ; Propensity Score ; Prospective Studies ; Respiration, Artificial ; Retrospective Studies ; Selection Bias

Fever (body temperature above 38℃) is relatively common during the first few days after general anesthesia. Postoperative fever is usually caused by the inflammation induced by surgery and resolves spontaneously; however, it can be a manifestation of a serious complication such as malignant hyperthermia. We report a case of postoperative hyperthermia (body temperature > 40℃) that was refractory to conventional anti-pyretic measures and finally resolved with dantrolene administration.
Anesthesia, General* ; Dantrolene* ; Fever ; Humans ; Inflammation ; Malignant Hyperthermia* ; Postoperative Period

Malignant hyperthermia (MH) may lead to metabolic crisis of skeletal muscle in susceptible individuals following exposure to triggering agents such as volatile anesthetics or depolarizing muscle relaxants. MH is a rare and a potentially lethal disease, which can lead to cardiac arrest. We report a case of severe MH, in which the rapidly evolving signs of hypermetabolism eventually resulted in cardiac arrest. Despite conventional treatments following cardiopulmonary resuscitation, the patient's vital signs did not improve. Therefore, we applied extracorporeal membrane oxygenation for providing hemodynamic support.
Anesthetics ; Cardiopulmonary Resuscitation* ; Dantrolene ; Extracorporeal Membrane Oxygenation* ; Heart Arrest* ; Hemodynamics ; Humans ; Malignant Hyperthermia* ; Muscle, Skeletal ; Neuromuscular Depolarizing Agents ; Vital Signs

We report a case of increased values of entropy parameters Response Entropy (RE) and State Entropy (SE) during intravenous general anesthesia in a sleepwalking patient. An ASA class II, 64-year-old woman with stress incontinence underwent mid-urethral sling surgery. Prior to surgery, the patient had been administered paroxetine, valproic acid and clonazepam for the treatment of sleepwalking disorder. After 10 min of target-controlled infusion of propofol and remifentanil, entropy values increased up to 94 (RE) and 88 (SE) for 10 min. The target effect-site concentrations of anesthetics increased from 4 to 7 microg/ml propofol and 4 ng/ml remifentanil, at which point values fell back to adequate anesthesia levels. Episodes of recall or of explicit memories did not occur during the anesthesia. In conclusion, sleepwalking patients with long-term use medications may need increment of anesthetic dose caused by the anesthetic drug metabolism activation or impairment or immaturity of inhibitory circuits in brain.
Anesthesia* ; Anesthesia, General ; Anesthetics ; Brain ; Clonazepam ; Entropy* ; Female ; Humans ; Metabolism ; Middle Aged ; Paroxetine ; Propofol* ; Somnambulism* ; Suburethral Slings ; Valproic Acid

We report a case of increased values of entropy parameters Response Entropy (RE) and State Entropy (SE) during intravenous general anesthesia in a sleepwalking patient. An ASA class II, 64-year-old woman with stress incontinence underwent mid-urethral sling surgery. Prior to surgery, the patient had been administered paroxetine, valproic acid and clonazepam for the treatment of sleepwalking disorder. After 10 min of target-controlled infusion of propofol and remifentanil, entropy values increased up to 94 (RE) and 88 (SE) for 10 min. The target effect-site concentrations of anesthetics increased from 4 to 7 microg/ml propofol and 4 ng/ml remifentanil, at which point values fell back to adequate anesthesia levels. Episodes of recall or of explicit memories did not occur during the anesthesia. In conclusion, sleepwalking patients with long-term use medications may need increment of anesthetic dose caused by the anesthetic drug metabolism activation or impairment or immaturity of inhibitory circuits in brain.
Anesthesia* ; Anesthesia, General ; Anesthetics ; Brain ; Clonazepam ; Entropy* ; Female ; Humans ; Metabolism ; Middle Aged ; Paroxetine ; Propofol* ; Somnambulism* ; Suburethral Slings ; Valproic Acid

OBJECTIVE: Propofol and volatile anesthesia have been associated with metabolic acidosis induced by increased lactate. This study was designed to evaluate changes in pH, base excess (BE), and lactate in response to different anesthetic agents and to characterize propofol infusion-associated lactic acidosis. METHODS: The medical records of patients undergoing neurosurgical anesthesia between January 2005 and September 2012 were examined. Patients were divided into 2 groups : those who received propofol (total intravenous anesthesia, TIVA) and those who received sevoflurane (balanced inhalation anesthesia, BIA) anesthesia. Propensity analysis was performed (1 : 1 match, n=47), and the characteristics of the patients who developed severe acidosis were recorded. RESULTS: In the matched TIVA and BIA groups, the incidence of metabolic acidosis (11% vs. 13%, p=1) and base excess (p>0.05) were similar. All patients in the TIVA group who developed severe acidosis did so within 4 hours of the initiation of propofol infusion, and these patients improved when propofol was discontinued. CONCLUSIONS: The incidence of metabolic acidosis was similar during neurosurgical anesthesia with propofol or sevoflurane. In addition, severe acidosis associated with propofol infusion appears to be reversible when propofol is discontinued.
Acidosis* ; Acidosis, Lactic ; Anesthesia* ; Anesthesia, Inhalation ; Anesthesia, Intravenous ; Anesthetics ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Lactic Acid ; Medical Records ; Neurosurgery ; Propofol* ; Retrospective Studies*

This paper aims to examine the factors that affect the amount of official development assistance (ODA) a developing country receives for healthcare by the Korean government. We empirically tested to what extent the amount of Korea's ODA in health care services, infrastructure, HIV/AIDS, and tuberculosis are affected by the relevant demand factors in the recipient countries. To do so, we carried out country-level multivariate regression analyses by setting the amount of ODA for four health care sectors as dependent variables and the relevant demand factors and economic factors as independent variables. A panel dataset was constructed by combining ODA data from the Organisation for Economic Cooperation and Development and World Development Indicators. The analyses showed that the ODA for health care in Korea is partly meeting the recipient's health care needs. In particular, the recipients with a smaller number of physicians are likely to receive more ODA for medical services. Meanwhile, the amount of international trade with Korea is likely to affect the amount of ODA for medical services. However, disease factors, such as prevalence of HIV/AIDS and tuberculosis, did not positively affect the amount of ODA for those diseases. These results indicate that Korea's ODA system for health care needs to be improved to meet the demand of the recipients in order to achieve the humanitarian objectives set by the international community. We hope that the medical community and the government of Korea can cooperate in setting the global policy agenda for health care ODA based on concrete evidence-based healthcare policy research.
Delivery of Health Care ; Developing Countries ; Health Care Sector ; Korea ; Prevalence ; Tuberculosis

No abstract available.
Cadaver ; Humans ; Hypernatremia ; Liver ; Liver Transplantation ; Myelinolysis, Central Pontine ; Tissue Donors

No abstract available.
Humans ; Liver Transplantation* ; Liver*

BACKGROUND: We designed this double-blind, placebo-controlled study to compare the efficacy of remifentanil in reducing the pain of both propofol and rocuronium injection during rapid-sequence induction. METHODS: Ninety-five patients, scheduled for elective surgery under general anesthesia, were divided into 3 groups: saline (Group S, n = 31), remifentanil 1 microg/kg (Group R, n = 32), and lidocaine 1.5 mg/kg (Group L, n = 32) were administered after tourniquet application. The occlusion was released after 1 min and 5 ml of 1% propofol was injected over 10 s. Pain on propofol injection was evaluated by a 10-point verbal numeric rating scale (VNRS). The rest of the induction dose of propofol and 1 mg/kg of rocuronium, were injected. Pain on rocuronium injection was evaluated by a four-point score (FPS). RESULTS: The VNRS of propofol injection was as follows: R (0.78) = L (1.34) < S (4.26). The incidence of withdrawal response due to rocuronium was as follows: R (6.3%) < L (53.1%) < S (83.9%). The FPS of rocuronium injection was as follows: R (0.81) < L (1.78) < S (2.93). CONCLUSIONS: Pretreatment with a bolus of remifentanil was effective in simultaneously reducing injection pain of propofol and rocuronium. In addition, remifentanil pretreatment was more effective in suppression of withdrawal response by rocuronium than lidocaine.
Androstanols ; Anesthesia, General ; Humans ; Incidence ; Lidocaine ; Piperidines ; Propofol ; Tourniquets