Clinical Study for Monitored Anesthesia Undergoing Ophthalmic Surgery

Jeong Won Lee,Suk Hun Yoon,Tae Seong Kim,Hyun Soo Kim,Kwang Min Kim Korean Society of Critical Care Medicine 1997 Acute and Critical Care Vol.12 No.1

Intoduction: The phrase "Monitored Anesthesia Care" refers to instances in which an anesthesiologist has been called upon to provide specific anesthesia services to a particular patient understanding a planned procedure, in connection with which a patient receives local anesthesia. Monitored anesthesia care is being increasingly used in the 1990s for a wide variety of diagnostic and therapeutic procedure. The primary objective in providing monitored anesthesia care is to ensure patient comfort and safety. METHOD: We classified patients in three groups by premedication and oxygen administration, no premedication and no oxygen administration (group A), premedication and oxygen administration (group B), premedication and no oxygen administration (group C), measured vital signs and SpO2 (peripheral oxygen saturation) from just before operation, and checked the satisfaction score of surgeon and patients. RESULT: SpO2 and satisfaction score of surgeon and patients are the best at premedication and oxygen administration group. CONCLUSION: Monitored anesthesia is assumed to give more comfort and safety to patients than local anesthesia alone.

Clinical Analysis of Cases Dead within 48 Hours after Admission

In Ho Kim,Mi Ja Kim,Hong Soon Lee,Hak Choong Lee Korean Society of Critical Care Medicine 1987 Acute and Critical Care Vol.2 No.1

The authors performed a review on the records of 64 cases who lied within 48 hours after admission to the medical ward, department of interal medicine, National Medical Center, from February 1979 to September 1983. We tried in this analysis to seek the preadmission health status of the patients, the contributing factors to the early death and the problems related with the future critical care. Thirty one patients had limitingor advanced un-derlying diseases with organ failure such as liver cirrhosis, congestive heart failure and malignancy. Considerable portion of the subject presented mental impairment and dyspnea as their chief complaints on admission. Azotemia was found in 19 of 23 patients with available data. Fourteen of 17 patients with available data showed high anion gap metabolic aido-sis. Mechananical ventilation had to be performed in 23 patients and dopamine had to be infused in 20 patients. Major immediate causes of death were sepsis, respiratory failure, arrhythmia, and hepatic failure. The predominent pathophysiologid factor of their early death was considered as the interaction among underlying diseases, delayed admission, acute aggra-vating factors, severe infection and multiple organ failure.

Clinical Study of Patients with Neonatal Respiratory Distress Syndrome

Shin Ok Koh,Hung Kun Oh,Dong Kwan Han Korean Society of Critical Care Medicine 1986 Acute and Critical Care Vol.1 No.1

Forty neonates with respiratory distress syndrome were transferred from nursery after birth to the 1CU at Severance Hospital, Yonsei Medical Complex between March 198l to July 1983 and ventilatory support was given with the pressure-cycled ventilator, Baby- log I, Bourns BP 200, in ICU. We have analysed the 40 cases according to sex, incidence, symptoms and signs, birth weight and gestation weeks and time to the ventilator support, 1CU days and mortality. The results were as follows 1) The proportion of the patients was 0.7% neonates and the overall mortality was 52 5% 2) Obstetric and delivery backgrown4 were as follows. Ceasarean section, 19 cases; pre-eclampsia, 5 cases; placenta-previa, 5 cases, spontaneous premature rupture of membrane; 4 cases, 3) The percentage and mortality of male patients was 57.5% and 57,1%, higher than famale patients. 4) All the patients showed symptoms and signs within 12 houre after birth. 5) Mortality of those cases born with less than 32 wks gestation was 15%, but above 32 wks the mortality was 35%. 6) The number of babies born with a birth weight below 2000 grams was 27 and the mortality for them was 70%. 7) The number of cases who had ventilator support begun at 10 hra, 1l-20 and 21- 30 hours after symptoms and signs developed, were 30, 5 and 5. The mortality was 53, 20 and 60% respectively for these 3 groups. 8) The number of ventilator days less than 4 days duration was 27 cases with a 70% mortality but those above 5 days was 13 cases with 16% mortality. In 1981, the number of patients with ventilator days less than 2 days was 11 cases and 2 cases used the ventilator for 7-8 days. But in 1983 the number of patients with less than 4 ventilator days was 6 cases., and 7 cases used ventilator for more than 5 days. 9) The number of patients with ICU days 1ess 5 daye was 23 cases and a morta!ity of 78% and those of 6-10 day stay was 6 cases with a mortality of 50%,. The number of patients with ICU days above 15 days was 18 and a11 survived. In 1981, 10 cases stay in the ICU for less than 5 days. Only 2 cases stayed in the ICU for 6-10 days. In 1983, 6 cases stayed in the ICU for less than 5 days, but 4 cases stayed stayed in the ICU for more than 15 days, 10) Complications were neonatal hyperbilirubinemia, pneumothorax, pneumomediastinum, sepsis, disseminated intravascuIar coagulopathy, bronchopulmonary dysplasia, and cerebraI hemorrhage. From the above results the mortality rate decreased year by year and this is attributed to the early application of ventilator support and adequate intensive care.

Cutting of Guide Wire and Hydrothorax after Subclavian Venous Catheterization for Premature Infant: A case report

Hyun Soo Moon,Sung Hee Han Korean Society of Critical Care Medicine 1999 Acute and Critical Care Vol.14 No.1

Central venous catheterization is one of the common procedures in the care of critically ill patients but numerous major complications have been reported. This report is about a case of sequential complications that were developed after two attempts of subclavian venous catheterization via supraclavicular approach for a critically ill 1.5 kg premature infant in intensive care unit. In the first attempt, the guidewire was cut and remained in the right atrium but fortunately removed without surgery. In the second attempt for the same patient, the catheter positioned out of the vessel. It was in right pleural cavity and caused hydrothorax. After third attempt, successful left subclavian vein catheterization was done.

Clinical Survey of Patients in the Post-Anesthesia Care Unit

Sung Su Chung,Myung Gi No,Seong Wook Jeong,Sang Hyun Kwak,Woong Mo Im Korean Society of Critical Care Medicine 1999 Acute and Critical Care Vol.14 No.1

BACKGOUND: The purpose of this study was to evaluate characteristics and mortality rates of patients admitted to the post-anesthesia care unit (PACU) for obtaining the better clinical guidances and more advanced therapeutic plan in the future. METHODS: The medical records of total 425 patients admitted to the PACU from January to December 1998 were reviewed and analyzed according to age, sex, department, duration of stay, mechanical ventilator care, and mortality rates. RESULTS: Patients admitted PACU were 6% of total anesthesia patients. The ratio of male to female was 1.5:1. Patients of manhood aged from 45 to 64 were 37%, pediatric patients under 15 year-old were 23%. and elderly patients over 64 year-old were 18% of total PACU patients. The ratio of patients with ventilatory support was 42%. Mortality rate of neonate under 1 month of age was about 47%. Total mortality rate was 12%. CONCLUSIONS: To improve the outcome of the patients in PACU, continuous nutritional and medical support, cardiovascular and pulmonary monitoring, appropriate nursing care, and availability of medical staff were needed.

Predictive Factors for the Mortality of Cardiovascular Patients at Coronary Care Unit

Eun Suk Shin,Myung Ho Jeong,Sang Chun Lim,Myung Ja Choi,Seon Young Jeong,Gill Yup Kim,Eun Jeong Lee,Su Mi Bang,Hyo Ran Lee,Young Joon Hong,Hyung Wook Park,Ju Han Kim,Weon Kim,Young Keun Ahn,Jeong Gwan Korean Society of Critical Care Medicine 2004 Acute and Critical Care Vol.19 No.1

BACKGROUND: Recently the incidence of coronary artery disease has been increased rapidly in Korea. After the introduction of coronary care unit, the mortality rate of cardiovascular patients has been decreased. The predictive factors for mortality in patients admitted at Coronary Care Unit (CCU) are important in the management of acutely ill cardiovascular patients. METHODS: One thousand one hundred and thirty patients (64.8+/-14.5 years), who were admitted at CCU from January 2002 to June 2003, were analyzed. The patients were divided into two groups according to mortality: the survived group (Group I: n=1055, 63.3+/-13.3 years) and the moribund group (Group II: n=75, 64.8+/-14.1 years). Clinical characteristics, risk factors, clinical diagnosis, laboratory, echocardiographic and coronary angiographic findings were compared between the two groups. RESULTS: The overall mortality at CCU was 6.6%, 75 out of 1130 patients. Age and sex were not different between both groups. Coronary artery disease was the most common cause of admission (886 out of 1130 patients) and death (46 out of 75 patients). Coronary angiographic findings were not different between the two groups. Left ventricular ejection fraction (LVEF) by echocardiogram was higher in Group I than in Group II (53.1+/-15.6% vs. 42.3+/-16.3%, p

Clinical Findings of Critical Illness Polyneuropathy in Patients with Mechanical Ventilator Treatment

Sung Soon Lee,Jae Yong Chin,Chae Man Lim,Younsuck Koh Korean Society of Critical Care Medicine 2005 Acute and Critical Care Vol.20 No.1

BACKGROUND: Critical illness polyneuropathy (CIP) is a primary distal axonal degeneration of motor and sensory fibers leading to severe limb weakness and difficulty in weaning from ventilator in critically ill patients. The object of this study is to evaluate the clinical findings of CIP and the risk factors associated with CIP development in patients with mechanical ventilator treatment. METHODS: We examined 40 patients, between March 2002 to February 2003, who manifested muscular weakness and received mechanical ventilation (MV) more than three days, prospectively. Nerve conduction velocity (NCV) and electromyography (EMG) were performed in all patients in the ICU. We examined the use of drugs (neuromuscular blocking agents, corticosteroid, and aminoglycoside), duration of MV and weaning, and APACHE II score. RESULTS: We observed 40 patients who showed muscular weakness, 9 patients were diagnosed as CIP. NCV study demonstrated decreased action potential amplitude, predominantly in motor nerve, distal part. There was no significant difference in duration of MV and weaning, drug use, APACHE II score between the groups with CIP and without CIP. CONCLUSIONS: CIP is an important neuromuscular complication of the patients in ICU. We should consider the possibility of the development of CIP in patients who showed muscular weakness and difficult weaning in critically ill patients.

Endoventricular Circular Patch Plasty and Intra-operative and Post-operative Care for Patients with Ischemic Cardiomyopathy

Jin Hee Kim,Byung Moon Ham,Yong Lak Kim,Yoon Seok Jeon,Sung Hee Han,Jae Sang Sung,Ki Bong Kim,Hyeong Ryul Kim Korean Society of Critical Care Medicine 2002 Acute and Critical Care Vol.17 No.2

BACKGROUND: Endoventricular circular patch plasty (EVCPP)was introduced as an effective reconstructive procedure for ventricular aneurysm and diffuse dilated cardiomyopathy after myocardial infarction.We report the 4-year results of EVCPP in Seoul National University Hospital, the experiences of anesthesia and intensive care for EVCPP in patients with ischemic cardiomyopathy. METHODS: EVCPP has been performed on 31 patients (22 men and 9 women wit h a mean age of 62 years)during 4 years from March 1998 to March 2002.Six patients (19%)were NYHA cl ass II,24 pat i ent s were cl ass III,and 1 pat i ent was cl ass I V.Preoperative and postoperative left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),ejection fraction (EF)were determined and compared.Transesoghageal echocardiograghy (TEE)was used to measure the distance between aortic annulus and ventricular aneurysm during EVCPP.Milrinone combined with beta -adrenergics was infused during separation from cardiopulmonary bypass (CPB) and in the intensive care unit. RESULTS: Three patients (10%)needed an intra-aortic balloon pump to wean from CPB and one patient (3%)died in the hospital.Out of 30 survivors,29 patients returned to NYHA class I or II and one patient to class III.Out of 30 patients who underwent echocardiographic study before and after EVCPP,EF increased from 34 +/-9%to 38 +/-10%,and LVEDV and LVESV decreased from 139 +/-43 ml to 94 +/-20 ml and from 90 +/-34 ml to 59 +/-17 ml,respectively. CONCLUSIONS: EVCPP is effective to exclude the akinetic left ventricular segment,thus improving left ventricular function and clinical status of patients with ischemic cardiomyopathy.However, studies concerning postoperative intensive care are warranted to reduce the postoperative complications and morbidity.

Perioperative Intensive Care for Liver Transplantation

Shin Hwang,Dong Lak Choi,Cheol Soo Ahn,Dong Eun Park,Sun Hyung Joo,Jang Yong Jeon,Kyeong Mo Kim,Yang Won Nah,Kwang Min Park,Young Joo Lee,Sung Gyu Lee Korean Society of Critical Care Medicine 2001 Acute and Critical Care Vol.16 No.1

Many liver recipients have required intensive care, which is individualized and customized to each recipient. Prerequisites qualifying this care are wide comprehension of characteristics of end-stage liver disease and mechanisms of surgical procedures and immunologic knowledge. We present our principles of intensive care and experience from more than 300 cases of liver transplantation. There are roughly two types of liver transplantation, cadaveric and living-donor. These two types are different in their postoperative courses as following; severity of preservation injury, graft-size matching and morphologic liver regeneration and risk of vascular and biliary complications. Intensive care for liver recipients should be directed toward preventive and protective care along reasonable prediction of its clinical course. We described our experience about following subjects: management of hepatorenal syndrome, fulminant hepatic failure, acute renal failure, pneumonia, disturbance of consciousness, prophylaxis of viral hepatitis B, tumor recurrence, use of antibiotics, induction of liver function recovery, maintenance of vital signs, electrolyte balance, diet and infection control, nutritional support. The most important factor is the state of transplanted liver graft in determination of posttransplant course. If the graft functions well, many problems will be solved spontaneously. If not, intensive care will be required. Most of operative complications are related to the surgery itself, so that comprehension to surgical procedures to each recipient should be preceded for early detection and proper management. To achieve a favorable posttransplant course, all factors including maintenance of vital signs, elimination of obstacles to hepatic recovery, appropriate immunosuppression and solution of surgical complications should be met altogether. Of course, every member of liver transplantation team should pay durable attention and dedication to each liver recipient.

The Usage Pattern of Neuromuscular Blocker at Intensive Care Unit

Jun Gol Song,Hwa Sung Jung,Jae Do Lee,Yoon Kyung Lee,Hong Seuk Yang Korean Society of Critical Care Medicine 2006 Acute and Critical Care Vol.21 No.1

BACKGROUND: The neuromuscular blocker is helpful to intubate the patients and reduce the amount of anesthetic agent. It also used at intensive care unit (ICU) to maintain airway patency, to achieve proper ventilatory care, etc. This survey is to determine the neuromuscular blocker usage patterns in ICU settings. METHODS: Three hundred general hospitals with ICU settings were chosen. We designed a 10 itemed questionnaire which has several subquestions with multiple choices and sent it to them. After three months, forty seven hospitals returned the questionnaire and we made careful analysis with it. RESULTS: The most frequent indication of neuromuscular blocker was to facilitate the mechanical ventilation (80.9%). Vecuronium was the most common neuromuscular blocker used (97.9%). Only 6.4% of them used peripheral nerve stimulator and the rest of them (89.4%) used clinical information to determine the degree of neuromuscular blocker. The respondents reported that recovery from muscle relaxation was needed on a periodic basis for regular neurological examinations (59.6%) in ICU settings. All respondents used the sedatives or narcotics with neuromuscular blocker and only 6.4% used reversal agents. CONCLUSIONS: Although the rate of reply was not much (15.7%), we could get the current usage pattern of neuromuscular blocker at ICU. We recommend using short to intermediate acting neuromuscular blocker than long acting agents. Continuous infusion with careful dosage titration by peripheral nerve stimulator would be helpful to achieve rapid recovery. Additional sedatives and narcotics are beneficial to reduce the amount of neuromuscular blocker and to make patients comfortable as well.