Pediatric perioperative fluid management

이형묵,김진태 대한마취통증의학회 2023 Korean Journal of Anesthesiology Vol.76 No.6

The purpose of perioperative fluid management in children is to maintain adequate volume status, electrolyte level, and endocrine system homeostasis during the perioperative period. Although hypotonic solutions containing glucose have traditionally been used as pediatric maintenance fluids, recent studies have shown that isotonic balanced crystalloid solutions lower the risk of hyponatremia and metabolic acidosis perioperatively. Isotonic balanced solutions have been found to exhibit safer and more physiologically appropriate characteristics for perioperative fluid maintenance and replacement. Additionally, adding 1–2.5% glucose to the maintenance fluid can help prevent children from developing hypoglycemia as well as lipid mobilization, ketosis, and hyperglycemia. The fasting time should be as short as possible without compromising safety; recent guidelines have recommended that the duration of clear fluid fasting be reduced to 1 h. The ongoing loss of fluid and blood as well as the free water retention induced by antidiuretic hormone secretion are unique characteristics of postoperative fluid management that must be considered. Reducing the infusion rate of the isotonic balanced solution may be necessary to avoid dilutional hyponatremia during the postoperative period. In summary, perioperative fluid management in pediatric patients requires careful attention because of the limited reserve capacity in this population. Isotonic balanced solutions appear to be the safest and most beneficial choice for most pediatric patients, considering their physiology and safety concerns.

국내 단일기관에서 시행한 13년간의 무수혈 수술 분석

유재화,조아나,이세진,염욱 순천향대학교 순천향의학연구소 2014 Journal of Soonchunhyang Medical Science Vol.20 No.1

Objective: Patient’ desire of transfusion free surgery has been increasing due to blood transfusion risks. We analyzed the perioperative parameters and perioperative management of transfusion free surgical treatment in Soonchunhyang University Seoul Hospital. Methods: Operation quantity and blood unstoring count from blood bank between 2000 and 2012 were collected from chronological records. Perioperative parameters including preoperative hemoglobin level, postoperative hemoglobin level, and lowest hemoglobin level were collected from medical records. Perioperative blood management such as acute normovolemic hemodilution, intraoperative blood cell salvage, or hematinic agents and complication were assessed. Results: A total of 3,088 patients underwent transfusion free surgery at Soonchunhyang University Seoul Hospital between 2000 and 2012. Postoperative hemoglobin level <5.0 g/dL were 33 patients. Four patients expired at postoperative period with serious perioperative complications. Average of expired patient’s hemoglobin was 3.22 g/dL and overall mortality was 0.12%. Operation was increased as years go by. The amount of blood use bank wasn’t increased in general patients with transfusion. Conclusion: Careful perioperative blood management for transfusion free surgical treatment was responsible for safety and results in good clinical outcomes. Overall transfusion rate was decreased in spite of increasing operation quantity.

Perioperative Anesthetic Consideration of Brugada Syndrome

Ki Tae Jung,Sang Hun Kim,Hwa Song Jong,Tae Hun An 조선대학교 의학연구원 2017 The Medical Journal of Chosun University Vol.42 No.1

Brugada syndrome is associated with high risk for sudden death without structural cardiac defects due to ventricular arrhythmias. A 47-years-old man with Brugada syndrome has admitted because of right patella fracture. General anesthesia with sevoflurane and remifentanil was carefully maintained according to the BIS for the maintenance of adequate anesthetic depth and to avoid tachycardia during the surgery. Blood pressure and heart rate of the patient were maintained less than 150/90 mmHg and 100 beat/min perioperatively. There were no adverse events, and the patient was discharged home after ten days.

A preliminary study: aspirin discontinuation before elective operations; when is the optimal timing?

Kamil Gulpinar,Suleyman Ozdemir,Erpulat Ozis,Zafer Sahli,Selda Demirtas,Atilla Korkmaz 대한외과학회 2013 Annals of Surgical Treatment and Research(ASRT) Vol.85 No.4

Purpose: To evaluate the optimum timing of aspirin cessation before noncardiac surgeries. We have conducted a pilot study to minimize the aspirin cessation time before various surgeries. Methods: Eighty patients who were taking regular aspirin for secondary prevention undergoing elective surgical operations were enrolled in the study. We separated the patients into two groups. The control group had 35 patients who stopped aspirin intake 10 days before surgery. The study group had 45 patients who stopped their aspirin intake and underwent surgery one day after arachidonic acid aggregation tests were within normal limits. Bleeding, blood loss, and transfusion requirements were assessed perioperatively. Results: The mean time between aspirin cessation and aspirin nonresponsiveness were found to be 4.2 days with a median value of 4 days. In addition, the mean time between aspirin cessation and operation day were found to be 5.5 days with a median value of 5 days. No perioperative bleeding, thromboembolic or cardiovascular complications were encountered. Conclusion: Reducing time of aspirin cessation from 7-10 days to 4-5 days is a possibility for patients using aspirin for secondary prevention without increased perioperative complications.

노인의 퇴행성 요추 질환에서 후방 요추 수술후 수술주의기간의 합병증

석세일,김진혁,김원중,이상민,정의룡,황훈,김우일,김태윤 대한척추외과학회 2000 대한척추외과학회지 Vol.7 No.2

연구계획 : 퇴행성 요추 질환으로 후방감압 및 후외방 유합술을 시행받은 노인에서의 수술 주위기간 합병증을 후향적 방법으로 분석하였다. 목적 : 후방감압 및 후외방 유합술의 수술 주위기간 합병증과 유합 범위가 이환율에 미치는 영향을 알아보고자 하였다. 대상 및 방법 : 1997년 6월부터 1998년 7월까지 본원에서 퇴행성 요추 질환으로 후방감압 및 후외방 유합술을 시행 받은 65세 이상의 환자 51례로 3개월 이상 추시 가능했던 경우를 대상으로 하였다. 동반된 내과적 질환, 수술중 감압 및 유합 범위 따른 합병증을 분석하였다. 결과 : 51명중 17명(33.3%)에서 수술주위기간 합병증이 발생하였으며 7명(13.6%)은 적어도 1개 이상의 고도의 합병증을, 5명(9.8%)은 적어도 1개 이상의 중등도의 합병증을, 8명(15.7%)은 적어도 1개이상의 경도의 합병증을 가지고 있었다. 혈종 및 감염이 흔한 수술적 합병증이었다. 가장 흔한 내과적 합벙증으로 마비성 장폐색이었다. 분류한 유합군 사이의 수술 주위기간 합병증의 비는 통계적으로 의미있는 차이는 없었다. 75세 이상의 환자들은 수술 주위기간 합병증의 높은 발생율을 보였다. 환자의 성별, 진단, 수술시간, 골이식 방법, 혹은 수혈량과 수술 주위기간 합병증 발생사이의 통계학적으로 의미있는 관계는 없었다. 결론 : 수술 주위기간의 합병증이 전체 33.3%로 비교적 높은 편이었으며, 75세 이상의 고령은 수술주위기간의 합병증 발생의 위험요소였다. 유합범위와 동반 질환은 합병증 발생과 연관성이 없었다. Study Design : A retrospective study of perioperative complications was performed in elderly patients undergoing posterior decompression and fusion for lumbar degenerative conditions. Objective : To identify the perioperative complications and to analyze the influence of posterior decompression and fusion on the occurrence of the morbidity. Summary of Background Data : Because of the better long-term results, the decompression and fusion with instrumentation have been recently recommended for treatment of degenerative lumbar disease in the elderly. However, the perioperative complication rate and their correlating factors have not been adequately defined. Materials and Methods : A retrospective review of the medical charts of fifty-one patients aged 6.5 years or older operated during June 1997 to July 1998 was undertaken. The minimum follow-up required for inclusion was three months. All medical and surgical perioperative complications directly related to the surgical procedure were noted. The association of fusion levels and other factors with the occurrence of perioperative complications were analyzed. Results : Perioperative complications occurred in 17(33.3%) of the 51 patients. Seven satients(13.7%) had at least one major complication, 5(9.8%) had at least one minor complication and 9(17.6%) had insignificant complications. Hematoma and wound infection were the most common surgical complications Paralytic ileus was the most common medical complication. There was no difference in the rate of perioperative complications between the long and short fusion groups. An age of more than eventyfive years at the time of surgery was associated with a higher risk of complications. There was no statistically significant relationship between the perioperative complications and sex diagnosis, operative time, type of bone grafting, amount of blood transfusion, or preoperative comorbidity of the patients. Conclusion : Perioperative complications were quite common in the present series, occurring in 33.3% of the patients. An age over seventy-five hyears was a risk factor for associated with morbidity. The number of levels fused and the comorbidity did not associated the development of the complications.

The Incidence of Perioperative Stroke: Estimate Using State and National Databases and Systematic Review

Rami Al-Hader,Khalid Al-Robaidi,Tudor Jovin,Ashutosh Jadhav,Lawrence R. Wechsler,Parthasarathy D. Thirumala 대한뇌졸중학회 2019 Journal of stroke Vol.21 No.3

Background and Purpose Perioperative stroke remains a devastating complication after surgical procedures, due to hemodynamic and inflammatory changes that increase the risk of strokes within 30 days following surgery. We aimed to assess the incidence of perioperative strokes in patients undergoing various surgical procedures and reach a national estimate. Methods A retrospective cohort study was conducted using California State Inpatient Databases, State Emergency Department Databases, State Ambulatory Surgery and Services Databases, and the National Inpatient Sample (NIS) during the period 2008 to 2011 from the Healthcare Cost and Utilization Project. A systematic review was conducted using PubMed, Embase, and Web of Science databases to obtain published articles that reported the incidence of perioperative stroke in various surgical procedures. Results Analysis of 3,694,410 surgical encounters from the state of California (mean±standard deviation age: 52.4±21.1 years) yielded an overall rate of perioperative stroke of 0.32% (n=11,759). The incidence of perioperative strokes was highest following neurological (1.25%), vascular (1.07%), and cardiac (0.98%) surgeries. The NIS database contained a total of 48,672,974 weighted hospitalizations and yielded a rate of perioperative stroke of 0.42% (n=204,549). The systematic review completed yielded 187 articles, which had an overall sample size of 184,922 and an incidence of perioperative stroke ranging from 0% to 13.86%. It is estimated that in any given year, there would be approximately 40,000 to 55,000 (0.33% to 0.46%) perioperative strokes nationally. Conclusions Our findings support further strategies to identify and stratify patients undergoing surgical procedures with a high incidence of perioperative strokes to improve patient counseling and a future potential treatment plan.

수술간호자료세트(PNDS: Perioperative Nursing Data Set)를 적용한 수술간호 분석 : Analysis of Perioperative Nursing applying the Perioperative Nursing Data Set(PNDS)

김고은,정선희 중앙대학교 의과대학 간호학과 간호과학연구소 2011 중앙간호논문집 Vol.15 No.-

Purpose: The purpose of this study is to analyze the application of nursing outcomes, nursing diagnoses and nursing interventions of the surgical patients by applying the Korean-language vfersion(Part et al, 2005) of Perioperative Nursing Data(AORN, 2002) to the frequent operations by the departments. Method: The data were collected from November 1 through December 31, 2010, and twenty seven nurses who have participated in operations checked perioperative nursing details of 208 patients who received each of the high frequency operations in total eight departments. The Results of the colleted data were measured by descriptive statistics such as frequency, percentages, average and standard deviation. Result: The result of analysing of the data, the mostly used nursing outcomes were: "Patient does not have any symptoms and signs of damage due to foreign objects" and "Patient does not have any signs and symptoms of infection". The mostly used nursing diagnosis was "The risk of bodily injury due to foreing objects", and nursing intervention was "Protecting from cross-infection". Conclusion: This study shows the characteristics of the perioperative nursing that more than 50% of perioperative nursing is carried out in the area of safety of patients. By the basis of research results, this study suggests developing PNDS according to the frequent operations by the departments for the standardization of perioperative nursing.

The SingHealth Perioperative and Anesthesia Subject Area Registry (PASAR), a large-scale perioperative data mart and registry

Abdullah Hairil Rizal,Lim Daniel Yan Zheng,Ke Yuhe,Salim Nur Nasyitah Mohamed,Lan Xiang,Dong Yizhi,Feng Mengling 대한마취통증의학회 2024 Korean Journal of Anesthesiology Vol.77 No.1

Background: To enhance perioperative outcomes, a perioperative registry that integrates high-quality real-world data throughout the perioperative period is essential. Singapore General Hospital established the Perioperative and Anesthesia Subject Area Registry (PASAR) to unify data from the preoperative, intraoperative, and postoperative stages. This study presents the methodology employed to create this database.Methods: Since 2016, data from surgical patients have been collected from the hospital electronic medical record systems, de-identified, and stored securely in compliance with privacy and data protection laws. As a representative sample, data from initiation in 2016 to December 2022 were collected.Results: As of December 2022, PASAR data comprise 26 tables, encompassing 153,312 patient admissions and 168,977 operation sessions. For this period, the median age of the patients was 60.0 years, sex distribution was balanced, and the majority were Chinese. Hypertension and cardiovascular comorbidities were also prevalent. Information including operation type and time, intensive care unit (ICU) length of stay, and 30-day and 1-year mortality rates were collected. Emergency surgeries resulted in longer ICU stays, but shorter operation times than elective surgeries.Conclusions: The PASAR provides a comprehensive and automated approach to gathering high-quality perioperative patient data.

Korean clinical practice guideline for perioperative red blood cell transfusion from Korean Society of Anesthesiologists

이은호,구본녀,권민아,김상현,김종엽,문영진,박선영,채민석,최성욱,최정현,황진영 대한마취통증의학회 2019 Korean Journal of Anesthesiology Vol.72 No.2

Background: Considering the functional role of red blood cells (RBC) in maintaining oxygen supply to tissues, RBC transfusion can be a life-saving intervention in situations of severe bleeding or anemia. RBC transfusion is often inevitable to address intraoperative massive bleeding; it is a key component in safe perioperative patient management. Unlike general medical resources, packed RBCs (pRBCs) have limited availability because their supply relies entirely on voluntary donations. Additionally, excessive utilization of pRBCs may aggravate prognosis or increase the risk of developing infectious diseases. Appropriate perioperative RBC transfusion is, therefore, crucial for the management of patient safety and medical resource conservation. These concerns motivated us to develop the present clinical practice guideline for evidence-based efficient and safe perioperative RBC transfusion management considering the current clinical landscape. Methods: This guideline was obtained after the revision and refinement of exemplary clinical practice guidelines developed in advanced countries. This was followed by rigorous evidence-based reassessment considering the healthcare environment of the country. Results: This guideline covers all important aspects of perioperative RBC transfusion, such as preoperative anemia management, appropriate RBC storage period, and leukoreduction (removal of white blood cells using filters), reversal of perioperative bleeding tendency, strategies for perioperative RBC transfusion, appropriate blood management protocols, efforts to reduce blood transfusion requirements, and patient monitoring during a perioperative transfusion. Conclusions: This guideline will aid decisions related to RBC transfusion in healthcare settings and minimize patient risk associated with unnecessary pRBC transfusion.

환자혈액관리 관점에서 본 수술 환자의 빈혈 처치법

고재환 대한수혈학회 2020 大韓輸血學會誌 Vol.31 No.1

Perioperative anemia is common during surgery and is an important risk factor for the transfusion of RBC, morbidity and mortality. Blood transfusion has been a common practice for a long time, and has been a traditionally accepted solution to perioperative anemia. However, increasing evidence is now showing that this traditional treatment may actually do more harm than good. Research has shown that transfusion is independently associated with morbidity and mortality. A paradigm shift is currently taking place towards patient-oriented blood management and patient blood management, PBM. PBM consists of 3 pillars: the optimization of the red blood cell mass, reduction of blood loss and bleeding, and optimization of the patients’ physiological tolerance toward anemia. Of the three fillers, perioperative management is mainly included in the second pillar, but integration of these 3 pillars and strategies into perioperative pathways should improve care processes and patient outcome. Bleeding during surgery and efforts to stop it continue, and treatment for bleeding and many hemostatic methods have been developed. In recent decades, minimally invasive surgical techniques have led to a reduction of bleeding, where hemostatic agents, surgical instruments and new techniques have played an important role in the perioperative field of PBM. This paper summarized why PBM is needed, and the strategy during surgery simply and easily. This paper focuses on the surgeons’ role in PBM. The main PBM protocol is not discussed, but rather the paper focuses on selective clinical practice. (Korean J Blood Transfus 2020;31:21-33)