• Journal of Chest Surgery
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• v.27 no.3
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• pp.191-195
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• 1994

Twenty-four patients with left main coronary artery stenosis exceeding 50% underwent coronary artery bypass grafting from January 1991 through June 1993. Four patients [17%] had stenosis only in left main coronary artery and 20 patients [83%] had associate lesion[s] in left anterior descending , circumflex, or right coronary artery. Sixteen patients [67%] had higher degrees of stenosis [>70%] in left main coronary artery. Preoperatively 18 patients [75%] had unstable angina pectoris even during aggressive medical treatment. Preoperatively aggressive medical treatment was performed to relieve the symptom in patients with unstable angina. All patients were perioperatively treated with continuous infusion of isosorbide dinitrate to stabilize symptomatic and hemodynamic states. Twenty patients underwent elective coronary bypass surgery and 4 patients urgent operations due to severe unstable angina. There was no thirty-day mortality or late death. Angina recurred in 1 patient, but coronary angiographic study showed good patency of grafts and the symptom was relieved with medical treatment. We concluded that coronary artery bypass grafting can be safely performed by perioperative efforts, including continuous infusion of isosorbide dinitrate, for hemodynamic stabilization in patients with left main coronary artery stenosis.

• Archives of Plastic Surgery
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• v.46 no.3
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• pp.189-197
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• 2019

There has been an exponential increase in plastic surgery cases over the last 20 years, surging from 2.8 million to 17.5 million cases per year. Seventy-two percent of these cases are being performed in the office-based or ambulatory setting. There are certain advantages to performing aesthetic procedures in the office, but several widely publicized fatalities and malpractice claims has put the spotlight on patient safety and the lack of uniform regulation of office-based practices. While 33 states currently have legislation for office-based surgery and anesthesia, 17 states have no mandate to report patient deaths or adverse outcomes. The literature on office-base surgery and anesthesia has demonstrated significant improvements in patient safety over the last 20 years. In the following review of the proceedings from the PRS Korea 2018 meeting, we discuss several key concepts regarding safe anesthesia for office-based cosmetic surgery. These include the safe delivery of oxygen, appropriate local anesthetic usage and the avoidance of local anesthetic toxicity, the implementation of Enhanced Recovery after Surgery protocols, multimodal analgesic techniques with less reliance on narcotic pain medications, the use of surgical safety checklists, and incorporating "the patient" into the surgical decision-making process through decision aids.

• Korean Journal of Adult Nursing
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• v.27 no.1
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• pp.73-82
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• 2015

Purpose: This study examined the effects of peer assisted learning (PAL) using video recordings in standardized patients (SP) simulation. Methods: A mixed-method approach was adopted, in which quantitative data were supplemented with qualitative data. Research participants consisted of 49 nursing students, 24 of whom were assigned to the experimental group, and 25 to the control group. The 12 item instrument was used to measure perioperative care knowledge, while performance confidence was assessed with the 10 item questionnaire, and clinical critical thinking skills with the Clinical Critical Thinking Skill Test (CCTS). Qualitative data were collected using a reflective journaling and in-depth interviews. Results: Participants in the experimental group exhibited significantly higher levels of knowledge than those in the control group (t=5.43, p<.001), and were significantly more confident in their performances (F=52.33, p<.001). However, no significant differences were found between the experimental and the control groups with regard to CCTS (t=0.72, p=.477). A qualitative content analysis was conducted using the interview and reflective journaling data, in which six major themes were elicited from three codes. Conclusion: PAL employing video recordings is expected to be utilized as a teaching and learning strategy in simulation-based nursing practicum with greater frequency and longer period, given the positive effects observed in this study.

• Journal of Gastric Cancer
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• v.11 no.2
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• pp.101-108
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• 2011

Purpose: Despite the compelling scientific and clinical data supporting the use of early oral nutrition after major gastrointestinal surgery, traditional bowel rest and intravenous nutrition for several postoperative days is still being used widely after gastric cancer surgery. Materials and Methods: A phase II study was carried out to evaluate the feasibility and safety of postoperative early oral intake (water intake on postoperative days (POD) 1-2, and soft diet on POD 3) after a gastrectomy. The primary outcome was morbidity within 30 postoperative days, which was targeted at <25% based on pilot study data. Results: The study subjects were 90 males and 42 females with a mean age 61.5 years. One hundred and four (79%) and 28 (21%) patients underwent a distal and total gastrectomy, respectively. The postoperative morbidity rate was within the targeted range (15.2%, 95% CI, 10.0~22.3%), and there was no hospital mortality. Of the 132 patients, 117 (89%) successfully completed a postoperative early oral intake regimen without deviation; deviation in 10 (8%) due to gastrointestinal symptoms and in five (4%) due to the management of postoperative complications. The mean times to water intake and a soft diet were $1.0{\pm}0.2$ and $3.2{\pm}0.7$ days, respectively, and the mean hospital stay was $10.0{\pm}6.1$ days. Conclusions: Postoperative early oral intake after a gastrectomy is feasible and safe, and can be adopted as a standard perioperative care after a gastrectomy. Nevertheless, further clinical trials will be needed to evaluate the benefits of early oral nutrition after upper gastrointestinal surgery.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.13
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• pp.5389-5393
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• 2014

Background: A clinical pathway (CP) can standardize and improve perioperative care for a number of interventions. In hepatic surgery, however, pertinent evidence is very limited. This study was conducted to implement a CP for hepatocellular carcinoma (HCC) patients undergoing hepatectomy, and to evaluate its effects on hospital costs, length of hospital stay (LOHS) and early clinical outcomes. Materials and Methods: Medical records for HCC patients undergoing hepatectomy were retrospectively reviewed before implementation of a CP (the non-CP group) from March 2012 to August 2012. This information was compared with the data collected prospectively from patients after implementation of the CP (the CP group) between September 2012 and April 2013. Hospital costs, LOHS and early clinical outcomes were evaluated and compared between groups. Results: There were no significant differences in terms of patient clinical characteristics between the two groups. For clinical outcome measures, no significant differences were found in postoperative complications, mortality and readmission rate. The hospital costs were significantly reduced from 24,844 RMB in the non-CP group to 19,761 RMB in the CP group (p<0.01). In addition, patients of the CP group also had shorter LOHS compared with the non-CP group (8.3 versus 12.3 days, p<0.001). Conclusions: The CP proved to be an effective approach to minimize hospital costs and LOHS with hepatectomy for HCC without compromising patient care.

• Journal of Chest Surgery
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• v.33 no.8
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• pp.630-637
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• 2000

Backgroud: There are well-known problems in the management of low weight neonates or infants with congenital heart defects. In the past, because of a perceived high risk of operations using cardiopulmonary bypass(CPB) in these patients, there was a tendency for staged palliation without the use of CPB. However, the recent trend has been toward early reparative surgery using CPB, with acceptable mortality and good long-term survival. Therefore we reviewed our results of the operations in infants weighing less than 3kg and considered the technical aspect of conducting the CPB including myocardial protection. Material and Method: Between Jan. 1995 and Jul. 1998, 28 infants weighing less than 3kg underwent open heart surgery for many cardiac anomalies with a mean body weight of 2.7kg(range; 1.9-3.0kg) and a mean age of 41days(range; 4-110days). Preoperative management in the intensive care unit was needed in 20 infants and preoperative ventilator support therapy in 11. Total correction was performed in 23 infants and the palliative procedure in 5. Total circulatory arrest was needed in 11 infants(39%). Result: There were seven hospital deaths(25%) caused by myocardial failure(n=3), surgical failure(n=2), multiorgan failure(n=1), and sudden death(n=1). The median duration of hospital stay and intensive care unit stay were 13days(range; 6-93days) and 6days(range; 2-77days) respectively. The follow-up was achieved in 21 patients and showed three cases of late mortality(15%) and a one-year survival rate of 62%. No neurologic complications such as clinical seizure and intracranial bleeding were noticed immediately after surgery and during follow-up. Conclusion: The early and late mortality rate of open heart surgery in our infants weighing less than 3 kg stood relatively high, but the improved outcomes are expected by means of the delicate conduct of cardiopulmonary bypass including myocardial protection as well as the adequate perioperative management. Also, the longer follow-up for the neurologic development and complications are needed in infants undergoing circulatory arrest and continuous low flow CPB.

• Journal of Chest Surgery
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• v.47 no.3
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• pp.211-219
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• 2014

Background: Our objectives were to review our institutional early and midterm experience with primary tetralogy of Fallot (TOF) repair, and identify predictors of intensive care unit (ICU) morbidity. Methods: We analyzed perioperative and midterm follow-up data for all cases of primary TOF repair from 2001 to 2012. The primary endpoint was early mortality and morbidity, and the secondary endpoint was survival and functional status at follow-up. Results: Ninety-seven patients underwent primary repair. The median age was 4.9 months (range, 1 to 9 months), and the median weight was 5.3 kg (range, 3.1 to 9.8 kg). There was no early surgical mortality. The incidence of junctional ectopic tachycardia and persistent complete heart block was 2% and 1%, respectively. The median length of ICU stay was 6 days (range, 2 to 21 days), and the median duration of mechanical ventilation was 19 hours (range, 0 to 136 hours). By multiple regression analysis, age and weight were independent predictors of the length of ICU stay, while the surgical era was an independent predictor of the duration of mechanical ventilation. At the 8-year follow-up, freedom from death and re-intervention was 97% and 90%, respectively. Conclusion: Primary TOF repair is a safe procedure with low mortality and morbidity in a medium-sized program with outcomes comparable to national standards. Age and weight at the time of surgery remain significant predictors of morbidity.

• Journal of Veterinary Clinics
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• v.32 no.4
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• pp.374-379
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• 2015

A 10-year-old gelding Warmblood weighing 560 kg was referred to J&C Equine Hospital with the history of hyperpnea, depression, pawing, and rolling for 7 hours. According to the results of clinical and ultrasound examination, it was considered that intestines were distended with thickened wall. The horse had been treated with lactated Ringers' solution (14 L, IV), flunixin meglumine (1.1 mg/kg, IV), and mineral oil (1 L, PO), but he did not show any responses to those treatments. Exploratory laparotomy was performed and identified incarcerated small intestine through the epiploic foramen. The horse received resection and anastomosis of the entrapped small intestine. After surgery, the horse was treated with intensive postoperative care of fluid therapy (5 L with 20 mEq/L KCl, every 2 hours), flunixin meglumine (1.1 mg/kg, IV, sid), antibiotics (penicillin 22,000 IU/kg, IV, qid and gentamicin 6.6 mg/kg, IV, sid), lidocaine constant rate infusion (bolus 1.3 mg/kg over 15 minutes then 0.05 mg/kg/minute), common nutritional supplements, nasogastric intubation every 2 hours and trunk bandage. Postoperative feeding program had started with small amount of hay every 4 hours and gradually increased to normal amount till 5 days. At 77 days after surgery, he showed sudden outbreak of colic and was euthanized. The causes of colic were small intestinal strangulation by passing through the mesenteric rents and postoperative adhesion between small intestines. According to the results, it is recommended to perform perioperative intensive care of horse with colic and to use several methods to prevent adhesions during abdominal surgery of horses.

• Journal of Chest Surgery
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• v.55 no.2
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• pp.118-125
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• 2022

Background: A time course analysis was undertaken to evaluate how perioperative process-of-care and outcome measures evolved after implementation of an enhanced recovery after thoracic surgery (ERATS) program. Methods: Outcome and process-of-care measures were compared between patients undergoing major elective thoracic surgery during a 9-month pre-ERATS implementation period to those at 1-3, 4-6, and 7-9 months post-ERATS implementation. Outcome measures included length of stay, the 30-day readmission rate, 30-day emergency department visits, and minor and major adverse events. Process measures included first time to activity, out-of-bed, ambulation, fluid diet, diet as tolerated, as well as removal of the first and last chest tube, epidural, patient-controlled analgesia, and Foley and intravenous catheters. Results: In total, 704 patients (352 pre-ERATS, 352 post-ERATS) were included. Mobilization-related process measures, including time to first activity (16.5 vs. 6.8 hours, p<0.001), out-of-bed (17.6 vs. 8.9 hours, p<0.001), and ambulation (32.4 vs. 25.4 hours, p=0.04) saw statistically significant improvements by 1-3 months post-ERATS implementation compared to pre-ERATS. Time to Foley removal improved by 4-6 months post-ERATS (19.5 vs. 18.2 hours, p=0.003). Outcome measures, including the 30-day readmission rate and emergency department visits, steadily decreased post-ERATS. By 7-9 months post-ERATS, both minor (18.2% vs. 7.9%, p=0.009) and major (13.6% vs. 4.4%, p=0.007) adverse events demonstrated statistically significant improvements. Length of stay trended towards improvement from 6.2 days pre-ERATS to 4.8 days by 7-9 months post-ERATS (p=0.06). Conclusion: The adoption of ERATS led to improvements in multiple process-of-care measures, which may collectively and gradually achieve optimization of clinical outcomes.

• Journal of Veterinary Clinics
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• v.31 no.2
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• pp.102-107
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• 2014

This study was conducted to analyze the results of inhalation anesthesia performed at the equine hospital of Korea Racing Authority (KRA) and to find out the influencing factors on mortality during and/or after inhalation anesthesia. Among 585 cases of anesthesia, orthopedic surgery (410) was performed the most frequently, followed by colic surgery (85) and upper airway surgery (45). Twenty out of 585 horses were either euthanized or died during and/or after anesthesia. Among those twenty horses, fourteen horses received colic surgery, three received orthopedic surgery, and three others received upper airway surgery. The major causes of mortality were rupture of intestine in colic surgery and airway obstruction during recovery in upper airway surgery. Myopathy, refracture, laminitis were the causes of mortality in orthopedic surgery. Consequently, the horses that received colic and upper airway surgeries showed significantly high mortality rate rather than horses that received orthopedic surgery (p < 0.01). According to the results, horses that received colic surgery showed the highest mortality rate from euthanasia due to poor and grave prognosis. To reduce the perioperative mortality of horses, it is recommended to perform perioperative intensive care for colic surgery and careful monitoring for upper airway surgery during recovery.