• Radiation Oncology Journal
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• v.12 no.3
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• pp.307-313
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• 1994

Purpose : Maxillary sinus cancers usually are locally advanced and involve the structures around sinus. It is uncommon for this cancer to spread to the regional lymph-nodes. For this reason, local control is of paramount important for cure. A policy of combined treatment is generally accepted as the most effective means of enhancing cure rartes. This paper reports our experience of a retrospective study of 31 Patients treated with radiation therapy alone and combination therapy of surgery and radiation. Materials and Methods: Between July 1974 and January 1992, 47 Patients with maxillary sinus cancers underwent either radiation therpay alone or combination therapy of surgery and radiation. Of these, only 31 patients were eligible for analysis. The distribution of clinical stage by the AJCC system was $26\%$(8/31) for T2 and $74\%$(23/31) for T3 and T4. Eight patients had palpable lymphadenopathy at diagnosis. Primary site was treated by Cobalt-60 radiation therapy using through a $45^{\circ}$ wedge-pair technique. Elective neck irradiation was not routinely given. Of these 8 patients, the six who had clinically involved nodes were treated with definite radiation therapy. The other two patients had received radical neck dissection. The twenty-two patients were treated with radiation alone and 9 patients were treated with combination radiation therapy, The RT alone patients with RT dose less than 60 Gy were 9 and those above 60 Gy were 13. Results : The overall 5 year survival rate was $23.8\%$. The 5 year survival rate by T-stage was $60.5\%$ and $7.9\%$ for T2 and T3,4, respectively. Statistical significance was found by T-stage(p<0.005). The 5 year survival rate by N-stage was $30\%$ for N (-) and $8.3\%$ for N(+), but statistically no significant difference was seen(p${\geq}$0.1). The 5 year survival rate for RT alone and combination RT was $22.5\%$ and $27.4\%$, respectively. The primary local control rate was $65\%$ (20/31). Conclusion : This study did not show significant difference in survival between RT alone and combination RT. There is still much controversy with regard to which treatment is optimum. Improved RT technique and development of multimodality treatment are essential to improve the local control and the survival rate in patients with advanced maxillary sinus cancer.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.156-163
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• 2001

Background: The categorical scales and visual analogue scales (VAS) are methods used for evaluating variations of postoperative pain intensity. Several studies have introduced the idea that there is a clear correlation between visual scales and categorical scales. However, when VAS is the only pain measure in the study, we do not know what point on the VAS represents a category on the categorical scale and their degree of correlation with satisfaction for postoperative pain. Methods: 252 patients who had undergone elective surgery were studied. A 5-point categorical scale (none, mild, moderate, severe, worst possible pain), a 0-100 mm VAS (no pain to worst possible pain) and patient satisfaction score were checked 24 hours after surgery using a pain questionnaire and VAS tool. Results: The mean VAS score of the 14 patients reporting 'no-pain' was $1.9{\pm}0.9$, $23.9{\pm}1.0$ for the 132 patients reporting 'mild-pain', $47.2{\pm}1.1$ for the 82 patients reporting 'moderate-pain' and $67.5{\pm}2.8$ for the 24 patients reporting 'severe-pain'. Of the patients reporting moderate pain, 85% scored over 45.6 mm on the corresponding VAS, with a mean score 47.2 mm. The mean satisfaction scores were $90.6{\pm}2.7$ for the 'no pain', patients, $75.1{\pm}1.3$ for ‘mild pain', $58.3{\pm}1.5$ for 'moderate pain', and $55.1{\pm}4.0$ for 'severe pain' patients. The categorical scale was significantly correlated with VAS (P < 0.01). The satisfaction score was significantly inversely correlated with VAS (P < 0.01). Conclusions: Our results indicate that if a patient records a VAS score in excess of 45.6 mm they would probably have recorded at least moderate pain on a 5-point categorical scale. The categorical scale can be used properly for postoperative pain measurement with VAS. More research is required for the development of suitable pain descriptor for a categorical scale and pain questionnaire in Korean.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.4
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• pp.195-202
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• 2020

Background: Nasotracheal intubation is the most commonly used method to secure the field of view when performing surgery on the oral cavity or neck. Like orotracheal intubation, nasotracheal intubation uses a laryngoscope. Hemodynamic change occurs due to the stimulation of the sympathetic nervous system. Recently, video laryngoscope with a camera attached to the end of the direct laryngoscope blade has been used to minimize this change. In this study, we investigated the optimal effect-site concentration (Ce) of remifentanil for minimizing hemodynamic responses during nasotracheal intubation with a video laryngoscope. Methods: Twenty-one patients, aged between 19 and 60 years old, scheduled for elective surgery were included in this study. Anesthesia was induced by slowly injecting propofol. At the same time, remifentanil infusion was initiated at 3.0 ng/ml via target-controlled infusion (TCI). When remifentanil attained the preset Ce, nasotracheal intubation was performed using a video laryngoscope. The patient's blood pressure and heart rate were checked pre-induction, right before and after intubation, and 1 min after intubation. Hemodynamic stability was defined as an increase in systolic blood pressure and heart rate by 20% before and after nasotracheal intubation. The response of each patient determined the Ce of remifentanil for the next patient at an interval of 0.3 ng/ml. Results: The Ce of remifentanil administered ranged from 2.4 to 3.6 ng/ml for the patients evaluated. The estimated optimal effective effect-site concentrations of remifentanil were 3.22 and 4.25 ng/ml, that were associated with a 50% and 95% probability of maintaining hemodynamic stability, respectively. Conclusion: Nasotracheal intubation using a video laryngoscope can be successfully performed in a hemodynamically stable state by using the optimal remifentanil effect-site concentration (Ce₅₀, 3.22 ng/ml; Ce₉₅, 4.25 ng/ml).

• Korea Journal of Hospital Management
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• v.7 no.3
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• pp.44-62
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• 2002

Advanced surgical technology demands more precise, meticulous, and time-consuming procedures. In addition, the patient's preference of tertiary health providers makes over crowding of the University Hospitals. Therefore, it has been necessary to maximize utilization of the operating room of such hospitals to accommodate these requirements. This study, targeting 1,302 surgical cases performed in 22 operating rooms at a university hospital in Seoul from October 8 to November 1, 2001, analyzed reasons for delay, and factors that caused delayed use of operating rooms. This study also assessed that the rate of operating room use would increase if the sources for possible reform were improved. 1. Among total of 1,302 cases of surgery, the incidence of surgeries in which there were no time delays and no factors for delay were discovered is 71.4% or 930 cases: the incidence in which surgeries were delayed was 28.6% or 372 cases. 2. As results of logistic regression for delay, procedures involving women were delayed 1.4 times more frequently than those of men. Compared to Department A, Department B was 1.8 times more likely to be delayed, and Department H was 0.4 times less likely to be delayed. Regional anesthesia was 2.4 times more likely to be delayed than general anesthesia, and surgeries that PCA was applied were 0.6 times less likely to be delayed than those when it was not. Surgeries performed on the Thursday were 1.7 times more likely to be delayed than those performed on the Monday. Compared to surgeries performed between 07:00-07:59, those performed between 08:00-08:29 were 4.3 times higher. 3. The reasons for delay were related to surgeon, surgical department, patient, anesthesia, administrative system, sick ward, and support services. Among these, 5,755 minutes for 276 delayed cases could be resolved easily, and resolving delays of 3,320 minutes for 131 cases would be more difficult. Among the causes for delay that could be improved, delays due to patient's transfer and surgeon's factor were the most common, 21.6% and 17.4% respectively. 4. If resolvable delays are improved, pre-anesthesia room is administered, and regional anesthesia and PCA are done ahead of time, use of emergency operating rooms will increase, we can increase overall utilization by 4.09%, we will save 744 minutes a day, we can reduce the time the operation room is used after 4 PM by 35%, and we can resolve the operation cancellations due to insufficient operating rooms. For the increase in the use of operating rooms, we need to maximally decrease the delays that could be improved, by allocating block time based on used totals hours of elective cases, giving accurate information on surgery schedule, voluntary cooperation by staff participating in surgeries in reducing delay time, and the hospital management's will to improve delay.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.151-158
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• 1996

Background: Buprenorphine, a new synthetic thebaine derivative, is a partial agonist of the opioid $\mu$-receptor with high receptor affinity, great lipid solubility, and slow rate of opiate receptor association and dissociation. Continuous epidural infusion of opioid can possibly produced undesirable effects, such as respiratory depression, pruritus, etc, in spite of effective postoperative analgesia. Methods: The present study was undertaken to compare the analgesic properties and side effects of continuous epidural infusion of buprenorphine combined with bupivacaine, and morphine combined with bupivacaine in 90 patients following elective gynecologic lower abdominal surgery. At the end of surgery, the initial bolus doses were 3 mg morphine (M group), 0.15 mg buprenorphine (0.15B group), 0.3 mg buprenorphine (0.3B group) combined with 0.25% bupivacaine 10ml, and subsequent continuous infusion doses were 6 mg morphine plus 0.125% bupivacine 100 ml (M group) and 0.6mg buprenorphine plus 0.125% bupivacaine 100 ml (0.15B, 0.3B, group) during 48 hours. The assessment of analgesic efficacy and side effects were made at arrival of recovery room, 1 hr, 4 hr, 8 hr, 24 hr, 36 hr, and 48 hr after the epidural injection. Results: The pain score during 48 hours was significantly higher in the 0.15B group than in the M group and 0.3B group (P<0.05), and the number of patients requiring additional analgesics was significantly higher in the 0.15B group than in the M group and 0.3B group (P<0.05). Signs of respiratory depression were not noted, and the incidence of pruritus, nausea, and vomiting was slightly lower in the 0.15B group and 0.3B group than in the M group, and the incidence of sedation and urinary retention was similar in three group. The subjective rating of satisfaction was better in the 0.3B group than in the M group and 0.15B group (P<0.05). Conclusion: The above results suggest that continuous epidural infusion of buprenorphine combined with low-dose bupivacaine is an advisable method of postoperative analgesia.

• The Korean Journal of Pain
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• v.6 no.2
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• pp.231-236
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• 1993

Clonidine, a centrally-acting antihypertensive agent known to reduce central sympathetic outflow and modulate presynaptic transmitter's release, has shown to suppress central noradrenergic hyperactivity induced by immobilization stress in animals, by decreasing the MAC of halothane and the dose of narcotics required to prevent reflex cardiovascular response to noxious stimuli, and to have potent analgesic properties in humans. These characteristics suggest that clonidine might be a useful adjunct to the anesthetic management of patients with preexisting hypertension. Accordingly, we determined the clinical efficacy and safety on analgesia, sedation and hemodynamic stability in the perioperative period. Thirty patients(ASA physical status II-III) with a history of arterial hypertension, scheduled for elective orthopedic surgery were randomly assigned to two groups. We applied CPA-clonidine patch($6.9\;mg/cm^2$, 0.2 mg delivered daily) or placebo patch to each groups, 48 hours prior to induction of anesthesia. Antihypertensive medication was continued until the morning of the scheduled surgery. All patients received premedication of atropine and lorazepam, and induced anesthesia with thiopental and succinylcholine, and maintained with enflurane and 50% nitrous oxide, while sustaining the BP and pulse rate at acceptable range. For the relief of pain postoperatively, diclofenac and fentanyl were administered intramuscularly on demand. The results were as follows: 1) The change of hemodynamic responses in clonidine group was less compared to the placebo group. 2) Intraoperative anesthetic requirement for enflurane in clonidine group were significantly lower than placebo group. 3) Postoperative analgetic requirement in clonidine group were significantly lower than placebo group. In clonidine group, 5 cases out of 15 cases were required no analgetics, and the incidence of administration of additional fentanyl was decreased to 5 cases, comparing with 10 cases in placebo group.

• The Korean Journal of Pain
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• v.22 no.2
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• pp.135-140
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• 2009

Background: The chronobiology of postoperative pain is an interesting topic. This study was performed to evaluate the effects of adenosine on inta-operative remifentanil requirements and on postoperative pain in patients undergoing tonsillectomies and how those effects change with changing time of day the surgery is performed. Methods: For this study, 120 patients were randomly allocated into four groups. Patients in groups B and D received adenosine at a dose of $50{\mu}g/kg/min$, and those in group A and C received an equal volume of saline from 10 minutes after the induction of anesthesia until the end of surgery. Group A (saline) and B (adenosine) patients entered the operating room after 08:30 and finished before 11:00, Group C (saline) and D (adenosine) patients entered the operating room after 13:30 and finished before 16:00. We evaluated the intraoperative time-weighted mean remifentanil dose, and postoperative pain scores at 1, 6, 12, and 24 hours, and the analgesic dose required during the following 24 hours. Results: Time-weighted mean remifentanil doses during the intraoperative period and the analgesic requirement during the following 24 hours in group D was significantly lower than in the other groups. The numeric rating scale for pain at 1, and 6 hours in group D was significantly lower (P < 0.01) than that of group A. There were no significant differences in side effects among groups. Conclusions: Use of intraoperative adenosine infusion provides perioperative analgesia. Postoperative pain is affected by the time of day the operation is performed.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.882-890
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• 2021

Objective : The aim of this study to investigate the benefits of patient-based 3-dimensional (3D) cerebral arteriovenous malformation (AVM) models for preoperative surgical planning and education. Methods : Fifteen patients were operated on for AVMs between 2015 and 2019 with patient-based 3D models. Ten patients' preoperative cranial angiogram screenings were evaluated preoperatively or perioperatively via patient-based 3D models. Two patients needed emergent surgical intervention; their models were solely designed based on their AVMs and used during the operation. However, the other patients who underwent elective surgery had the modeling starting from the skull base. These models were used both preoperatively and perioperatively. The benefits of patients arising from treatment with these models were evaluated via patient files and radiological data. Results : Fifteen patients (10 males and five females) between 16 and 66 years underwent surgery. The mean age of the patients was 40.0±14.72. The most frequent symptom patients observed were headaches. Four patients had intracranial bleeding; the symptom of admission was a loss of consciousness. Two patients (13.3%) belonged to Spetzler-Martin (SM) grade I, four (26.7%) belonged to SM grade II, eight (53.3%) belonged to SM grade III, and one (6.7%) belonged to SM grade IV. The mean operation duration was 3.44±0.47 hours. Three patients (20%) developed transient neurologic deficits postoperatively, whereas three other patients died (20%). Conclusion : Several technological innovations have emerged in recent years to reduce undesired outcomes and support the surgical team. For example, 3D models have been employed in various surgical procedures in the last decade. The routine usage of patient-based 3D models will not only support better surgical planning and practice, but it will also be useful in educating assistants and explaining the situation to the patient as well.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.741-747
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• 2003

Background: Coronary artery bypass graf t (CABG) has been settled as most safe surgery among the open heart surgeries. However, in patients with cardiogenic shock, the emergency CABG has higher mortality than elective CABG. We analyzed thirty four patients who underwent emergency CABG and report the middle and long-term results. Material and Method: From June 1994 to December 2001, 34 patients who underwent emergency CABG at Kang-dong Sacred Heart Hospital were include in this study. On the basis of hospital databases and Out Patient Department (OPD) follow up data, preoperative diagnosis, risk factor, coronary artery anatomy, operation technique, postoperative mortality, complication, recurrence of symptom, and mid and long term mortality were analyzed retrospectively. Result: Indications for emergency CABG were 29 cardiogenic shocks (85.3%), 4 intractable chest pains (11.8%), and 1 polymorphic ventricular tachycardia (2.9%). Preoperative angiographic diagnoses were triple vessel disease in 16 (47.1%) and left main disease in 8 (23.5%) patients. We used saphenous vein grafts in 81 and left internal thoracic artery grafts in 14 anastomosis. The mean number of grafts per patients was 2.8$\pm$0.8. The mean aortic cross clamp time was 91.9$\pm$34.6 minutes and the mean cardiopulmonary bypass time was 262.7$\pm$198.3 minutes. Early mortality was 50% and the most common cause of early mortality was low cardiac output in 7 (20.6%) patients. The mean follow-up period was 30.9$\pm$35.7 months. There were no recurrences of symptom and late mortality. Conclusion: In the case of emergency operation, aggressive and proper management with drugs and IABP should be done for preoperative hemodynamic stability and early surgical intervention is the most important factor for patient salvage.

• Journal of Chest Surgery
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• v.34 no.7
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• pp.524-533
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• 2001

Background: Hyperoxemic cardiopulmonary bypass (CPB) has been recognized as a safe technique and is widely used in cardiac surgery. However, hyperoxemic CPB may produce higher toxic oxygen species and cause more severe oxidative stress and ischemia/reperfusion injury than normoxemic CPB. This study was undertaken to compare inflammatory responses and myocardial injury between normoxemic and hyperoxemic CPB and to examine the beneficial effect of normoxemic CPB. Material and method: Thirty adult patients scheduled for elective cardiac surgery were randomly divided into normoxic group (n=15), who received normoxemic CPB (about Pa $O_{2}$ 120 mmHg), and hyperoxic group (n=15), who received hyperoxemic CPB (about Pa $O_{2}$ 400 mmHg). Myeloperoxidase (MPO), malondialdehyde (MDA), adenosine monophosphate (AMP), and troponin-T (TnT) concentrations in coronary sinus blood were determined at pre- and post-CPB. Total leukocyte and neutrophil counts in arterial blood were measured at the before, during, and after CPB. Lactate concentration in mixed venous blood was analyzed during CPB, and cardiac index (Cl) and pulmonary vascular