• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.1
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• pp.39-44
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• 2020

Homozygous familial hypercholesterolemia (HoFH) is a rare inherited disorder that presents as abnormally elevated levels of low-density lipoprotein cholesterol and premature heart disease, requiring frequent intervention through lipid apheresis for management. The risk of perioperative cardiac events is higher in patients with HoFH because of its pathophysiological manifestations in the vascular system. Careful cardiac precautions and anesthetic assessments are necessary to ensure patient safety. In the following case report, we discuss the clinical course and anesthetic considerations for a 14-year-old girl with HoFH undergoing sedation for dental extractions and mandibular molar uprighting in an outpatient oral surgery clinic. Considerations included the use of heparin in the patient's weekly plasma lipid apheresis treatment. In order to reduce the risks of peri- and postoperative bleeding and perioperative cardiac events, the operation was scheduled for 4 days after apheresis. This allowed for adequate heparin clearance, while also reducing the likelihood of possible cardiac events. A literature review revealed no results for the outpatient management of patients with HoFH undergoing sedation for noncardiac procedures. Our reported case serves as a clinical example for physicians to be utilized in the future.

• The Korean Journal of Pain
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• v.29 no.2
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• pp.71-72
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• 2016

• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2006.11a
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• pp.335-352
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• 2006

• Journal of Chest Surgery
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• v.20 no.1
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• pp.139-147
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• 1987

in general rapid and complete resolution of pulmonary emboli, even massive, is the natural history. However, rarely, the emboli do not resolve but rather became fibrotic organization and densely adherent to the arterial wall, therefore, may lead to significant clinical disability. In patients with chronic pulmonary embolism, medical management usually has little effect and only surgical treatment can offer improvement. The case was 30-year-old man who had admission to the Hanyang University Hospital due to fall-down from 11th floor 407 days before operation and then transferred to our department for surgical management under the diagnosis of chronic pulmonary embolism, Pulmonary angiogram demonstrated multifocal thromboembolism with infarction and lung scans showed no improvement in spite of anticoagulant and thrombolytic therapy. At median sternotomy for pulmonary artery thromboembolectomy, the well organized and multiple septic emboli could be removed by gallstone forceps. But reoperation of left upper lobectomy was performed because of the repeated hemoptysis and suspicious pulmonary arterio-bronchial fistula 19 days postoperatively. Despite of ventilatory support and drug treatment, the patient died due to right heart failure associated with cor pulmonale 27 days after first operation. Discussion of the operative and perioperative problems are offered.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.50 no.3
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• pp.146-152
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• 2024

Objectives: This prospective observational study aimed to assess the clinical outcomes of perioperative airway and ventilatory management in patients undergoing surgery for oral cavity cancer. The study described the frequencies and types of procedures for securing the airway and the duration and types of postoperative ventilatory support. We compared the findings with those of the TRACHY study. Patients and Methods: One hundred patients undergoing oral cavity oncological surgeries were included. Airway assessment included inter-incisor gap, Mallampati class, neck movements, and radiological features. Surgical parameters, postoperative ventilatory support, and complications were documented. Results: The buccal mucosa was the most common cancer site (48.0%), and direct laryngoscopy was deemed difficult in 58.0% of patients. Awake fibreoptic intubation or elective tracheostomy was required in 43.0% of cases. Thirty-three patients were extubated on the table, and 34 patients were successfully managed with a delayed extubation strategy. In comparison with the TRACHY study, variations were observed in demographic parameters, tumour characteristics, and surgical interventions. Our mean TRACHY score was 1.38, and only five patients had a score ≥4. Prophylactic tracheostomy was performed in 2.0% of cases, in contrast to the TRACHY study in which 42.0% of patients underwent the procedure. Conclusion: The study emphasizes the challenges in airway management for oral cavity cancer surgery. While prophylactic tracheostomy may be necessary in specific cases, individualized approaches, including delayed extubation, are preferrable to maximize safety. Our findings contribute to better understanding and managing perioperative challenges in oral cancer patients and highlight the need for personalized strategies. Scoring systems like TRACHY should not be accepted as universally applicable.

• Korean Journal of Adult Nursing
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• v.28 no.6
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• pp.680-690
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• 2016

Purpose: This study was designed to identify knowledge, attitude, environment, and self-efficacy among perioperative nurses in terms of radiation protection and to describe those factors affecting radiation protection behaviors. Methods: The sample was comprised of 128 perioperative nurses who agreed to participate in this descriptive study. Data were collected from a self-administered questionnaire and were analyzed using the t-test, analysis of variance, Mann-whitney U test, Kruskal-Wallis test, Pearson's correlation, and multiple regression analyses. Results: Radiation protection behaviors were significantly different by participant's gender, length of career as a perioperative nurse, educational level and prior experience with radiation protection education. Radiation protection behaviors were significantly correlated with radiation protection environment and self-efficacy in terms of radiation protection behaviors. In the multiple linear regression models, radiation protection environment and self-efficacy on radiation protection behaviors were statistically significant predictors of radiation protection behaviors, which accounted for 50.3% of variance in dependent variable. Conclusion: This study concluded that radiation protective environment in operating room is important to promote radiation protective behaviors and radiation safety management program to enhance self-efficacy is highly recommended.

• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.18-23
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• 2019

As the population grows older and medical treatments are advancing, the number of spine surgeries in elderly patients has been increasing. To obtain a successful outcomes of spine surgery in elderly patients, surgeons should prepare meticulously because elderly patients can have osteoporosis and surgery can be more extensive than in younger patients. Therefore, this study reviewed the perioperative medical treatment, particularly for osteoporosis, to improve the surgical outcomes in elderly patients.

• Journal of The Korean Dental Society of Anesthesiology
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• v.8 no.2
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• pp.118-121
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• 2008

Background: This retrospective study aims to describe the airway management and to search predictive parameter for difficult intubation in 700 patients undergoing oromaxillary surgery. Methods: The medical records of 700 patients undergone oromaxillary surgery were reviewed for airway management during perioperative period. The cases of difficult intubation were selected and those radiologic findings were reviewed. The mandibular depth (MD), mandibular length (ML), thyromental distance (TMD) were measured. Results: In 41 cases difficult intubation were recorded in anesthetic record. The grade of Cormack and Lehane was III in 36 patients and IV in 5 cases. The MD of difficult intubation cases was $4.2{\pm}3.2\;cm$. The ML of difficult intubation cases was $10.1{\pm}3.8\;cm$. The TMD of difficult intubation cases was $5.9{\pm}4.3\;cm$. Under the fiberoptic guided awake intubation was undertaken in 75 patient. In none of the cases was failed nasotracheal intubation. Conclusions: The patients undergoing oromaxillar surgery have a potentially difficult airway but, if managed properly during perioperative preiod, morbidity and mortality can be reduced or avoided. The radiologic findings were poor predict for difficult intubation. The fiberoptic guided awake intubation is a safe alternative to direct laryngoscopic intubation.

• Journal of Yeungnam Medical Science
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• v.39 no.3
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• pp.223-229
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• 2022

Background: The first large coronavirus disease 2019 (COVID-19) outbreak outside China occurred in Daegu. In response, we developed infection prevention measures for surgical patients during the outbreak at our hospital and retrospectively reviewed the outcomes of COVID-19-related surgical patients. Methods: We reviewed the medical records of 118 COVID-19-related surgical patients and monitored their clinical outcomes until March 31, 2021. We also interviewed healthcare workers who participated in their perioperative care at Kyungpook National University Chilgok Hospital. The perioperative management guidelines for COVID-19-related patients were prepared through multidisciplinary discussions, including the infection control department, surgical departments, and anesthesiology department before and during the COVID-19 outbreak. Results: One standard operating room was temporarily converted to a negative-pressure room by increasing the exhaust air volume, creating a relative pressure of -11.3 Pa. The healthcare workers were equipped with personal protective equipment according to the patient's classification of the risk of COVID-19 transmission. The 118 COVID-19-related patients underwent emergent surgery in the negative-pressure room, including three COVID-19-confirmed patients and five COVID-19-exposed patients. Conclusion: All surgeries of the COVID-19-related patients were performed without specific adverse events or perioperative COVID-19 transmission. Our experience setting up a negative-pressure operating room and conservative perioperative protocol to prevent COVID-19 transmission will help plan and execute infection control measures in the future.

• Korean Journal of Clinical Pharmacy
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• v.27 no.1
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• pp.15-21
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• 2017

Objective: The perioperative management of antithrombotic therapy is often challenging and it requires a fine balance between the risk of hemorrhage and thrombosis. We aimed to evaluate the antithrombotic management for moderate to high risk patients in real world setting. Methods: Among the patients who were consulted to the neurologist for the evaluation of perioperative risk from 2010 to 2012, patients undergoing moderate to high risk surgery and taking antithrombotics within 30 days were identified. We analyzed the timing of discontinuation and reinitiation of antithrombotic drugs before or after surgery as well as the status of bridging therapy. In addition, the conformity with the guideline suggested by American College of Chest Physicians was assessed. The rate of thromboembolic event and major hemorrhage were also investigated. Results: A total of 329 patients were included. The concordance rate of warfarin stop and restart time with guideline was 23.4% and 10.3%, respectively. Continuing aspirin in patients undergoing coronary artery bypass surgery or non-cardiac surgery in patients with high risk for cardiovascular events were 59.2% and 2.6%, respectively. Bridging therapy was adopted in 92.9% and 81.2% in patients who had received anticoagulant before surgery and who were at high and low risk thromboembolism, respectively. In entire cohorts, 30-day incidence of major bleeding and thromboembolic event were 31.9% and 3.0%. Co-morbid renal disease were shown as independent predictor for major bleeding (adjusted OR 2.65. 95% CI 1.33-5.28). Conclusion: The concordance rate with guideline regarding perioperative antithrombotic use was low and bridging therapy was prevalent in patients undergoing moderate to high risk surgery.