Analysis of variations in anesthesia cost according to severity of physical status and cancer stage in colorectal cancer patients

Background: Since the late 2000s, the number of anesthesia performed has increased yearly. However, there has not been research into the appropriate cost of anesthesia based on the difficulty of anesthesia performed, the number of medical personnel participated, and materials administered for anesthesia. The purpose of this study was to analyze the variations in anesthesia cost according to severity of their physical status and cancer stage in patients who had undertaken colorectal cancer surgeries. Methods: In order to analyze the cost of anesthesia for colorectal cancer surgery, we used Electronic Data Interchange data from 2011 to 2012 of the three superior general hospitals in Seoul. Colorectal cancer codes were limited to seven codes included in the cancer screening statistics of the Health Insurance Review and Assessment Service. Based on these data, a frequency analysis and a multiple linear regression analysis were performed. Results: There was no variation in the cost of anesthesia according to gender and age. However, the ASA physical status (PS) class and the cancer stage variables were confirmed to modify the anesthesia cost. Conclusions: These study imply that there is a difference in the technology used for anesthesia by medical personnel as well as the anesthesia related materials used according to the ASA PS and the cancer stage among patients having the same disease.ope

Incidence and Risk Factors of Acute Kidney Injury After Kasai Operation for Biliary Atresia: A Retrospective Study

Background: Biliary atresia is a progressive, inflammatory, and destructive pathology of the bile ducts. Patients who undergo surgery for correction of biliary atresia (Kasai operation) are at risk of acute kidney injury (AKI) because of their young age at the time of surgery, long operation time, and liver fibrosis or failure as complication of biliary atresia. Conversely, AKI is associated with poor outcomes after surgery. This study therefore aimed to evaluate the incidence, risk factors, and outcomes of AKI after Kasai operation. Methods: All consecutive patients who underwent Kasai operation between March 2006 and December 2015 in a single tertiary-care university hospital were enrolled. AKI was defined based on the Acute Kidney Injury Network criteria. Multivariate logistic regression models were used to assess risk factors for AKI. Results: One hundred sixty-six patients received Kasai operation during study period. Of these, AKI occurred in 37 of 166 patients (22.3%). In multivariate logistic regression analysis, age older than 30 days, higher preoperative estimated glomerular filtration rate, and preoperative contrast use within 7 days were associated with the development of AKI. Perioperative packed red blood cells transfusion was related to reduced occurrence of AKI. AKI was associated with longer ICU stay (OR = 1.015, p = 0.016). More patients with AKI were also found to receive additional surgery except liver transplantation within 1 year compared to those without AKI (10.8 % vs. 2.3 %, p = 0.045). Conclusions: Increased age is strongly associated with the development of AKI after Kasai operation. These findings indicate a rational basis for early corrective surgery for biliary atresia, early screening for AKI, and intervention to improve the results of Kasai operation.ope

Comparison of the impacts about climate factors and emission change on multimedia concentration of PBDEs in Korea

학위논문 (석사)-- 서울대학교 환경대학원 : 환경계획학과, 2015. 2. 이동수.기후변화는 유해화학물질의 환경 농도에 영향을 끼쳐 인체 및 생태계의 노출량을 변화시킬 수 있다. 특히 소비제품에서 배출되는 화학물질은 온도에 따라 환경으로의 배출량이 달라지므로 직·간적접인 기후변화의 영향을 받을 수 있다. 따라서 이 연구에서는 소비 제품에 첨가되어 배출되는 PBDEs를 대상으로 환경 농도 변화에 미칠 수 있는 기후인자와 배출량의 영향을 정량적으로 이해하고자 했다. 기후인자 및 배출량 변화로 인한 오염도 변화를 예측하기 위해 다매체모형인 KPOP-CC와 RCP8.5 기후 시나리오를 적용하였고, (1) 하나는 대기 배출이 시간에 따라 동일한, (2) 또 하나는 대기 배출이 미래 온도에 따라 변하는, 두 가지 대기 배출 시나리오를 적용하여 분석하였다. 연구 결과, 환경 농도 변화에 끼치는 기후인자와 배출량 변화의 영향은 평균적으로 모든 매체에서 배출량의 영향이 큰 것으로 나타났다. 특히 대기 농도변화의 약 95% 이상이 배출량의 영향으로 나타났으며 토양은 평균적으로 약 70% 이상, 수체는 약 80% 이상이 배출량의 영향이었다. 기후인자가 농도 변화에 끼치는 비중은 상대적으로 낮았지만 일부 시기와 지역에 따라 기여도가 비교적 높아질 수 있음을 확인하였다. 계절에 따라서는 대기는 여름철, 토양은 봄철, 수체는 겨울철이 기후인자의 기여도가 비교적 높았다. 또한 지역에 따라서는 대기는 자체 대기배출량이 상대적으로 높은 지역에서 기후인자의 기여도가 농도 증가 방향으로 작용했고, 토양은 강우량 변화가 큰 지역에서 기후인자의 기여도가 크게 나타났다. 이러한 변화의 요인으로는, 토양 농도는 강우량과 온도와 상관성이 나타났고 대기의 경우는 지역을 둘러싼 배출 환경 조건에 따라 달랐으며 자체 배출량이 높은 지역에서 풍속과 음의 상관성이 나타났다. 따라서 대기는 주변보다 배출량이 높은 대도시 지역에서, 토양은 강우량 변화가 적은 조건에서 미래의 오염도 증가가 클 수 있다. 농도 변화는 배출량 변화의 영향이 지배적이었기 때문에, 현재 제품에 첨가되고 다양한 물성을 가진 물질에 대해 배출 산정을 포함한 기후변화의 영향이 평가되어야 할 것이다. 또한 유해화학물질의 미래의 잠재적인 노출 변화를 감소시키기 위해서는 배출량의 제어가 필요하며 소비제품의 생산과정에서부터 관련물질을 규제하고 관리하는 것이 필요할 것이다.Ⅰ. 서론 1 1. 연구의 배경과 목적 1 2. 연구의 범위와 방법 3 Ⅱ. 기존연구의 고찰 7 1. RCP8.5 시나리오에 따른 기후인자 변화 7 2. PBDEs의 물리화학적 특성 및 배출특성 12 3. 기후변화가 POPs 동태변화에 미치는 영향 15 Ⅲ. 결과 및 토의 17 1. PBDEs 배출량 및 모형 평가 17 1) 배출량 17 2) 실측 농도와 예측 농도의 비교 20 2. 기후변화에 의한 농도 변화 22 1) 대기 22 2) 토양 33 3) 수체 46 Ⅳ. 요약 및 결론 58 ■ 참고문헌 60 PBDEs의 농도변화(ΔCcc)와 기상인자(ΔMeteo)의 상관성 62 PBDEs의 유입과 손실 기작의 기여도(%) 63Maste

Prospective, Randomized Comparison of the i-gel and the Self-Pressurized air-Q Intubating Laryngeal Airway in Elderly Anesthetized Patients

BACKGROUND: Age-related changes in upper airway anatomy may affect the overall performance of supraglottic airways significantly. The clinical performance of the i-gel and the self-pressurized air-Q intubating laryngeal airways with noninflatable cuffs for elderly populations remains unknown, unlike in children. Thus, we performed a prospective, randomized comparison of these 2 supraglottic airways in elderly patients undergoing general anesthesia. METHODS: We recruited 100 patients, 65-90 years of age, who were scheduled for elective surgery under general anesthesia with muscle relaxation. The enrolled patients were allocated to the i-gel or self-pressurized air-Q group. We assessed oropharyngeal leak pressure as the primary outcome and fiberoptic view after placement and fixation of the airway and at 10 minutes after the initial assessment. The fiberoptic view was scored using a 5-point scale as follows: vocal cords not visible; vocal cords and anterior epiglottis visible, >50% visual obstruction of epiglottis to vocal cords; vocal cords and anterior epiglottis visible, <50% visual obstruction of epiglottis to vocal cords; vocal cords and posterior epiglottis visible; and vocal cords visible. We also investigated success rate and ease of insertion, insertion time, and manipulations during insertion as insertion variables, complications during maintenance and emergence periods, and postoperative pharyngolaryngeal complications including sore throat, dysphagia, and dysphonia. RESULTS: After assessing for eligibility, 48 patients were allocated to each group. Oropharyngeal leak pressures were significantly higher in the i-gel group than in the self-pressurized air-Q group (P < .001) at the 2 measurement points. The raw mean difference at initial assessment and the median difference after 10 minutes were 5.5 cm H2O (95% confidence interval, 3.3-7.6 cm H2O) and 5.0 (95% confidence interval, 2.0-7.0 cm H2O), respectively. The initial scores of fiberoptic view were similar in the 2 groups. However, the self-pressurized air-Q supraglottic airway provided a significantly improved fiberoptic view at 10 minutes after initial assessment (P = .030). We found no statistically significant differences in insertion variables and complications between the 2 groups. CONCLUSIONS: The i-gel provided better sealing function than the self-pressurized air-Q supraglottic airway according to the high oropharyngeal leak pressures in elderly patients during general anesthesia. The self-pressurized air-Q supraglottic airway had improved fiberoptic views in elderly patients during general anesthesia.restrictio