No abstract

Background In elderly patients, spinal anesthesia-induced hypotension (SAH) can be frequently caused by reduced preload and stiff ventricles. The primary purpose of this study was to investigate the ability of ultrasonographic carotid artery flow measurements during the passive leg raise (PLR) test to predict SAH in elderly patients. The correlation between preoperative transthoracic echocardiography (TTE) measurements and SAH was also investigated. Material/Methods The patients aged over 65 years scheduled for elective surgery under spinal anesthesia were recruited. Preoperative TTE was performed in all patients. Corrected carotid flow time and carotid blood flow were measured in the supine, semirecumbent, and PLR positions. Ultrasonographic carotid artery flow and preoperative TTE measurements were compared between patients who developed SAH and those who did not. Receiver operating characteristic (ROC) curve analysis and logistic regression analysis were used to test the association with SAH. Results SAH occurred in 17 of 50 patients. Carotid blood flow in the semirecumbent position and preoperative mitral inflow E velocity could predict SAH, showing an area under the ROC curve of 0.754 (95% CI, 0.612–0.865) and 0.775 (95% CI, 0.634–0.881), respectively. However, according to the multivariate analysis, the independent risk factor for SAH was mitral inflow E velocity (OR 0.918, 95% CI 0.858–0.982, P =0.013). Conclusions In elderly patients, ultrasonographic carotid artery flow measurements failed to predict the occurrence of SAH. Only preoperative mitral inflow E velocity of TTE was selected as an independent risk factor for SAH.

Solid organ transplantation is distinguished from other high-risk surgical procedures by the fact that it utilizes an extremely limited and precious resource and requires a multidisciplinary team approach. For several decades, institutional experience, as quantified by center volume, has been shown to be strongly associated with patient outcomes and graft survival after solid organ transplantation. The United States has implemented a minimum case volume requirement and performance standards for accreditation as a validated transplantation center. Solid organ transplantation in Europe is also governed by the European Union, which monitors patient outcomes and organ allocation. The number of solid organ transplantation cases in Korea is increasing, with patient outcomes comparable to international standards. However, Korea has outdated regulations regarding hospital facilities, and performance indicators including patient outcomes after transplantation are not monitored. Therefore, centers perform solid organ transplantation with no meaningful oversight. In this review, data regarding the impact of institutional case volume of kidney, liver, lung, and heart transplantation are summarized, followed by a description of current transplantation center regulations in the United States and Europe. The basis for the necessity of adequate transplantation center regulations in Korea is presented.

Hypoxic-ischemic brain injury (HIBI) after cardiac arrest (CA) is a leading cause of mortality and long-term neurological disorders in survivors. Targeted temperature management (TTM) has been rigorously studied as a way to improve results compared to a normal body temperature for preventing secondary damage after HIBI. We report a case of successful TTM in a patient who was suspected to have HIBI after resuscitation from cardiovascular collapse due to respiratory failure during elective surgery under brachial plexus block with dexmedetomidine and remifentanil infusion. A 27-year-old male patient developed CA due to apnea during orthopedic surgery. TTM was performed in the surgical intensive care unit for 72 hours after resuscitation, and the patient recovered successfully. TTM application immediately after resuscitation from CA in patients with suspected HIBI may be an appropriate treatment.

The primary aim of this review is to explore current knowledge on the relationship between institutional intensive care unit (ICU) patient volume and patient outcomes. Studies indicate that a higher institutional ICU patient volume is positively correlated with patient survival. Although the exact mechanism underlying this association remains unclear, several studies have proposed that the cumulative experience of physicians and selective referral between institutions may play a role. The overall ICU mortality rate in Korea is relatively high compared to other developed countries. A distinctive aspect of critical care in Korea is the existence of significant disparities in the quality of care and services provided across regions and hospitals. Addressing these disparities and optimizing the management of critically ill patients necessitates thoroughly trained intensivists who are well-versed in the latest clinical practice guidelines. A fully functioning unit with adequate patient throughput is also essential for maintaining consistent and reliable quality of patient care. However, the positive impact of ICU volume on mortality outcomes is also linked to complex organizational factors, such as multidisciplinary rounds, nurse staffing and education, the presence of a clinical pharmacist, care protocols for weaning and sedation, and a culture of teamwork and communication. Despite some inconsistencies in the association between ICU patient volume and patient outcomes, which are thought to arise from differences in healthcare systems, ICU case volume significantly affects patient outcomes and should be taken into account when formulating related healthcare policies.