A Comparison of the Use of a 22 G Quincke Needle with the Use of a 25 G Quincke Needle in Elderly Patients Undergoing Spinal Anesthesia Regarding Postoperative Complications / 대한마취과학회지

BACKGROUND: Several reports have indicated that there are fewer postoperative complications after using a smaller spinal needle in young patients. However, no comparative report has been issued on the incidences of postoperative complications after using differently sized spinal needles for spinal anesthesia in elderly patients. Here, we compared a 22 G Quincke needle with a 25 G Quincke needle in elderly patients and investigated postoperative complications. METHODS: Fifty patients, aged over 60 years presented for an elective urological operation. Patients were randomized into two groups to receive spinal anesthetics using a 22 G Quincke needle (group L) or a 25 G Quincke needle (group S). The incidences of postdural puncture headache (PDPH), backaches, and the outcomes of spinal anesthesia were compared between the two groups. RESULTS: Two patients in group L and one in group S developed PDPH postoperatively with no significant statistical difference between the two groups. Four patients suffered backache in group L and two in group S again without significance. But the number of puncture attempts was significantly higher in group S. CONCLUSION: In conclusion, postoperative complications were similar for both groups. However, spinal anesthesia was performed more easily when using a larger spinal needle. Therefore, we recommend that a larger spinal needle be used when difficult spinal anesthesia is anticipated in elderly patients.

The Optimal Depth of Central Venous Catheter by Using Transesophageal Echocardiography for Pediatric Patients / 대한마취과학회지

BACKGROUND: Incorrect positioning of central venous catheter leads to serious complications. To prevent these complications, catheter tip should be at the superior vena cava and right atrial junction. METHODS: We studied 60 right internal jugular catheterizations in infants and children undergoing surgery for congenital heart disease. To confirm the optimal depth of central venous catheter, we measured the distance from the skin puncture site to subclavian vein-right atrial junction using transesophageal echocardiography. RESULTS: The measured distance highly correlated with the patient height. Based on these data, following guideline could avoid intra-atrial placement in 94% of the time: optimal depth of insertion (cm) = 2.5 + (0.06 x height). CONCLUSIONS: We postulate that initial using a simple practical guideline could prevent malposition of central venous catheter.

The Current Status of Cardiopulmonary Resuscitation in Korean University Hospitals: Education, CPR Cart Items, Post-CPR Report / 대한마취과학회지

BACKGROUND: The low cardiopulmonary resuscitation (CPR) survival rate in Korea might be associated with inadequate education, an insufficient number of trained medical personnel, the inappropriate management of instruments and drugs in CPR carts. The purpose of this study was to determine the current status of these factors in major Korean university hospitals. METHODS: We surveyed the following items among anesthesiologists at 13 university hospitals via E-mail. The items in the questionnaire were; 1) the time allocated to CPR instruction for medical students and anesthesiology residents in a year, 2) the organization, call system, and the role of each member of the CPR team, 3) the establishment of standard in-hospital CPR protocol, 4) the CPR cart items list and their exchange intervals, and 5) post-CPR reporting. RESULTS: The durations of education for anesthesiology residents and medical students were <3 and 7 hours per year. The CPR team designated on documents differed from actual practice. Only one hospital had a standard CPR protocol. Most hospitals had a list of CPR cart, contents, items but the exchange intervals were irregular. Post-CPR reports were written only in intensive care units and emergency rooms. The involvement of nurses in CPR was minimal. CONCLUSIONS: In conclusion, recommend that the following be established; more profound CPR education program for anesthesiology residents and medical students, appropriate clarification of duties for each CPR team members, a standard in-hospital CPR protocol, and the systematic maintenance of drugs, instruments, and CPR records.