Virtual reality simulator’s effectiveness on the spine procedure education for trainee: a randomized controlled trial / 대한마취과학회지

Background@#Since the onset of the coronavirus disease 2019 pandemic, virtual simulation has emerged as an alternative to traditional teaching methods as it can be employed within the recently established contact-minimizing guidelines. This prospective education study aimed to develop a virtual reality simulator for a lumbar transforaminal epidural block (LTFEB) and demonstrate its efficacy. @*Methods@#We developed a virtual reality simulator using patient image data processing, virtual X-ray generation, spatial registration, and virtual reality technology. For a realistic virtual environment, a procedure room, surgical table, C-arm, and monitor were created. Using the virtual C-arm, the X-ray images of the patient’s anatomy, the needle, and indicator were obtained in real-time. After the simulation, the trainees could receive feedback by adjusting the visibility of structures such as skin and bones. The training of LTFEB using the simulator was evaluated using 20 inexperienced trainees. The trainees’ procedural time, rating score, number of C-arm taken, and overall satisfaction were recorded as primary outcomes. @*Results@#The group using the simulator showed a higher global rating score (P = 0.014), reduced procedural time (P = 0.025), reduced number of C-arm uses (P = 0.001), and higher overall satisfaction score (P = 0.007). @*Conclusions@#We created an accessible and effective virtual reality simulator that can be used to teach inexperienced trainees LTFEB without radiation exposure. The results of this study indicate that the proposed simulator will prove to be a useful aid for teaching LTFEB.

Burst stimulation for refractory angina pectoris - A case report -

Background@#Refractory angina pectoris (RAP) is a chronic, severe chest pain associated with coronary artery disease that cannot be resolved using optimal medical or surgical approaches. Spinal cord stimulation (SCS) is a suitable treatment option. Conventional waveforms of SCS have shown a potent effect on the tempering of RAP. However, SCS is associated with undesired paresthesia. The new burst SCS waveforms have been reported to have fewer adverse effects.Case: We reviewed a case in which RAP was successfully treated with burst SCS in a middle-aged male, with a tonic waveform employed for breakthrough pain as needed. @*Conclusions@#Appropriate use of tonic and burst stimulations according to the symptoms is expected to maximize the effect of relieving chest pain induced by RAP.

Application of purified porcine collagen in patients with chronic refractory musculoskeletal pain

Background@#This study aimed to assess the potential efficacy of purified porcine atelocollagen (PAC) for the management of refractory chronic pain due to suspected connective tissue damage. @*Methods@#Patients treated with PAC were retrospectively evaluated. Patients with chronic refractory pain, suspected to have originated from musculoskeletal damage or defects with the evidence of imaging studies were included. Pain intensity, using the 11-point numerical rating scale (NRS), was assessed before the procedure, and 1 month after the last procedure. @*Results@#Eighty-eight patients were finally included for investigation. The mean NRS score was decreased from 5.8 to 4.1 after 1 month of PAC injection (P < 0.001). No independent factor was reported to be directly related to the decrease in NRS score by more than half. @*Conclusions@#Application of PAC may have potential as a treatment option for refractory chronic musculoskeletal pain. PAC might promote tissue recovery, act as a scaffold for repair, or directly reduce inflammation.

Relationship between PaO₂/FiO₂ and number of regions with B-line on transthoracic lung ultrasound: a prospective, observational study

BACKGROUND: Aeration of the lungs must be monitored during general anesthesia because of the possibility of postsurgical pulmonary complications. The aim of this study was to compare PaO₂/FiO₂ and the number of regions with B-line on transthoracic lung ultrasonography (TLU) between the postinduction and postsurgical periods. METHODS: Twenty-six adult patients undergoing major abdominal surgery were enrolled. Arterial blood gas analysis and TLU were performed 30 min after the induction of anesthesia (postinduction) and after skin closure (postsurgical period) while patients were under mechanical ventilation. TLU was performed in 12 regions (anterior, lateral, and posterior in the upper and lower regions of both lungs). The number of regions with B-line was counted. RESULTS: Compared with postinduction values, the number of regions with B-line on TLU was increased in the postsurgical period (0.3 ± 0.5 to 1.3 ± 1.2, P < 0.001); however, PaO₂/FiO₂ did not significantly differ (421.3 ± 95.8 to 425.2 ± 86.0, P = 0.765). The change in PaO₂/FiO₂ (postinduction-postsurgical period) was significantly higher in Group B than in Group A (P = 0.028). CONCLUSIONS: Although the number of regions with B-line on TLU was increased in the postsurgical period, lung oxygenation did not differ, based on the main assessment in this study. In contrast, patients with an increased number of regions with B-line tended to show a reduction in PaO₂/FiO₂ during the postsurgical period. Further study seems necessary to establish the number of regions with B-line on TLU as a tool for evaluation of perioperative oxygenation.

Relationship between paravertebral muscle twitching and long-term effects of radiofrequency medial branch neurotomy

BACKGROUND: To achieve a prolonged therapeutic effect in patients with lumbar facet joint syndrome, radiofrequency medial branch neurotomy (RF-MB) is commonly performed. The purpose of this study was to evaluate the prognostic value of paravertebral muscle twitching when performing RF-MB in patients with lumbar facet joint syndrome. METHODS: We collected and analyzed data from 68 patients with confirmed facet joint syndrome. Sensory stimulation was performed at 50 Hz with a 0.5 V cut-off value. Patients were divided into 3 groups according to the twitching of the paravertebral muscle during 2 Hz motor stimulation: ‘Complete’, when twitching was observed at all needles; ‘Partial’, when twitching was present at 1 or 2 needles; and ‘None’, when no twitching was observed. The relationship between the long-term effects of RF-MB and paravertebral muscle twitching was analyzed. RESULTS: The mean effect duration of RF-MB was 4.6, 5.8, and 7.0 months in the None, Partial, and Complete groups, respectively (P = 0.47). Although the mean effect duration of RF-MB did not increase significantly in proportion to the paravertebral muscle twitching, the Complete group had prolonged effect duration (> 6 months) than the None group in subgroup analysis. (P = 0.03). CONCLUSIONS: Paravertebral muscle twitching while performing lumbar RF-MB may be a reliable predictor of long-term efficacy when sensory provocation under 0.5 V is achieved. However, further investigation may be necessary for clarifying its clinical significance.

Clinical Identification of the Vertebral Level at Which the Lumbar Sympathetic Ganglia Aggregate

BACKGROUND: The location and the number of lumbar sympathetic ganglia (LSG) vary between individuals. The aim of this study was to determine the appropriate level for a lumbar sympathetic ganglion block (LSGB), corresponding to the level at which the LSG principally aggregate. METHODS: Seventy-four consecutive subjects, including 31 women and 31 men, underwent LSGB either on the left (n = 31) or the right side (n = 43). The primary site of needle entry was randomly selected at the L3 or L4 vertebra. A total of less than 1 ml of radio opaque dye with 4% lidocaine was injected, taking caution not to traverse beyond the level of one vertebral body. The procedure was considered responsive when the skin temperature increased by more than 1℃ within 5 minutes. RESULTS: The median responsive level was significantly different between the left (lower third of the L4 body) and right (lower margin of the L3 body) sides (P = 0.021). However, there was no significant difference in the values between men and women. The overall median responsive level was the upper third of the L4 body. The mean responsive level did not correlate with height or BMI. There were no complications on short-term follow-up. CONCLUSIONS: Selection of the primary target in the left lower third of the L4 vertebral body and the right lower margin of the L3 vertebral body may reduce the number of needle insertions and the volume of agents used in conventional or neurolytic LSGB and radiofrequency thermocoagulation.

The Effects of the Frequency of Fish Consumption on the Blood Mercury Levels in Koreans / 대한산업의학회지

OBJECTIVE: We studied two districts in Korea in order to investigate if the frequency of fish consumption has an effect on the blood mercury levels. METHODS: This survey was conducted on 164 fishing district residents in Geoje city and 219 agricultural district residents in Changwon city from July to August in 2008. The data on the demographic characteristics, the living environment, lifestyle habits and the frequency of fish consumption was collected by interviewers. We used ANOVA to estimate the particular relevance between the frequency of fish consumption and the blood mercury concentration, and other various factors. RESULTS: The mean total blood mercury level was 6.54+/-4.01 microgram/L for the total study population. Our results were even higher than that of the National Health and Nutrition Examination Survey (USA) in, 2001~2002 and the German Environmental Survey in, 1998. In this study, there was a significant difference for the frequency of eating fish between the groups. (p<0.01, The level of the groups that ate fish 3 to 4 times per week was significantly higher as compared with the level of the other groups that ate fish 2 to 3 times per month and 1 to 2 times per week, respectively). As the frequency of fish consumption increased, so did the blood mercury concentration. CONCLUSIONS: We found that the blood mercury concentration increases along with fish consumption and this was statistically significant and this fact reveals that fish consumption is positively related to the blood levels of mercury. Accordingly, we need systematic and periodic research on the general population to prevent mercury poisoning, which can be caused by low-level mercury exposure from dietary intake such as chronic fish consumption.

Comparison of the laryngeal view during intubation using Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization and mouth opening limitation / 대한마취과학회지

BACKGROUND: For patients suspicious of cervical spine injury, a Philadelphia cervical collar is usually applied. Application of Philadelphia cervical collar may cause difficult airway. The aim of this study was to evaluate the laryngeal view and the success rate at first intubation attempt of the Airtraq and conventional laryngoscopy in patients with simulated cervical spine injury after application of a Philadelphia cervical collar. METHODS: Anesthesia was induced with propofol, remifentanil, and rocuronium. After a Philadelphia cervical collar applied, patients were randomly assigned to tracheal intubation with an Airtraq (Group A, n = 25) or with conventional laryngoscopy (Group L, n = 25). Measurements included intubation time, success rate of first intubation attempt, number of intubation attempts, and percentage of glottic opening (POGO) score. Mean blood pressure and heart rate were also recorded at baseline, just before and after intubation. RESULTS: The success rate of the first attempt in Group A (96%) was significantly greater than with the Group L (40%). POGO score was significantly greater in Group A (84 +/- 20%) than in Group L (6 +/- 11%). The duration of successful intubation at first tracheal intubation attempt and hemodynamic changes were not significantly different between the two groups. CONCLUSIONS: The Airtraq offers a better laryngeal view and higher success rate at first intubation attempt in patients who are applied with a Philadelphia cervical collar due to suspicion of cervical spine injury.