Comparison of two types of combined spinal-epidural sets in terms of catheter positioning: reinforced catheter vs. non-reinforced catheter

BACKGROUND: The purpose of this study is to examine the usefulness of a combined spinal-epidural set with reinforced catheter (CombiSpeed(R), Ace Medical, Seoul, Korea) as compared with the non-reinforced catheter (PORTEX(R), Smiths medical, Brisbane, Australia) in terms of catheter positioning and clinical aspects of anesthesia. METHODS: One hundred and two patients scheduled for regional anesthesia were enrolled in this study. They were allocated randomly either into group A (CombiSpeed(R)) or group P (PORTEX(R)). Vital signs and the levels of sensory and motor block were measured every 5 minutes. Ease of insertion and the removal of the catheter were assessed, so was the incidence of venous cannulation and paresthesia during epidural catheter insertions. After the placement of epidural catheter, we checked the location of catheter by radiography and measured in a clockwise angle from the midline to catheter tip (angle X). In laboratory, tensile strength of the two products was measured by using tonometry. RESULTS: There were no significant differences between groups in intra-operative vital sign, block level and ease of catheter insertion and removal. No difference was observed in angle X between the groups (group A: 93.6 +/- 129.5degrees, group P: 124.5 +/- 127.7degrees, P = 0.22). There were no complications such as paresthesia or venous cannulation during catheter insertion. The tensile strength was higher in group A (group A: 1.70 +/- 0.05 kg, group P: 1.30 +/- 0.03 kg, P < 0.05). CONCLUSIONS: CombiSpeed(R) is as useful as PORTEX(R) in terms of ease for catheter placement, positioning of catheter tip and clinical aspects of anesthesia.

Erratum: Comparison of two types of combined spinal-epidural sets in terms of catheter positioning: reinforced catheter vs. non-reinforced catheter

We found an error in our published article.

Airway management using laryngeal mask airway in insertion of the Montgomery tracheal tube for subglottic stenosis: A case report / 대한마취과학회지

The Montgomery tracheal tube (T-tube) is a device used as a combined tracheal stent and airway after laryngotracheoplasty for patients with tracheal stenosis. This device can present various challenges to anesthesiologists during its placement, including the potential for acute loss of the airway, inadequate administration of inhalation agents, and inadequacy of controlled mechanical ventilation. The present case of successful airway management used a laryngeal mask airway under total intravenous anesthesia with propofol and remifentanil in the insertion of a Montgomery T-tube in a tracheal resection and thyrotracheal anastomosis because of severe subglottic stenosis.

A study on the usefulness of motor evoked potentials monitoring during spinal surgery

BACKGROUND: Intraoperative monitoring of transcranial electrical motor evoked potentials (TCE-MEPs) can be a useful tool to detect iatrogenic spinal cord injury. But the efficacy of TCE-MEPs monitoring in the spine surgery has not been reported in South Korea. The purpose of this study is to investigate the reliability of intraoperative TCE-MEPs in spinal surgery. METHODS: Thirty five patients scheduled for elective surgery for spine correction were enrolled in the study. After induction of general anesthesia with target controlled infusion (TCI) system of propofol and remifentanil, intraoperative TCE-MEPs from upper or lower limb muscles were monitored. No additional muscle relaxants were given except for tracheal intubation. We recorded intraoperative abnormal signs of TCE-MEPs and postoperative neurologic deficits. From these results, sensitivity, specificity, positive predictive value, and negative predictive value of TCE-MEPs monitoring for the detection of neurologic damage during spinal surgery were calculated. RESULTS: Six patients showed decreases in amplitudes. Postoperative neurologic deficits occurred in 5 patients out of them. Only one patient developed postoperative neurologic deficit even though there were no intraoperative TCE-MEPs change. Sensitivity, specificity, positive predictive value, and negative predictive value of TCE-MEPs monitoring for the detection of neurologic deficits were 83.3%, 96.7%, 83.3%, 96.7%, odds ratio was 140 and relative risk was 24.2. CONCLUSIONS: Intraoperative TCE-MEPs monitoring is a reliable and sensitive method to detect the neurologic deficits during spinal surgery.