Chien-Kun Ting
National Yang Ming Chiao Tung University, Medicine, Faculty Member
Background There is no consensus regarding the superiority of volatile or total intravenous anesthesia (TIVA) in reducing the incidence of postoperative pulmonary complications (PPCs) after lung resection surgery (LRS). Thus, the aim of... more
Background There is no consensus regarding the superiority of volatile or total intravenous anesthesia (TIVA) in reducing the incidence of postoperative pulmonary complications (PPCs) after lung resection surgery (LRS). Thus, the aim of this study was to investigate the different anesthetic regimens and the incidence of PPCs in patients who underwent LRS. We hypothesized that TIVA is associated with a lower incidence of PPCs than volatile anesthesia. Methods This was a retrospective cohort study of patients who underwent LRS at Taipei Veterans General Hospital between January 2016 and December 2020. The patients’ charts were reviewed and data on patient characteristics, perioperative features, and postoperative outcomes were extracted and analyzed. The patients were categorized into TIVA or volatile anesthesia groups and their clinical data were compared. Propensity score matching was performed to reduce potential selection bias. The primary outcome was the incidence of PPCs, wherea...
Research Interests:
Research Interests:
Malignant hyperthermia (MH) is an operative emergency associated with general anesthesia. Early diagnosis and prompt treatment are the keynotes in management of MH. Dantrolene is the only specific drug and all of the institutions where... more
Malignant hyperthermia (MH) is an operative emergency associated with general anesthesia. Early diagnosis and prompt treatment are the keynotes in management of MH. Dantrolene is the only specific drug and all of the institutions where general anesthesia is a daily routine should have a stockpile of this drug for the rare occurrence of MH. Nonetheless, the enormous expenditure on stockpile and 3-year validity make a large reserve of the drug to forestall MH, a disorder of rare occurrence, seems disputable, especially in small hospitals where general anesthesia is seldom practiced. We herein report two cases of MH with excellent response to small doses of dantrolene and then discuss the way of practicable management and debate on the question of whether fewer stock of dantrolene is an alternative way for hospitals of smaller scale.
Research Interests: Medicine, Humans, Pubmed, Male, Anesthesia, and 5 moreAged, Adult, Malignant Hyperthermia, Dantrolene, and Stockpile
Research Interests: Medicine, Anesthesia, Propofol, Sedation, Clinical Sciences, and 3 moreAnesthetic, Remifentanil, and Sedative
Research Interests:
Research Interests:
Incorrect placement of the needle causes medical complications in the epidural block, such as dural puncture or spinal cord injury. This study proposes a system which combines an optical coherence tomography (OCT) imaging probe with an... more
Incorrect placement of the needle causes medical complications in the epidural block, such as dural puncture or spinal cord injury. This study proposes a system which combines an optical coherence tomography (OCT) imaging probe with an automatic identification (AI) system to objectively identify the position of the epidural needle tip. The automatic identification system uses three features as image parameters to distinguish the different tissue by three classifiers. Finally, we found that the support vector machine (SVM) classifier has highest accuracy, specificity, and sensitivity, which reached to 95%, 98%, and 92%, respectively.
Research Interests:
Propofol and fentanyl are commonly used agents for the induction of anesthesia, and are often associated with hemodynamic disturbances. Understanding pharmacodynamic impacts is vital for parasympathetic and sympathetic tones during the... more
Propofol and fentanyl are commonly used agents for the induction of anesthesia, and are often associated with hemodynamic disturbances. Understanding pharmacodynamic impacts is vital for parasympathetic and sympathetic tones during the anesthesia induction period. Inspired by the thermodynamic interaction between drug concentrations and effects, we established a machine-learning-based response surface model (MLRSM) to address this predicament. Then, we investigated and modeled the biomedical phenomena in the autonomic nervous system. Our study prospectively enrolled 60 patients, and the participants were assigned to two groups randomly and equally. Group 1 received propofol first, followed by fentanyl, and the drug sequence followed an inverse procedure in Group 2. Then, we extracted and analyzed the spectrograms of electrocardiography (ECG) and pulse photoplethysmography (PPG) signals after induction of propofol and fentanyl. Eventually, we utilized the proposed MLRSM to evaluate t...
Research Interests:
Incorrect placement of the needle causes medical complications in the epidural block, such as dural puncture or spinal cord injury. This study proposes a system which combines an optical coherence tomography (OCT) imaging probe with an... more
Incorrect placement of the needle causes medical complications in the epidural block, such as dural puncture or spinal cord injury. This study proposes a system which combines an optical coherence tomography (OCT) imaging probe with an automatic identification (AI) system to objectively identify the position of the epidural needle tip. The automatic identification system uses three features as image parameters to distinguish the different tissue by three classifiers. Finally, we found that the support vector machine (SVM) classifier has highest accuracy, specificity, and sensitivity, which reached to 95%, 98%, and 92%, respectively.
Research Interests:
Research Interests:
Within the past decade, a few cases of re-expansion pulmonary edema have been reported after one-lung ventilation for minimally invasive cardiac surgery. This complication is severe and may result in mortality, despite aggressive... more
Within the past decade, a few cases of re-expansion pulmonary edema have been reported after one-lung ventilation for minimally invasive cardiac surgery. This complication is severe and may result in mortality, despite aggressive treatment. In the present case, a 46-year-old man with mitral valve regurgitation was scheduled for robot-assisted mitral valve repair with one-lung ventilation. However, unilateral pulmonary edema was observed immediately after re-expansion of the right-sided collapsed lung. Pulmonary edema was improved after ventilator support, extracorporeal membrane oxygenation, and bronchoscopeassisted secretion clearance. The patient was extubated and discharged without any sequelae. In this case, risk factors contributing to pulmonary edema included a history of congestive heart failure with pulmonary edema, undergoing mitral valve repair, longer cardiopulmonary bypass and cross-clamp times, transfusion of fresh frozen plasma during the operation, and a relatively hi...
BACKGROUND: Cardiovascular waveforms contain information for clinical diagnosis. By learning and organizing the subtle change of waveform morphology from large amounts of raw waveform data, unsupervised manifold learning helps delineate a... more
BACKGROUND: Cardiovascular waveforms contain information for clinical diagnosis. By learning and organizing the subtle change of waveform morphology from large amounts of raw waveform data, unsupervised manifold learning helps delineate a high-dimensional structure and display it as a novel 3-dimensional (3D) image. We hypothesize that the shape of this structure conveys clinically relevant inner dynamics information. METHODS: To validate this hypothesis, we investigate the electrocardiography (ECG) waveform for ischemic heart disease and arterial blood pressure (ABP) waveform in dynamic vasoactive episodes. We model each beat or pulse to be a point lying on a manifold—like a surface—and use the diffusion map (DMap) to establish the relationship among those pulses. The output of the DMap is converted to a 3D image for visualization. For ECG datasets, first we analyzed the non–ST-elevation ECG waveform distribution from unstable angina to healthy control in the 3D image, and we inves...
Research Interests:
Apnea should be monitored continuously in the post anesthesia care unit (PACU) to avoid serious complications. It has been confirmed that tracheal sounds can be used to detect apnea during sedation in healthy subjects, but the performance... more
Apnea should be monitored continuously in the post anesthesia care unit (PACU) to avoid serious complications. It has been confirmed that tracheal sounds can be used to detect apnea during sedation in healthy subjects, but the performance of this acoustic method has not been evaluated in patients with frequent apnea events in the PACU. Tracheal sounds were acquired from the patients in the PACU using a microphone encased in a plastic bell. Concurrently, a processed nasal pressure signal was used as a reference standard to identify real respiratory events. The logarithm of the tracheal sound variance (log-var) was used to detect apnea, and the results were compared to the reference method. Sensitivity, specificity, positive likelihood ratios (PLR), and negative likelihood ratios (NLR) were calculated. One hundred and twenty-one patients aged 55.5 ± 13.2 years (mean ± SD) with a body mass index of 24.6 ± 3.7 kg/m were included in data analysis. The total monitoring time was 52.6 h. Th...
Research Interests:
Postbypass pulmonary hypertension in surgical correction of tetralogy of Fallot (TOF) is a risk for right ventricular failure. Effective management remains a major challenge. Milrinone is a new drug with a unique mechanism of... more
Postbypass pulmonary hypertension in surgical correction of tetralogy of Fallot (TOF) is a risk for right ventricular failure. Effective management remains a major challenge. Milrinone is a new drug with a unique mechanism of "inodilation", which offers both inotropic and vasodilatory effects. We attempted to determine if application of milrinone could improve cardiopulmonary dysfunction in children after TOF repair. We studied 10 children with postbypass pulmonary hypertension after TOF repair within six months. Heart rate, systolic pulmonary arterial pressure (PAP), systolic arterial blood pressure (SBP), pulmonary capillary wedge pressure and PAP/SBP ratio were recorded. Standard cardiopulmonary bypass (CPB) was performed. After CPB, if PAP/SBP was more than 0.5, pulmonary hypertension was suspected and milrinone was administered with a loading dose of 20 micrograms/kg followed by continuous infusion of 0.2 microgram/kg/minute. Hemodynamics were compared before and afte...
Research Interests:
Research Interests:
The Oxygen Reserve Index (ORi™) is a dimensionless parameter with a value between 0 and 1. It is related to the real-time oxygenation status in the moderate hyperoxic range. The purpose of this study is to investigate the added warning... more
The Oxygen Reserve Index (ORi™) is a dimensionless parameter with a value between 0 and 1. It is related to the real-time oxygenation status in the moderate hyperoxic range. The purpose of this study is to investigate the added warning time provided by different ORi alarm triggers and the continuous trends of ORi, SpO2, and PaO2. We enrolled 25 patients who were scheduled for elective surgery under general anesthesia with planned arterial catheterization before induction. The participants received standardized preoxygenation, induction, and intubation. The patients remained apneic and ventilation was resumed when the SpO2 fell below 90%. The ORi and SpO2 were recorded every ten seconds and arterial blood was sampled every minute, from preoxygenation to resumed ventilation. Alarm triggers set to the ORi peak and the ORi 0.55 values provided 300 and 145 s of significant added warning time compared to SpO2 (p < 0.0001). The coefficient of determination was 0.56 between the ORi and the PaO2 ≤ 240 mmHg and showed a positive correlation. The ORi enables the clinicians to monitor the patients’ oxygen status during induction of general anesthesia and can improve the detection of impending desaturation. However, further studies are needed to assess its clinical potential in the high hyperoxic range. The protocol was retrospectively registered at ClinicalTrials.gov on July 21, 2021 (NCT04976504).
Research Interests:
Research Interests:
Research Interests:
Background: A double-blind, randomized study was designed to compare the recovery manner of mivacurium infusion with or without edrophonium reversal in microscopic laryngeal surgery. Neuromuscular blockade was quantified using the... more
Background: A double-blind, randomized study was designed to compare the recovery manner of mivacurium infusion with or without edrophonium reversal in microscopic laryngeal surgery. Neuromuscular blockade was quantified using the train-of-four stimuli to the ulnar nerve and quantification of the ratio of the fourth twitch to the first twitch. Methods: With the approval of the Human Studies Committee of the Taipei Veterans General Hospital and patient informed consent, 40 healthy (ASA I or II) patients with age from 24 to 54 years, undergoing microscopic laryngeal surgery were randomly selected for study. Mivacurium chloride 0.2 mg/kg was given intravenously, and then it was given in continuous infusion to maintain muscle relaxation at 90% twitch block during the procedure. At the end of operation, mivacurium infusion was terminated. In a double-blind manner, group I patients (n = 20) received intravenous edrophonium 1 mg/kg and atropine 0.01 mg/kg for reversal when T1 was at 10% recovery whereas patients in Group II (n = 20) received placebo in the same manner. Mean infusion rate, recovery index (RI50, time from T1 25% to T1 50%; RI75, time from T1 25% to T1 75%), extubation time, and discharge time between groups were compared. Nausea, vomiting, and dysrhythmias were also documented until the patient was discharged from hospital. Results: The demographic data between two groups were similar. The recovery index (RI75) for group I was shorter than that of placebo group (5.3 +/- 2.19 min vs. 7.3 +/- 0.9 min) and the difference was statistically significant (P = 0.017). There were no statistically significant differences in mean infusion rate, incidence of nausea and vomiting, and discharge time from the POR. The incidence of tachycardia or arrhythmia in group I was significantly greater than that in group placebo. Conclusions: Mivacurium, a short-acting nondepolarizing agent, is a suitable muscle relaxant for patients receiving microscopic laryngeal surgery. Recovery time with the use of edrophonium as reversal agent was shorter than with placebo, but extubation and discharge time did not differ in two groups. The time which could be saved by the use of edrophonium for reversal of mivacurium to hasten the maximal recovery appears to be less than a few minutes. Therefore, clinically, the value of routine use of edrophonium to obtain a faster recovery does not outweigh its demerits of cost and risk and is not worthy of recommendation.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Surgery, Medicine, Humans, Female, Male, and 7 morePatient Satisfaction, Aged, Middle Aged, Adult, Elsevier, Catheter, and Medical and Health Sciences
Research Interests:
Research Interests:
Research Interests:
The safe establishment of pneumoperitoneum is a critical step in all laparoscopic surgeries. A closed pneumoperitoneum is usually obtained by inserting a Veress needle into the peritoneal cavity. However, there is no definite measure to... more
The safe establishment of pneumoperitoneum is a critical step in all laparoscopic surgeries. A closed pneumoperitoneum is usually obtained by inserting a Veress needle into the peritoneal cavity. However, there is no definite measure to visually confirm the position of the Veress needle tip inside the peritoneal cavity. This study aimed to describe a method of real-time visual detection of peritoneal placement of the Veress needle using an incorporated optical coherence tomography (OCT) probe in a porcine model. A 14-gauge Veress needle was incorporated with a miniature fiber probe to puncture the piglet’s abdominal wall into the peritoneal cavity. A total of 80 peritoneal punctures were attempted in four piglets. For each puncture, continuous two-dimensional OCT images of the abdominal wall were acquired for real-time visual detection of the needle placement into the peritoneal cavity. Characteristic OCT image patterns could be observed during the puncturing process, especially a d...
Research Interests:
Objectives Dexmedetomidine is an alpha-2 agonist with anti-anxiety, sedative, and analgesic effects and causes a lesser degree of respiratory depression. We hypothesized that the use of dexmedetomidine in non-intubated video-assisted... more
Objectives Dexmedetomidine is an alpha-2 agonist with anti-anxiety, sedative, and analgesic effects and causes a lesser degree of respiratory depression. We hypothesized that the use of dexmedetomidine in non-intubated video-assisted thoracic surgery (VATS) may reduce opioid-related complications such as postoperative nausea and vomiting (PONV), dyspnea, constipation, dizziness, skin itching, and cause minimal respiratory depression, and stable hemodynamic status. Methods Patients who underwent non-intubated VATS lung wedge resection with propofol combined with dexmedetomidine (group D) or alfentanil (group O) between December 2016 and May 2022 were enrolled in this retrospective propensity score matching cohort study. Intraoperative vital signs, arterial blood gas data, perioperative results and treatment outcomes were analyzed. Results Of 100 patients included in the study (group D, 50 and group O, 50 patients), group D had a significantly lower degree of decrement in the heart ra...
Research Interests:
Intercostal nerve block is a widely used and effective approach to providing regional anesthesia in the thoracic region for pain relief. However, during ultrasound-guided intercostal nerve block, inaccurate identification of the anatomic... more
Intercostal nerve block is a widely used and effective approach to providing regional anesthesia in the thoracic region for pain relief. However, during ultrasound-guided intercostal nerve block, inaccurate identification of the anatomic structures or suboptimal positioning of the needle tip may result in complications and blockade failure. In this study, we designed an intraneedle ultrasound (INUS) system and validated its efficacy in identifying anatomic structures relevant to thoracic region anesthesia. The 20-MHz INUS transducer comprised a single lead magnesium niobate-lead titanate crystal, and gain was set to 20 dB. It fit into a regular 18G needle and emitted radiofrequency-mode ultrasound signals at 1 mm from the needle tip. One hundred intercostal punctures were performed in 10 piglets. Intercostal spaces were identified by surface ultrasound or palpation and located by inserting and advancing the INUS transducer needle until the appropriate anatomy was identified. Blockade success was defined by ideal saline and dye spreading and confirmed by dissection. The pleura had a distinctive ultrasound signal, and successful detection of the intercostal muscles, endothoracic fascia and double-layered parietal and visceral pleura was achieved in all 100 puncture attempts. INUS allows real-time identification of intercostal structures and facilitates successful intercostal nerve blocks.
Research Interests:
Purpose:Regulations have broadened to allow moderate sedation administration for gastrointestinal endoscopy by non-anesthesia personnel. The line between moderate and deep sedation is ambiguous. Deep sedation offers patient comfort as... more
Purpose:Regulations have broadened to allow moderate sedation administration for gastrointestinal endoscopy by non-anesthesia personnel. The line between moderate and deep sedation is ambiguous. Deep sedation offers patient comfort as well as greater safety concerns. Unintended deep sedation can occur if drug interactions are overlooked. We present a pharmacodynamic model for moderate sedation using midazolam, alfentanil and propofol. The model is suitable for training and devising rationales for appropriate dosing.Methods:The study consists of two parts: modeling and validation. In modeling, patients scheduled for esophagogastroduodenoscopy (EGD) or colonoscopy sedation are enrolled. The modified observer’s assessment of alertness/sedation (MOAA/S) score < 4 is defined as loss of response to represent moderate sedation. Two patient groups receiving bronchoscopy or endoscopic retrograde cholangiopancreatography (ERCP) are used for validation. Model performance is assessed by rece...
Research Interests:
Research Interests:
High-flow nasal oxygen (HFNO) has been used in “tubeless” shared-airway surgeries but whether HFNO increased the fire hazard is yet to be examined. We used a physical model for simulation to explore fire safety through a series of... more
High-flow nasal oxygen (HFNO) has been used in “tubeless” shared-airway surgeries but whether HFNO increased the fire hazard is yet to be examined. We used a physical model for simulation to explore fire safety through a series of ignition trials. An HFNO device was attached to a 3D-printed nose with nostrils connected to a degutted raw chicken. The HFNO device was set at twenty combinations of different oxygen concentration and gas flow rate. An electrocautery and diode laser were applied separately to a fat cube in the cavity of the chicken. Ten 30 s trials of continuous energy source application were conducted. An additional trial of continuous energy application was conducted if no ignition was observed for all the ten trials. A total of eight short flashes were observed in one hundred electrocautery tests; however, no continuous fire was observed among them. There were thirty-six events of ignition in one hundred trials with laser, twelve of which turned into violent self-sustained fires. The factors found to be related to a significantly increased chance of ignition included laser application, lower gas flow, and higher FiO2. The native tissue and smoke can ignite and turn into violent self-sustained fires under HFNO and continuous laser strikes, even in the absence of combustible materials. The results suggest that airway surgeries must be performed safely with HFNO if only a short intermittent laser is used in low FiO2.
Research Interests:
Research Interests:
Research Interests:
Background. Increasing attention has been paid to the predictive power of different prognostic scoring systems for decades. In this study, we compared the abilities of three commonly used scoring systems to predict short-term and... more
Background. Increasing attention has been paid to the predictive power of different prognostic scoring systems for decades. In this study, we compared the abilities of three commonly used scoring systems to predict short-term and long-term mortalities, with the intention of building a better prediction model for critically ill patients. We used the data from the National Health Insurance Research Database (NHIRD) in Taiwan, which included information on patient age, comorbidities, and presence of organ failure to build a new prediction model for short-term and long-term mortalities.Methods. We retrospectively collected the medical records of patients in the intensive care unit of a regional hospital in 2012 and linked them to the claims data from the NHIRD. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Elixhauser Comorbidity Index (ECI), and Charlson Comorbidity Index (CCI) were compared for their predictive abilities. Multiple logistic regression tests we...
Research Interests:
During sedated endoscopic examinations, upper airway obstruction occurs. Nasal breathing often shifts to oral breathing during open mouth esophagogastroduodenoscopy (EGD). High-flow nasal cannula (HFNC) which delivers humidified 100%... more
During sedated endoscopic examinations, upper airway obstruction occurs. Nasal breathing often shifts to oral breathing during open mouth esophagogastroduodenoscopy (EGD). High-flow nasal cannula (HFNC) which delivers humidified 100% oxygen at 30 L min−1 may prevent hypoxemia. A mandibular advancement (MA) bite block with oxygen inlet directed to both mouth and nose may prevent airway obstruction during sedated EGD. The purpose of this study was to evaluate the efficacy of these airway devices versus standard management. One hundred and eighty-nine patients were assessed for eligibility. One hundred and fifty-three were enrolled. This study randomly assigned eligible patients to three arms: the standard bite block and standard nasal cannula, HFNC, and MA bite block groups. EGD was performed after anaesthetic induction. The primary endpoint was the oxygen desaturation area under curve at 90% (AUCDesat). The secondary endpoints were percentage of patients with hypoxic, upper airway ob...
Research Interests:
Research Interests:
Several approaches of locating the epidural space have been proposed. However, loss of Resistance method (LOR) remains the most common method for epidural anesthesia. Different optical signals were received from the ligamentum flavum and... more
Several approaches of locating the epidural space have been proposed. However, loss of Resistance method (LOR) remains the most common method for epidural anesthesia. Different optical signals were received from the ligamentum flavum and the epidural space allows operator to pinpoint position of the needle and determine whether the needle tip has entered the epidural space. Optical signals throughout the penetration process was recorded and position of needle tip was confirmed with a C-arm fluoroscopy. 60 lumbar punctures were performed in 20 vivo porcine models, and success rate of locating the epidural space with the optical auxiliary is calculated statistically. The data are expressed in mean ± SD. During all the lumber puncture processes, the strength of optical signals received decreased significantly while the needle tip penetrates the ligamentum flavum and entered the epidural space. The strength of optical signal received when needle tip was in the ligamentum flavum was 1.38...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Background: The purpose of this study was to determine the efficacy of a mandibular advancement device (MAD) for increasing patient safety during sedated total knee arthroplasty (TKA) and total hip replacement (THR). Methods: Forty... more
Background: The purpose of this study was to determine the efficacy of a mandibular advancement device (MAD) for increasing patient safety during sedated total knee arthroplasty (TKA) and total hip replacement (THR). Methods: Forty patients undergoing TKA or THR surgery in the supine or lateral recumbent positions under spinal anesthesia were enrolled. Sedation and oxygenation were administered. The MAD (Sweet Sleep Anti-Snoring Device) was then placed after 15 minutes of observation. SpO2, PetCO2, blood pressure, and respiratory rate were recorded. Results: Sedated patients in the decubitus position had higher saturation nadirs, shorter desaturation durations, shorter airway obstruction durations, and fewer rescue events than those in the supine position. In patients at a high risk of obstructive sleep apnea syndrome (OSAS), desaturation duration, obstruction duration, apnea duration, desaturation duration, and rescue events were significantly lower after MAD placement. However, th...
Research Interests:
The Trachway video intubating stylet device facilitates the visualization of the airways of patients from the tip of an endotracheal tube (ETT) during intubation. The major limitations of Trachway are the restricted view due to secretions... more
The Trachway video intubating stylet device facilitates the visualization of the airways of patients from the tip of an endotracheal tube (ETT) during intubation. The major limitations of Trachway are the restricted view due to secretions and the risk of a prolonged apnea during intubation. We conducted a bench study to verify the performance of an alternative, easily applicable airway device that allows better visualization of trackways during Trachway-assisted intubation and prevents the detrimental effects of apnea-related hypoxia. We conducted a bench study to thoroughly evaluate the oral-secretion-elimination ability of a newly designed oxygen delivery device (ODD) to improve vocal-cord visualization using the three commonly used ETT sizes (i.e., 7, 7.5, and 8 mm). Moreover, we measured the fraction of inspired oxygen (FiO2) under different, continuous oxygen-flow supplies (1–10 L/min) during intubation. Each condition was analyzed for a 2 min video-stylet-intubation period. The supplemental oxygen flow and FiO2 fraction achieved using our ODD were higher, and smaller ETTs exhibited better secretion elimination. The ODD, which can be easily coupled with Trachway stylets, enabled high-quality visualization during oxygen flows of 6–8 L/min, and higher FiO2 fractions were achieved at higher oxygen flow rates. The use of the ODD improved the visualization of the airways during video stylet-assisted intubations using the additional FiO2 supply. The ODD developed in this study improves the visualization of airways with Trachway stylets and enhances the safety of intubation.
Research Interests:
Research Interests:
Pharmacodynamic models have described the interactions between anesthetics. Applying the models to clinical practice is still problematic due to inherent limitations: 1. modeling conditions are different from practice. 2. One model can... more
Pharmacodynamic models have described the interactions between anesthetics. Applying the models to clinical practice is still problematic due to inherent limitations: 1. modeling conditions are different from practice. 2. One model can only describe one endpoint. To tackle these, we propose a new method of model validation for recovery and intraprocedural sedation adequacy with a three-drug pharmacodynamic model using six published clinical studies that contain midazolam, opioid, and propofol. Mean drug dose, intraprocedural sedation level, procedure, and recovery time are extracted from each study. Simulated drug regimens are designed to best approximate study conditions. A published deep sedation model is used for simulation. Model-predicted recovery time and intraprocedural sedation scores are compared with the original clinical study outcomes. The model successfully predicted recovery times in eight out of nine regimens. Lower doses of midazolam are associated with faster recove...
Research Interests:
Research Interests:
Purpose: Technology of reflectance spectroscopy incorporated with auto-fluorescence spectroscopy were employed to increase the safety of epidural placement in regional anesthesia which is generally used for surgery, epidural anesthesia,... more
Purpose: Technology of reflectance spectroscopy incorporated with auto-fluorescence spectroscopy were employed to increase the safety of epidural placement in regional anesthesia which is generally used for surgery, epidural anesthesia, post-operative pain control and painless childbirth. Method: Ex vivo study of auto-fluorescence spectroscopy was performed for the para-vertebral tissues contained fat, interspinous ligament, supraspinous ligament and ligamentumflavum by multimode microplate reader at wavelength 405 nm for the purpose of tissue differentiation. A specially designed optic-fiber-embedded needle was employed to incorporate with both reflectance and autofluorescence spectroscopies in order to probe the epidural space as double assurance demands. In vivo study was carried out in a Chinese native swine weighted about 30 kg under intubated general anesthesia with ventilation support. The reflective (405 nm) and autofluorescence signals (λ and λ*) were recorded at 5 differen...