Chien-Kun Ting

National Yang Ming Chiao Tung University, Medicine, Faculty Member

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Papers by Chien-Kun Ting

Fiber-Needle Swept-Source Optical Coherence Tomography for the Real-Time Visualization of the Transversus Abdominis Plane Block Procedure in a Swine Model

Anesthesia & Analgesia, Nov 30, 2020

The technique of the loss of resistance (LOR) to air or hanging drops is the most common method u... more The technique of the loss of resistance (LOR) to air or hanging drops is the most common method used to identify the epidural space (ES). However, the use of LOR technique can cause an epidural failure rate of 10% owing to incorrect catheter placement. Recently, many technologically assisted epidural needle systems have been developed, including those using mechanical force or pressure monitoring, 7,8 ultrasound, 9-15 electrical stimulation, and optical methods. In our previous work, we proposed the use of optical methods 18 and A-mode ultrasound 15 to locate the ES. Although both techniques yield the improved accuracy of epidural placement in animal models, neither provides a visual image of the epidural tissue. An ideal method for locating the ES using direct sight has not yet been discovered. Optical coherence tomography (OCT) was originally demonstrated in 1991 as a unique biomedical imaging modality capable of cross-sectional imaging of the human eye at an axial resolution of approximately 10 to 15 μm. OCT is based on low-coherence interferometry. By scanning the mirror in the reference arm of a Michelson interferometer, the reflectivity profile of the sample is obtained, and no light outside the short coherence length will interfere (this is called time-domain OCT). This reflectivity profile is called an axial depth scan (A-scan). Although this is analogs to ultrasound imaging, OCT has a higher resolution than ultrasonography. Moreover, no exogenous What We Already Know about This Topic • Epidural needle placement using conventional techniques has significant limitations • Alternative techniques lack the ability to image tissues surrounding the needle tip with rapid time resolution What This Article Tells Us That Is New • An optical probe placed in the epidural needle coupled with swept-source optical coherence tomography can provide two-dimensional images of tissue surrounding the needle tip • Using a porcine model, high sensitivity and specificity for the identification of the epidural space were achieved

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Non‐intubated electromagnetic‐guided localization and resection of small indeterminate peripheral pulmonary nodules – Reply

Respirology, 2020

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Total intravenous anesthesia decreases hospital stay but not incidence of postoperative pulmonary complications after lung resection surgery: a propensity score matching study

BMC Anesthesiology

Background There is no consensus regarding the superiority of volatile or total intravenous anest... 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...

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Successful removal of a potentially lethal left atrial thrombus detected by transesophageal echocardiography following the removal of a left ventricular assist device inflow cannula

Journal of The Chinese Medical Association, Oct 1, 2012

The left ventricular assist device (LVAD) is a battery-operated, mechanical pump-type device that... more The left ventricular assist device (LVAD) is a battery-operated, mechanical pump-type device that helps in maintaining the pumping ability of a failing heart. Thromboembolism poses a significant risk during and after LVAD implantation. It occurs in up to 35% of patients with adverse sequelae. We present the case of a 75-year-old man who underwent coronary artery bypass graft surgery and LVAD implantation for acute myocardial ischemia and severe left ventricular dysfunction. However, subsequent transthoracic echocardiographic examination revealed an LVAD thrombus, and LVAD removal was suggested following the failure of thrombolytic therapy. After the LVAD cannula was removed, transesophageal echocardiography (TEE) revealed a residual thrombus in the left atrium. Thrombectomy was successfully performed by opening the left atrium with cardiopulmonary bypass. We believe that TEE monitoring aided the implantation and removal of the LVAD device. In this case, we found that TEE not only helped in monitoring the ventricular function but also in detecting other problems such as the residual thrombus. We strongly recommend TEE monitoring during the entire LVAD-removal procedure, particularly for patients who need to undergo LVAD removal because of thrombosis formation.

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Malignant hyperthermia with excellent response to small dose of dantrolene

PubMed, Dec 1, 2004

Malignant hyperthermia (MH) is an operative emergency associated with general anesthesia. Early d... 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.

A previously published propofol–remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery

Medicine, May 1, 2017

Modern anesthesia usually employs a hypnotic and an analgesic to produce synergistic sedation and... more Modern anesthesia usually employs a hypnotic and an analgesic to produce synergistic sedation and analgesia. Two remifentanil-propofol interaction response surface models were used to predict sedation using Observer's Assessment of Alertness/Sedation (OAA/S) scores; one predicts an OAA/S <2 and the other <4. We hypothesized that both models would predict regained responsiveness (RR) after videoassisted thoracic surgery (VATS) to reduce total anesthesia time and make early extubation clinically relevant. We included 30 patients undergoing VATS received total intravenous anesthesia (TIVA) combined with thoracic epidural anesthesia (TEA). Pharmacokinetic profiles were calculated using Tivatrainer. Model predictions were compared with observations to evaluate the accuracy and precision of emergence model predictions. The mean (standard deviation) differences between when a patient responded to their name and the time when the model predicted a 50% probability of patient response were 30.80± 17.77 and 13.71± 11.35 minutes for the OAA/S <2 model and <4 model, respectively. Both models had a limited ability to predict patient response in our patients. Both models identified target concentration pairs predicting time of RR in volunteers and some elective surgeries, but another model of epidural and intravenous anesthetic combinations may be needed to predict time of RR after VATS under TIVA with TEA. Abbreviations: ASA = American Society of Anaesthesiologists, CeP = effect-site concentration, DLT = double-lumen tube, ETT = endotracheal tube, LOR = loss of responsiveness, OAA/S = Observer's Assessment of Alertness/Sedation, OR = operating room, PACU = postanesthetic recovery unit, PCEA = patient-controlled epidural analgesia, RR = regained responsiveness, TCI = targetcontrolled infusion, TEA = thoracic epidural anesthesia, TIVA = total intravenous anesthesia, VAS = visual analogue scale, VATS = video-assisted thoracic surgery.

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Tracheal sounds accurately detect apnea in patients recovering from anesthesia

Journal of Clinical Monitoring and Computing, Aug 11, 2018

Apnea should be monitored continuously in the post anesthesia care unit (PACU) to avoid serious c... 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 2 were included in data analysis. The total monitoring time was 52.6 h. Thirty-four patients experienced 236 events of apnea lasting for a total of 122.2 min. The log-var apnea detection algorithm detected apnea with 92% sensitivity, 98% specificity, 46 PLR and 0.08 NLR. The performance of apnea detection in the PACU using the log-var tracheal sounds method proved to be reliable and accurate. Tracheal sounds could be used to minimize the potential risks from apnea in PACU patients.

format_quoteThe log-var apnea detection algorithm achieved 92% sensitivity and 98% specificity, identifying 217 apneic events correctly among 236 occurrences.format_quote

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Priming with Rocuronium to Accelerate the Onset Time of Cisatracurium During Intubation

Journal of The Chinese Medical Association, 2009

Background: The priming technique, in which a small dose of nondepolarizing muscle relaxant is ad... more Background: The priming technique, in which a small dose of nondepolarizing muscle relaxant is administered 3-6 minutes before giving the intubation dose, can speed up the onset of muscle relaxation in patients with paralysis during intubation. We investigated the priming technique and compared 2 different priming agents (rocuronium and cisatracurium) at a priming time of 3 minutes and its effect on decreasing the onset time of cisatracurium. Methods: A total of 60 patients with ASA physical status I-II scheduled for elective surgery were enrolled. After induction with propofol and fentanyl, the patients were randomized into 1 of 3 groups. Group 1 received rocuronium 0.06 mg/kg as a priming dose. Group 2 received cisatracurium 0.01 mg/kg as a priming dose. Group 3 received normal saline and constituted the control group. After a 3-minute priming time, intubation doses of cisatracurium were given (Groups 1 and 2, 0.14 mg/kg; Group 3, 0.15 mg/kg). First twitch height percentage (T1/T0%; % of control) and train-of-four percentage (T4/T1%) were recorded every 10 seconds from baseline until T1/T0% reached 0. Results: Rocuronium (Group 1) and cisatracurium (Group 2) significantly accelerated the onset of cisatracurium (Group 1, 117.0 ± 29.0 seconds; Group 2, 151.0 ± 37.5 seconds; Group 3, 221.5 ± 36.6 seconds; all p < 0.001). Conclusion: Priming with rocuronium or cisatracurium for 3 minutes significantly accelerated the onset of cisatracurium. Priming with rocuronium for 3 minutes improved the onset time of cisatracurium even more than priming with cisatracurium itself. [

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The epidural needle guidance with an intelligent and automatic identification system for epidural anesthesia

Incorrect placement of the needle causes medical complications in the epidural block, such as dur... 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.

Thermodynamic Interpretation of a Machine-Learning-Based Response Surface Model and Its Application to Pharmacodynamic Synergy between Propofol and Opioids

Mathematics

Propofol and fentanyl are commonly used agents for the induction of anesthesia, and are often ass... 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...

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The epidural needle guidance with an intelligent and automatic identification system for epidural anesthesia

Advanced Biomedical and Clinical Diagnostic and Surgical Guidance Systems XVI, 2018

COVID-19 Pandemic: Taiwan Society of Anesthesiologists' Response to the Ethical Aspects of Health and Safety in Operating Room Management

Asian journal of anesthesiology, 2021