Background: Submental intubation is commonly used during general anesthesia for maxillofacial surgeries as it provides a safe unrestricted surgical access compared to tracheostomy. During submental intubation, soft tissues and blood clots can become lodged in the endotracheal tube. To overcome this problem, we used a laparoscopic trocar.Case: A 52-year-old man with maxillofacial injury was scheduled to undergo an open reduction and internal fixation. We performed submental intubation using laparoscopic trocar, which created sufficient space for the insertion of the endotracheal tube. Unlike conventional methods, our method did not require any blunt dissection and caused significantly less soft tissue damage and required significantly less time.Conclusions: Submental intubation with laparoscopic trocar is a one-step method and is quick and easy-to-perform technique with less complications.

Background: Postoperative delirium (POD) has an incidence rate of 9% to 41%. It is directly linked to decreasing cognitive function, increasing length of hospitalization and cost, as well as other complications and mortality. We aimed to assess the risk factors for POD among elderly patients by analyzing data from those who underwent spinal surgery.Methods: This study included 446 patients aged 65 years or older who underwent spinal surgery at our institution between March 2013 and May 2018. Data were collected retrospectively from the patients’ electronic medical records, and logistic regression was used to identify the risk factors associated with POD. The diagnosis of POD was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and was made through consultation with a psychiatrist during postoperative hospitalization and before discharge.Results: Seventy-eight (78/446, 17.4%) patients were diagnosed with POD. The most relevant risk factor for POD was preoperative cognitive dysfunction (odds ratio [OR], 4.37; 95% confidence interval [CI], 1.60 to 11.93; P = 0.004), followed by emergency surgery (OR, 2.70; 95% CI, 1.27 to 5.74; P = 0.01), age (OR, 1.19; 95% CI, 1.13 to 1.26; P < 0.001), and anesthesia time (OR, 1.01; 95% CI 1.00 to 1.01; P = 0.002).Conclusions: Preoperative cognitive dysfunction, emergency surgery, age, and anesthesia time were factors that affected POD occurrence after spinal surgery. Patients with such associated factors may be at a higher risk for POD when undergoing spinal surgery, and hence, careful management may be necessary for these patients.

The use of a neuromuscular blocker (NMB) is often re- Background: The goal of this nationwide survey was to investigate the current concepts and practices of the use of neuromuscular blockers and their antagonists, and the availability and clinical practice of neuromuscular monitoring in Korea.Methods: After obtaining approval from the board of directors of the Korean Society of Anesthesiologists, we distributed a questionnaire via email to anesthesiology specialists with registered email addresses. The survey included questions on the availability and daily use of neuromuscular blockers, their antagonists and neuromuscular monitoring. Results:The overall response rate was 23.7%. Rocuronium and pyridostigmine were preferred as neuromuscular blocker (92.9%) and antagonist (86.1%), respectively. Although most anesthesiologists recognized the detrimental effect of postoperative residual neuromuscular blockade (87.7%) and the importance of neuromuscular monitoring (76.3%), quantitative monitoring was available in only 51.2% of the hospitals. More than 75% of respondents still prefer to use clinical signs to evaluate the recovery from paralysis.Conclusions: Changes in attitude and behaviors that mimic neuromuscular monitoring in Korea will be possible by regular and repeated publicity and education. Furthermore, greater distribution of neuromuscular monitoring devices and routine clinical use of these devices are also required.