Objective Lung sonography can be helpful to determine the position of a left-sided double-lumen tube (DLT). However, clinical experience is required for correct assessment. We investigated whether lung sonography can improve the diagnostic efficacy of determining the DLT position in novices and experts. Methods In this randomised prospective clinical study, 88 patients were allocated to two groups using auscultation or lung sonography for initial assessment of the DLT position. In each group, two repeated assessments were performed; the first was performed by a novice, and the second was performed by an expert. The final DLT position was confirmed by fibre-optic bronchoscopy. The primary outcome was the diagnostic efficacy (including overall accuracy, sensitivity, and specificity) in confirming the DLT position. Results In both the novices and experts, the specificity of determining the DLT position was significantly higher with lung sonography than auscultation (60.0% vs. 21.7% and 66.7% vs. 37.5%, respectively). Additionally, the predictability of an incorrect position was similar between the novices and experts using lung sonography (area under the curve of 0.665 and 0.690, respectively). Conclusions Lung sonography can improve the diagnostic efficacy of detecting an incorrect DLT position in both novices and experts.

General anesthesia is the main strategy for almost all thoracic surgeries. However, a growing body of literature has reported successful cases of non-intubated thoracic surgery with regional anesthesia. This alternative strategy not only prevents complications related to general anesthesia, such as lung injury, incomplete re-expansion and intubation related problems, but also accords with trends of shorter hospital stay and lower overall costs. We experienced a successful case of non-intubated thoracoscopic decortication for a 68-year-old man who was diagnosed as empyema while the patient kept spontaneously breathing with moderate sedation under thoracic epidural anesthesia. The patient showed a fast recovery without concerns of general anesthesia related complications and effective postoperative analgesia through thoracic epidural patient-controlled analgesia device. This is the first report of non-intubated thoracoscopic surgery under thoracic epidural anesthesia in Korea, and we expect that various well designed prospective studies will warrant the improvement of outcomes in non-intubated thoracoscopic surgery.

Preoperative anxiety in patients under spinal anaesthesia may cause serious complications. We report a case of combined transient convulsion and severe hypotension immediately after spinal anaesthesia for caesarean delivery in a patient who presented with severe preoperative anxiety. Our patient’s consciousness and blood pressure recovered normally without any sequelae. However, preoperative anxiety can induce such complications, particularly in patients under regional anaesthesia. Therefore, early detection and deliberate management for preoperative anxiety are required for the patient’s safety and satisfaction.

Currently, the regimen of intravenous patient-controlled analgesia (IV-PCA) has become lowering opioid to reduce opioid-related side effects, particularly, postoperative nausea and vomiting (PONV). Using nefopam in IV-PCA may decrease the incidence of PONV, but there is still a lack of evidence. 178 patients undergoing laparoscopic gynecological surgery were randomly assigned into two groups. The IV-PCA regimen for group F was 20 mg/kg fentanyl and for group N was 10 mg/kg fentanyl with 200 mg of nefopam. The severity of PONV and pain were assessed at both 1 hour and 24 hours after surgery. Patients' satisfaction with recovery was evaluated by a structured questionnaire. The incidence of PONV showed no statistical difference between group N and group F (28.2% vs. 26.8% at 1 hour, p=0.839 and 32.1% vs. 43.9% at 24 hours, p=0.120, respectively). Also, postoperative pain intensity showed no statistical difference between the two groups. Patient recovery was similar between the two groups. The combined use of nefopam in IV-PCA seems to effectively decrease the fentanyl dose in laparoscopic gynecological surgery. However, it did not contribute to decreasing the incidence of PONV.