@article{nishiyama2014thoracic,
  title = {Thoracic Epidural Catheterization Using Ultrasound in Obese Patients for Bariatric Surgery},
  author = {Tomoki Nishiyama},
  year = 2014,
  url = {https://ibimapublishing.com/articles/OBES/2014/538833/},
  journal = {Journal of Research in Obesity},
  volume = 2014 (2014),
  pages = 6,
  doi = 10.5171/2014.538833,
  abstract = {Objective: We investigated the usefulness of ultrasound for a thoracic epidural catheterization in bariatric surgery.Methods:  Sixteen patients with 125.9 kg in mean body weight and 45.5 kg/m2 in mean body mass index were studied.  The longitudinal view of the ultrasound scanning was used to detect the spinous process and ligamentum flavum-dura matter unit.  The distance from the skin to the ligamentum flavum-dura matter unit was measured as an ultrasound depth and corrected by the angle of the epidural needle.  An epidural puncture was performed by a median approach with a loss of resistance method.  The distance from the skin to the tip of the needle was measured as a needle depth.  Multiple regression analysis and Bland-Altman plot were used to judge the relation between the needle depth and the corrected ultrasound depth. Results:  Epidural catheterization was successfully performed at the first attempt in 14 patients and second in two patients. The needle depth was 9.1 (range, 5.5-11.0) cm and the ultrasound depth was 6.5 (4.0-8.5) cm.  The correlation coefficient (r2) of the corrected ultrasound depth and the needle depth was 0.81. The Bland-Altman analysis showed the bias of 1.8 cm and limits of agreement of 0.63 cm and 2.94 cm. Discussion: Ultrasound was useful to insert a thoracic epidural catheter in obese patients receiving bariatric surgery, while the measurement of the ultrasound depth could not be a surrogate measurement of the needle depth.},
  keywords = {bariatric surgery, epidural block, morbid obese, ultrasound},
  note = Article ID: 538833
}