P W Lui

Taoyuan Armed Forces General Hospital, Hsin-chu-hsien, Taiwan, Taiwan

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Publications (64)64.31 Total impact

  • Acta Anaesthesiologica Scandinavica - ACTA ANAESTHESIOL SCAND. 01/2008; 45(2):255-257.
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    ABSTRACT: The aims of this study were (a) to establish normative data of thermal symmetry (left vs. right) in normal subjects; (b) to compare the skin temperature in various regions between young and old people in Taiwan and between male and female. The skin surface of 57 healthy volunteers (aged 24 to 80 yr) was divided into 25 areas and measured by an infrared thermography (Avionics TVS-2000, Japan). The average temperatures of these 25 regions were compared: (a) left vs. right side, (b) young (< or = 60 yr, n = 37) vs. old (> 60 yr, n = 20), and (c) male vs. female. Student's t-test was used to assess means between both groups. The neck carried the highest skin temperature (31.9 degrees C +/- 0.6; mean +/- SD) of the body in comparison with the toes that had the lowest one (27.5 degrees C +/- 2.0). The side-to-side temperature differences were subtle, which did not exceed 0.5 degrees C. The average skin temperature of elderly was slightly lower than that of young subjects in 11 out of 25 areas (p < 0.05), especially the distal parts of extremities. Elderly female had lower skin temperature in various truncal areas as compared with their counterpart. However, the skin temperature was higher in the distal extremity (p < 0.05). The thermoregulatory system is substantially symmetrical. The result of this study offered valuable normative database on skin thermal symmetry in normal population of Taiwan, and may be useful as a diagnostic aid in patients with various states of disorders associated with autonomic dysfunctions.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 08/2001; 64(8):459-68.
  • F C Liu, C M Tsao, P W Lui
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    ABSTRACT: The volume of a bulky venous air emboli (VAE) can be estimated based on the calibration curve generated by injections of minute amount of air into the right atrium (RA) of dogs. We speculated that in patients similar VAE calibration curves could be generated using CO2 injections. As part of pre-clinical evaluation of the usefulness of CO2 injection, the present study was designed to determine whether injection of CO2 into the RA would cause less hemodynamic changes in dogs as compared with that of air or O2. Twenty-one anesthetized mongrel dogs were divided into 3 groups, i.e., groups air, CO2 and O2 (n = 7 each). Animals were injected a bolus of gas (air, CO2 or O2) in increasing volumes (from 0.25 to 4.0 mL/kg) into the RA via a central venous catheter at 10-min intervals. We measured the maximal changes in mean arterial pressure (MAP), pulmonary arterial pressure (PAP), central venous pressure (CVP), end-tidal CO2 (ETCO2), heart rate (HR), and mixed venous O2 saturation (SvO2). After venous injections, dogs receiving O2 or air showed greater decreases in MAP and ETCO2 as compared with those receiving CO2 (volume > 2.5 mL/kg; P < 0.05). The increases in PAP and CVP bore direct relation to O2 and air volume. In the CO2 group, the maximal changes in PAP and CVP were subtle as compared with the baseline (P < 0.05). There were no significant differences in HR and SvO2 among three groups. Injections of CO2 in increasing volumes into the RA of dogs caused less hemodynamic changes in comparison with that of air and O2.
    Acta anaesthesiologica Sinica 06/2001; 39(2):71-6.
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    ABSTRACT: Venous air embolism (VAE) is not uncommon during craniotomy, but repeated attacks of VAE during a single surgical procedure is rarely seen. We report a successful intraoperative management of repeated attacks of air embolism in a patient who sustained craniotomy for intracranial hemorrhage (ICH) in prone position. A 70-year-old male suffering from hemorrhage in the right cerebellar hemisphere with impending brainstem herniation was scheduled for craniotomy. He had history of hypertension but it was not well controlled with medical treatment. Emergent craniotomy for removal of blood clot resulting from ICH was performed. During the operation, sudden decrease of end-tidal CO2 (EtCO2) level, fall of blood pressure and increase of central venous pressure (CVP) were noted. Since air bubbles were retrieved from CVP catheter venous air embolism was highly suspected. With prompt diagnosis and proper management, we successfully improved the patient's hemodynamic status and he was discharged without any sequelae. Early detection together with aggressive treatment is the only way in the management of intraoperative venous air embolism.
    Acta anaesthesiologica Sinica 04/2001; 39(1):41-5.
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    ABSTRACT: We report a case of corrosive injury of upper gastrointestinal and respiratory tracts scheduled for feeding jejunostomy under thoracic epidural anesthesia. An epidural catheter was inserted at the T8-T9 intervertebral space and threaded 7 cm beyond the tip of the Tuohy needle in a rostral direction. Resistance was noticed during attempts to inject the local anesthetic. As resistance could not be relieved by changing the position of the patient, kinking of the epidural catheter was suspected. Following informing the patient of the associated risks, the catheter was retrieved successfully by gentle and steady pulling. A tight double-knot of catheter was found. No neurological sequelae to the procedure were noticed.
    Acta Anaesthesiologica Scandinavica 03/2001; 45(2):255-7. · 2.36 Impact Factor
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    ABSTRACT: Transaxillary endoscopic sympathectomy of thoracic ganglia (T2-T3) has recently gained wider acceptance as the treatment of choice for palmar hyperhidrosis. It requires one-lung ventilation to facilitate the surgery. One-lung ventilation, however, is not without complications, among which acute pulmonary edema has been reported. In this case report, we present a patient with palmar hyperhidrosis complicated by glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, who received bilateral endoscopic sympathectomy under alternate one-lung anesthesia, and developed acute pulmonary edema immediately after recruitment of the successive collapsed lung. The effects of hypoxemia, G-6-PD deficiency and sympathectomy might all add to the development of acute pulmonary edema secondary to reexpansion of each individual lung after alternate one-lung ventilation. The possibilities of the inferred causes are herein discussed.
    Acta Anaesthesiologica Scandinavica 02/2001; 45(1):123-6. · 2.36 Impact Factor
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    ABSTRACT: This retrospective study sought to determine the incidence of postthoracotomy pain syndrome (PTPS), and whether epidural morphine for the postoperative analgesia could prevent the development of PTPS. We reviewed the charts of 372 patients who had undergone thoracotomy. The majority underwent general anesthesia (GA) combined with thoracic epidural analgesia (TEA). Of the 372 patients, only 159 (42%) were available for interview. Patients were divided into two groups based on the duration of pain, i.e., pain group (pain > 3 months, n = 65) and pain-free group (pain < 3 months, n = 94). Both groups were comparable regarding sex, age, weight, height, smoking, alcohol ingestion, education, marital status, duration of surgery, and the number of patients either receiving GA plus TEA or GA alone. About 41% of the patients experienced PTPS that persisted for 21 +/- 12 mon (follow-up: 28 +/- 12 mon). Most pain was mild or moderate and was usually described as being only a discomfort. Only 6.2% suffered severe pain with shooting, aching, burning or numbness. Patients with PTPS suffered more depression and insomnia. The incidence of PTPS was not different in patients who received GA alone or GA plus TEA (39% vs. 42%). Epidural morphine for postoperative analgesia that continued for 3 days appeared to have no effect in the prevention of PTPS.
    Acta anaesthesiologica Sinica 12/2000; 38(4):195-200.
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    ABSTRACT: Using glucose-free solution as fluid maintenance is widely advocated during neurosurgery because of concerns about hyperglycemia aggravating cerebral ischemia. This study evaluated the alterations in plasma glucose concentrations in both adult and pediatric patients undergoing lengthy neurologic surgery, during which they were given glucose-free solutions. This study included 154 patients (ASA class II, aged 3 months-75 years) undergoing elective neurosurgical procedures. They were divided into two groups: group A (15-75 years-of-age) and group P (3 months-14 years-of-age). Groups A (n = 126) and P (n = 28) were further divided into five subgroups, respectively, based on the duration of surgery: 5, 6, 7, 8 and 9 hours. Anesthesia was maintained with isoflurane, fentanyl and vecuronium. Blood sampling was undertaken every hour throughout surgery. Adult patients differed significantly in body weight (61.5 +/- 10.9 vs 25.6 +/- 14.9 kg), age (58.9 +/- 15.7 vs 7.5 +/- 4.3 years), use of preoperative beta-blocking agents (33/126 vs 1/28) and the need for blood transfusion (58/126 vs 24/28). Neither group had elevated glucose levels. Compared with pediatric patients, the incidence of intraoperative hypoglycemia was statistically higher in adult patients, with a rate that peaked in the eighth (25.9%, group A vs 0% group P) and ninth hours (27.3%, group A vs 0% group P) of surgery. There were no differences in glucose concentrations at other points in time. In contrast to pediatric patients, intraoperative hypoglycemia occurred more often in adult patients during prolonged neurosurgical procedures when glucose-free solution was used for fluid maintenance. Therefore, frequent determination of plasma glucose concentrations is mandatory, especially in patients undergoing long-lasting neurosurgical anesthesia.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 07/2000; 63(6):467-74.
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    ABSTRACT: Perioperative pulmonary thromboembolism can proceed rapidly with grave prognosis, in which immediate or accurate diagnosis and management is not easy. According to the literatures, patients receiving spinal surgery are at relatively lower risk of developing thromboembolism. We would like to present a case of postoperative pulmonary thromboembolism which developed after a prolonged lumbar spinal surgery. Tachycardia and unstable hemodynamics were noted postoperatively. Pulmonary and right atrial thrombi were disclosed by transesophageal echocardiography. Although cardiotomy and thrombectomy were immediately performed, the patient finally died 3 days after the operation. The pathogenesis of venous thromboembolism (VTE) in the surgical patients, the risk factors which predispose a patient to VTE, diagnosis, and treatment as well as the prophylactic measures of VTE are herein reviewed and discussed.
    Acta anaesthesiologica Sinica 01/2000; 37(4):215-20.
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    ABSTRACT: Injury of the cervical spine may cause serious complications and neurological sequelae. Recently, a patient with C1-2 spinal cord compression developed pulmonary edema postoperatively associated with unstable hemodynamics, which might result from overzealous fluid administration in order to correct neurogenic shock during anesthesia. Therefore, early recognition and timely use of vasoconstrictors, together with judicious fluid replacement are important in the anesthetic management of patients with cervical spine injury undergoing surgery. In addition, the placement of pulmonary artery catheter is crucial for assessing the cardiac function and fluid status.
    Acta anaesthesiologica Sinica 09/1999; 37(3):147-50.
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    ABSTRACT: Quantitative sensory testing has gained popularity as a tool in the diagnosis of peripheral neuropathies. This study aims to establish normative data of quantitative thermal and vibratory thresholds in normal subjects in Taiwan. In addition, we also examined the effect of age and gender differences on these thresholds. The study included 100 healthy subjects (50 males and 50 females) who were admitted for regular physical examination. The quantitative testing of thermal, cold and vibratory sensations were performed having recourse to a Thermotest instrument applied on the right hand and foot of these subjects. Measurements included perception thresholds of warm (WT), cold (CT), heat pain, cold pain and vibration as well as a visual analog pain scale. Age was comparable between the sexes, but the male subjects were taller than the female subjects. A higher WT and CT in the hand, but not in the foot, were found in the male subjects in comparison with the female subjects. Heat pain threshold and cold pain threshold of both sites did not significantly differ between genders. Moreover, the groups did not differ in vibration threshold and visual analog pain scale. Young subjects (age < 30 years) showed a higher CT in the foot than the older subjects (age > 50 years). None of the above parameters were different between these two age groups. Overall, the age or height bore no significant relation to the difference between WT and CT (DDWT-CT). The female subjects were found to be more sensitive to warm and cold stimulation in the hand than their counterparts. These results have provided valuable normative data on sensory perceptive thresholds in Taiwanese, which are useful as a tool in the diagnosis of peripheral neuropathy.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 07/1999; 62(7):431-7.
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    ABSTRACT: Transurethral incision (TUI) is a simple and safe procedure. We, herein, present a case undergoing transurethral incision procedure during which he developed transurethral resection of prostate syndrome (TURP syndrome) and hypothermia precipitating an acute perioperative myocardial infarction attack. The potential risk of development of TURP syndrome in settings other than TURP surgery as well as its prevention are reviewed and discussed.
    Acta anaesthesiologica Sinica 07/1999; 37(2):105-8.
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    ABSTRACT: The spectrum of the embolic heart sounds (EHS) detected by precordial Doppler ultrasound has been previously characterized, but only on small volumes of venous air embolism (VAE). We sought to determine whether real-time wavelet analysis is useful in analyzing the signals of EHS and whether the embolic power of the EHS for larger volumes of air is proportionate to the volume of VAE that has been reported for small volumes of VAE. A series of small air boli (0.01, 0.02, 0.05, 0.07, 0.1, 0.15, 0.2, 0.3, 0.4, and 0.8 mL), followed by continuous infusion of larger volumes of air (0.8, 1.6, 2.4, 4.8, and 9.6 mL), was injected into the external jugular vein through a central catheter in seven pentobarbital-anesthetized dogs. We measured the spectrum of the Doppler heart sound (DHS) in a real-time manner by using wavelet analysis at different scales. Wavelet analysis at scale = 1 yielded satisfactory results in distinguishing abnormal EHS from normal DHS with high sensitivity (100%) and good positive predictive value (100%) compared with the conventional method, which requires an anesthesiologist to listen to the audio DHS signals in a real-time manner. There was a linear relationship (y = 1.08x + 7.89, r = 0.75, P < 0.001) between the cumulative embolic power of the EHS and the air volume introduced in the form of either bolus or continuous infusion. The 95% confidence intervals for slope and intercept were 0.89-1.27 and 7.65-8.13, respectively. Our results suggest that wavelet analysis is effective as a real-time monitor and that it is possible to distinguish larger volumes of air emboli based on previous injections of small volumes of air. Implications: The real-time wavelet analysis of the heart sound detected by precordial Doppler ultrasound may be useful in estimating larger volumes of air emboli based on previous injections of small volumes of air in anesthetized dogs.
    Anesthesia & Analgesia 03/1998; 86(2):325-31. · 3.30 Impact Factor
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    ABSTRACT: Investigators in the authors' laboratory previously established the critical participation of the cerulospinal noradrenergic pathway in muscular rigidity elicited by fentanyl. The identification of colocalization of glutamate with tyrosine hydroxylase in most locus ceruleus neurons suggests a role for cerulospinal glutamatergic neurotransmission in fentanyl-induced muscular rigidity. This suggestion and the subtype(s) of glutamate receptors involved were investigated here. Electromyographic signals activated by bilateral microinjection of 2.5 microg fentanyl into the locus ceruleus were recorded differentially from the left sacrococcygeus dorsi lateralis muscle of adult male Sprague-Dawley rats. The effect of intrathecal administration at the lower lumbar spinal cord of various N-methyl-D-aspartate (NMDA) and non-NMDA receptor antagonists or agonists on this index of muscular rigidity was studied. Rats were under mechanical ventilation, and intravenous infusion of ketamine (30 mg x kg(-1) x h(-1)) was maintained until 10 min before fentanyl was administered. Microinjection of fentanyl bilaterally into the locus ceruleus increased the root mean square and decreased the mean power frequency values of electromyographic signals. The efficacy of fentanyl to elicit muscular rigidity in this manner was significantly reduced by previous intrathecal administration of either 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX), (+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine maleate (MK-801), D-(-)-2-amino-5-phosphonovaleric acid (AP5), or (+/-)-3-(2-carboxypiperazin-4-yl)-propyl-1-phosphonic acid (CPP). Intrathecal administration of kainic acid or NMDA also resulted in significant electromyographic activation. In addition to the cerulospinal noradrenergic mechanism, the cerulospinal glutamatergic pathway and both NMDA and non-NMDA receptors in the spinal cord may mediate fentanyl-induced muscular rigidity in the rat.
    Anesthesiology 01/1998; 87(6):1450-9. · 5.16 Impact Factor
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    ABSTRACT: The Doppler heart sound signals detected by the precordial Doppler ultrasound method under simulated sub clinical and clinically significant venous air embolism were studied in anesthetized dogs. Signal processing using wavelet transform enhanced the contrast of embolic to normal signal, facilitating automatic detection and extraction of embolic signal simply by thresholding. Linear relationship of good correlation coefficient was obtained in log-log scale between the subclinical volume of injected air and the corresponding embolic signal power in all dogs. The calibration curve was found to be good estimate of the volume of embolic air during simulated clinically significant venous air embolism. Hence, we overcame the need of constant human attention for detecting venous air embolism and the lack of quantitative information on the volume of embolic air in the traditional precordial Doppler ultrasound method by the present approach
    Engineering in Medicine and Biology Society, 1998. Proceedings of the 20th Annual International Conference of the IEEE; 01/1998
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    ABSTRACT: A fast detection algorithm for venous air embolism (VAE) was developed and implemented as a real-time monitor for detecting embolic heart sound and estimating embolic air volume. Its performance was evaluated under bolus injection of sub-clinical (0.0l to 0.80 ml) and continuous infusion of clinically significant (0.80 to 9.60 ml) air volumes in anaesthetized dogs. The clinically significant air emboli could be estimated based on the calibration curve obtained during sub-clinical VAE for a subject. The monitor also kept track of the cumulative embolic air volumes and alerted the anaesthetists once a predefined clinically significant embolic air volume was reached. As both humans and dogs share similar physiological conditions, our monitor for dogs are expected to be applicable to humans
    Circuits and Systems, 1997. ISCAS '97., Proceedings of 1997 IEEE International Symposium on; 07/1997
  • P W Lui
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    ABSTRACT: In the present study, using hydrophilic adenosine antagonists either selective to A1 or A2 receptors, we investigated the central and spinal adenosinergic participation in fentanyl-induced muscular rigidity. Adult Sprague-Dawley rats were anesthetized with ketamine and were under mechanical ventilation. Fentanyl (100 micrograms/kg, i.v.) consistently elicited electromyographic (EMG) activation in the sacrococcygeal dorsalis lateralis muscle. This implied muscular rigidity was not blocked by i.c.v. administration of the adenosine A1 antagonist, 1-allyl-3,7-dimethyl-8-p-sulfophenyl-xanthine (ADSPX; 20 or 40 nmol/2.5 microliters), except at higher dose (80 nmol). Equimolar doses of the adenosine A2 antagonist, 3,7-dimethyl-1-propargylxanthane (DMPX), did not exert any inhibitory effect on fentanyl-induced rigidity. Intrathecal (i.t.) administration of the same doses of ADSPX (20, 40 or 80 nmol/10 microliters) appreciably suppressed the EMG activation. However, the rigidity was only inhibited by 40 or 80 nmol (i.t.) of DMPX, but not by the lowest dose. High-dose (80 nmol, i.t.) adenosine A1 or A2 antagonist per se did not induce motor impairment or hindlimb paralysis in conscious animals. These results suggest that adenosine A1 and A2 receptors in the spinal cord may play a more crucial role than those in the central nervous system (CNS) in fentanyl-induced muscular rigidity in rats.
    Neuroscience Letters 04/1997; 224(3):189-92. · 2.03 Impact Factor
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    ABSTRACT: Diuretic therapy after transurethral prostatectomy (TURP) is primarily intended to induce diuresis against water intoxication and cystic clot retention. This study was undertaken to compare the diuretic effects of glycerol with furosemide after TURP. Thirty patients (ASA I or II) undergoing TURP were studied. Spinal anesthesia was induced with bupivacaine. At the end of prostatic resection, the patients were randomly allocated into two groups. In one group (n = 15) the patients received furosemide 30 mg i.v., while in the other group (n = 15) they received glycerol 0.5 g/kg i.v. Blood samples were collected for measurements of osmolality, hematocrit, sodium and glucose concentration before anesthesia and after surgery. Urine output was also recorded after surgery in each group. Plasma osmolality in glycerol group was higher than furosemide group at 30 min (295.3 +/- 10.6 vs. 283.8 +/- 5.6 mOsm/kg, p < 0.01) and 1 h after operation (294.9 +/- 8.7 vs 286.3 +/- 6.7 mOsm/kg, p < 0.01). Blood glucose was higher in glycerol group than that in furosemide group at 2 h after operation (195.6 +/- 121.9 vs 152.9 +/- 70.1 mg/dl, p < 0.05). Measured urine output was significantly greater in furosemide group at 30 min after operation (904.6 +/- 491.5 vs. 248.4 +/- 143.4 ml, p < 0.05) but was greater in glycerol group at 12 h after operation. Since urine output is significantly less in glycerol group at 1 h after operation, glycerol is inferior to furosemide for preventing cystic clot retention after TURP. But glycerol may protect against water intoxication better for its merit of producing higher plasma osmolality.
    Acta anaesthesiologica Sinica 01/1997; 34(4):185-90.
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    ABSTRACT: Malignant hyperthermia is clinically an uncommon disorder characterized by acute hypercatabolic reactions in muscles in response to the triggering effects of certain drugs mainly used during anesthesia or to physical or emotional stress. We present a pediatric patient with multiple caries who was suspected to contract malignant hyperthermia while underwent the operative procedure of comprehensive restoration. Sinus tachycardia, hyperthermia, hypercapnia, metabolic acidosis, hyperkalemia and hypercalcemia developed unexpectedly during the operation. Fortunately, the patient survived the episode with early recognition and prompt management.
    Acta anaesthesiologica Sinica 10/1996; 34(3):167-71.
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    ABSTRACT: To compare the incidence and risk factors of guidewire-induced arrhythmia (GIA) during internal jugular venous catheterization (IJV). Prospective study. Operating rooms at a medical center. 303 ASA physical status I, II, III, and IV patients undergoing elective surgery. All patients were cannulated with the central venous catheters placed via the right internal jugular vein after induction of anesthesia. They were randomly divided into two groups. In one group, we used a marked J-wire and inverted up to, but not beyond 20 cm (Group M, n = 127). In the other group, a plain unmarked J-wire was used and inserted at will (Group UM, n = 176). All IJV catheterizations were performed by residents, and the length of J-wire inserted was then measured. Types of arrhythmia [eg, premature atrial contraction (PAC) or premature ventricular contraction (PVC)] were interpreted by attending anesthesiologists on lead II ECG. Patients in Group UM had a significantly greater incidence of GIA than those in Group M (28.4% vs. 3.9%; p < .005). However, in both groups, PAC occurred more frequently than PVC. Factors such as the inserted length of guidewire longer than 20 cm, body height less than 170 cm, and female gender were significantly associated with GIA (p < 0.005). Limiting the length of the guidewire insertion to less than or equal to 20 cm for right IJV catheterization by using a marked J-wire will reduce the incidence of GIA. We recommend the use of a marked J-wire for IJV catheterization.
    Journal of Clinical Anesthesia 08/1996; 8(5):348-51. · 1.15 Impact Factor

Publication Stats

201 Citations
64.31 Total Impact Points

Institutions

  • 2001
    • Taoyuan Armed Forces General Hospital
      Hsin-chu-hsien, Taiwan, Taiwan
  • 1989–2001
    • Taipei Veterans General Hospital
      • Department of Anesthesiology
      Taipei, Taipei, Taiwan
    • National Yang Ming University
      • • Department of Anesthesiology
      • • Institute of Clinical Medicine
      T’ai-pei, Taipei, Taiwan