title: A proposal of a simple epidural simulator for training novice anesthesiologists.
abstract: Confirming the epidural space during epidural anesthesia relies mainly on feel and experience, which are difficult techniques for a trainee to learn. We designed an epidural simulator for trainees to experience loss of resistance (LOR) and various degrees of pressure resistance.
  
  
  
  The simulator consists of a Perifix(®) LOR syringe and 1-, 5-, 10- and 50-mL syringes assembled by three-way stopcocks. A total of 89 anesthesiologists evaluated the simulator, given the choice of either the intermittent technique with air or continuous technique with saline. Sudden LOR and applicability of the simulator for training purposes were assessed using the numerical rating score (NRS). Pressure resistance at each lumbar structure was evaluated by the anesthesiologists using the intermittent technique with air.
  
  
  
  Seventy-four anesthesiologists used the intermittent technique with air and 15 used the continuous technique with saline. The NRSs for sudden LOR and the applicability for training purposes were 8 and 9 (median), respectively. The pressure resistance to a 50-mL syringe was regarded as the epidural space (odds ratio 602.3 for 5-mL syringe and 144.4 for 10-mL syringe) by 89 % of anesthesiologists using air for LOR. Resistance to the 10-mL syringe was most frequently considered as muscle, subcutaneous fat, or the interspinous ligament, while resistance to the 1-mL syringe was considered as the ligamentum flavum (odds ratio 2.3 for 5-mL syringe and 18.6 for 10-mL syringe).
  
  
  
  Our epidural simulator is a simple, low-cost device that can be easily constructed. It was shown to provide valid haptic feedback as a promising tool for training novice anesthesiologists.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
authors.forename: Sung-Moon
authors.initials: SM
authors.lastname: Jeong
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea. superoxide@naver.com.
authors.forename: Jae Moon
authors.initials: JM
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
authors.forename: Hwanhee
authors.initials: H
authors.lastname: Yoo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
authors.forename: Sukyung
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Republic of Korea.
authors.forename: Hyungseok
authors.initials: H
authors.lastname: Seo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
authors.forename: Sooyoung
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
authors.forename: Sung-Hoon
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000072080:Anesthesiologists / Q000193:education*; D004824:Epidural Space; D005260:Female; D006801:Humans; D007858:Learning; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D011312:Pressure; D013594:Syringes
keywords: Epidural anesthesia; Loss of resistance; Simulator