Quality of post-operative pain control in infants and neonates.

Objective: To date, little information has been reported regarding the quality of pain control in infants and neonates. We identified the incidence and risk factors of postoperative pain, effects of fentanyl on extubation, optimal doses of fentanyl and respiratory complications. Methods: This descriptive study was conducted in infants and neonates who underwent major surgery, by retrospective chart review. Patients who were assessed as having pain by using the Neonatal Infant Pain Scale (NIPS) >10 times in 24 hours were included. Demographic data, type of surgery, timing of extubation and NIPS, including type of analgesia and doses of fentanyl given, were recorded. Pain was defined as NIPS >4 twice in 24 hours. Risk factors which included age group, type of surgery and type of postoperative analgesia were recorded. Results: Seventy-two neonates and 68 infants, ASA I-III were enrolled. The overall incidence of pain was 26.4% (infants, 44.1%; neonate, 9.7%). The age group was the significant factor affecting pain (adjusted odd ratio=7.84, 95% CI = 3.00, 20.84, p <0.001). Among patients who were still receiving fentanyl infusion or just ceased from receiving infusion within 30 minutes, 91.2% of infants and 58.3% of neonates were able to be extubated. The median time to extubation in infants was less than in neonates (0 vs. 16 min). Optimal doses of intravenous fentanyl in neonates were commenced at 0.3 mcg.kg-1 for intermittent use and 0.3 mcg.kg-1.h-1 for infusion. Apneic episodes were found in 2 patients. Conclusion: From this study, the quality of pain control in infants was not as good as neonates.

Perioperative cardiac arrest at Siriraj Hospital between 1999-2001.

Cardiac arrest during the perioperative period is a good indicator of the quality of anesthetic management. The incidence of perioperative cardiac arrest in Siriraj Hospital hasn't been reported before. Our objectives were to determine the incidence of perioperative anesthesia-related cardiac arrest and the results of cardiopulmonary resuscitation in these cases in order to find out how to improve our anesthetic care. This prospective study was undertaken between 1999-2001 by sending a questionnaire to those witnessing a cardiac arrest. The incidence of perioperative cardiac arrest was 8.2:10,000 instances of anesthesia with a mortality of 5.6:10,000 within 48 hours of the arrest. The incidence of perioperative cardiac arrest that was related to anesthesia was 0.7:10,000 instances of anesthesia and the anesthesia related mortality was 0.19: 10,000 within 48 hours of arrest. Failed cardiopulmonary resuscitation occurred in of occasions 41.7 per cent. There was no difference between intraoperative and postoperative cardiopulmonary resuscitation. Twenty-one per cent of patients experiencing a cardiac arrest were discharged from hospital. Seventy-three per cent of events occurred in patients with an ASA rating 3-5 and most often the cause of arrest was massive or uncontrolled bleeding. In those patients with an ASA rating 1-2 there were no outstanding cause of arrest.