ABSTRACT
Objectives: The aims of the present study were to survey reasons regarding choosing Anaesthesiology as professional specialty and evaluate perception regarding being anaesthesiologists. Methods: This cross sectional, multi-institutional study anonymously surveyed first year Anaesthesiology residents in resident training centres in Bangkok who came for the first inter-hospital lectures at Department of Anaesthesiology, Faculty of Medicine, Chulalongkorn University in July, 2012. A structured questionnaire comprising of demographic data, reasons for choosing anaesthesiology, and attitude regarding anaesthesiologists was filled in and returned before beginning of lectures. Results: All 50 anaesthesia residents who attended the inter-hospital lectures responded; 40 residents (80%) were female. By selecting three preferred choices, the respondents stated reasons for choosing Anaesthesiology were as follows: 1) Responsibility of patient on case by case basis 38 (76%); 2) Impression of anaesthesiologist as a role model 17 (34%); 3) Career characteristic of both knowledge and skill 16 (32%); 4) Limited number of patients under responsibility 15 (30%); 5) Not too frequent communication 14 (28%). In the respondents‘ view point, disadvantages of being anaesthesiologist were high chance of being legally sued (74%) and contact with blood and/or body fluids (60%). Characteristics of good anaesthesiologists were identified as the ability to make decisions during critical events (86%), high responsibility (62%), ability to obtain patients‘ data for adjusting of anaesthesia care (46%) and knowledge of own limitations and capacity (46%). Conclusion: Career characteristics favouring controllable lifestyle such as responsibility of patients on case by case basis, identification of the anaesthesiologist as a role model and professional ability of both knowledge and skills were features that residents found most attractive.
ABSTRACT
Background: Noxious stimuli during craniotomy may induce hypertension and tachycardia, giving rise to morbidity in patients with intracranial hypertension. Craniotomy is followed by moderate level of postoperative pain. Objective: Evaluate the effectiveness of scalp block on hemodynamic response to noxious stimuli, intraoperative fentanyl requirement and post-operative analgesia. Methods: Sixty patients undergoing elective craniotomy were randomly assigned to receive a scalp block with either 0.5% bupivacaine or 0.25% bupivacaine and 1:200,000 adrenaline (group A and B) or normal saline with 1:200,000 adrenaline (group C). Fentanyl 0.5 mcg/kg was administered for hemodynamic control. Intraoperative mean arterial blood pressure (MAP), heart rate (HR), fentanyl doses, and post-operative pain scores were recorded. Post-operative analgesia was provided by patient-controlled analgesia (PCA) morphine for 24 hours. Results: MAP was greater in group C than group A during pinning and incision (p <0.05), and was greater in group C than group B during pinning, incision and craniotomy (p <0.05). HR differences were not statistically significant between all groups (p >0.05). Intraoperative fentanyl requirement was significantly greater in group C compared with group A and B (p < 0.05). Pain score, time to the first morphine administration and total morphine consumption were not significantly different between all groups. Conclusion: Pre-incision scalp blocks using either 0.25% or 0.5% bupivacaine with 1:200,000 adrenaline were effective to prevent rising of MAP, but not HR in response to cranial pinning and skin incision, causing less intraoperative fentanyl requirement. However, they did not reduce post-craniotomy pain and morphine consumption.
ABSTRACT
Deep hypothermic circulatory arrest may prove advantageous during surgery of some technically difficult brain lesions. This technique was first applied in one patient with a large intracavernous aneurysm which had failed standard neurosurgical techniques. For this technique to be successful the cooperation of neurosurgeons, cardiovascular surgeons, anesthesiologists, perfusionists and nurses is essential. Techniques aimed at improving the outcome include a short period of circulatory arrest, the depth of hypothermia, barbiturate administration, coagulation management and well-controlled blood glucose levels. The total time of circulatory arrest and the thiopentone dosage were 61 minutes and 1,700 mg respectively. The lowest core temperature was 13.9 degrees C. The positive outcome supports the use of this technique in selected patients with complex intracranial vascular lesions who may not be operable by standard techniques.