ABSTRACT
Objective: To identify the incidence of anesthesia-related cardiac arrest complications and related factors.Design: Prospective, descriptive study.Methods: This was part of a multi-center study conducted by the Thai Royal College of Anesthesiologists for surveillance of anesthetic-related complications in Thailand in 2003. We collected data from all of the cases receiving anesthesia service at Srinagarind Hospital between January 1 and December 31, 2003, to report the incidence of cardiac arrest and analyze the causes in order to improve the quality of service. Events of cardiac arrest were reported by the attending anesthesia personnel and anesthesiologists. All the forms were checked and verified by the principal author then included in the study.Results: 10,601 patients were included in this study. The incidence of cardiac arrest was 47 (44.33 per 10,000 95%CI 32.59, 58.91). The most common cause was hypotension (53.19%) while contributing factors included emergency situation (29.67%), poor patient preparation (16.48%), lack of experience (15.38%) and inappropriate decision-making (12.09%). The suggested corrective strategies were quality assurance activity and additional training.Conclusion: The most common cause of cardiac arrest during anesthesia at Srinagarind Hospital was hypotension from massive blood loss. Preventive and corrective strategies would include quality assurance activities that involve personnel development and the provision of sufficient equipment.
ABSTRACT
Background: Recently, the proportion of elderly persons is rising worldwide leading to increase amount of surgical patients of this age group. The evidences about pain control clearly supported that elderly persons received under-treatment. Whatever, data from our institute is limited and needs to be determined.Objective: To survey postoperative pain management and its outcomes in elderly patients at Srinagarind Hospital. Study design: Cross-sectional descriptive study.Setting: Post anesthesia care unit (PACU) and surgical wards, Srinagarind Hospital.Materials and Methods: Pain management and its outcomes were evaluated in patients over 65 years old underwent elective general surgery for a two months period. Data were collected from medical records and from patient assessment including method of pain treatment, pain intensity (at rest), pain relief, patient’s satisfaction and side effects of the treatment.Results: Ninety-one patients with the mean age of 72.0 + 5.7 years were evaluated. Most of them (72.5%) received general anesthesia and 56.1% underwent intra-abdominal surgery. Intravenous injection was the most common technique used for pain control (63.8%) while PCA pump was used about 20.9%. Pain assessment usingNRS was achieved in between 62-95.6% (average 75.5%). The proportion of patients experienced moderate to severe pain during arrival at the PACU, at discharged from the PACU and at 24 hours after operation were 29.4%, 23.1% and 18.8%, respectively. The most common side effect was nausea and vomiting (12.2%). Only 8.9% of patients reported that pain was not relief and 1.1% of patients unsatisfied with the treatment received. Conclusion: About 29.4% of the elderly patients experienced moderate to severe pain after surgery. Most of them received pain treatment by intravenous injection while only 20.9% received acute pain service from the acute pain unit of Anesthesiology department.Keyword: older patients, postoperative pain management