ABSTRACT
PURPOSE@#After damage control surgery, trauma patients are transferred to intensive care units to restore the physiology. During this period, massive transfusion might be required for ongoing bleeding and coagulopathy. This research aimed to identify predictors of massive blood transfusion in the surgical intensive care units (SICUs).@*METHODS@#This is an analysis of the THAI-SICU study which was a prospective cohort that was done in the 9-university-based SICUs in Thailand. The study included only patients admitted due to trauma mechanisms. Massive transfusion was defined as received ≥10 units of packed red blood cells on the first day of admission. Patient characteristics and physiologic data were analyzed to identify the potential factors. A multivariable regression was then performed to identify the significant model.@*RESULTS@#Three hundred and seventy patients were enrolled. Sixteen patients (5%) received massive transfusion in the SICUs. The factors that significantly predicted massive transfusion were an initial sequential organ failure assessment (SOFA) ≥9 (risk difference (RD) 0.13, 95% confidence interval (CI): 0.03-0.22, p = 0.01); intra-operative blood loss ≥ 4900 mL (RD 0.33, 95% CI: 0.04-0.62, p = 0.02) and intra-operative blood transfusion ≥ 10 units (RD 0.45, 95% CI: 0.06 to 0.84, p = 0.02). The probability to have massive transfusion was 0.976 in patients who had these 3 factors.@*CONCLUSION@#Massive blood transfusion in the SICUs occurred in 5%. An initial SOFA ≥9, intra-operative blood loss ≥4900 mL, and intra-operative blood transfusion ≥10 units were the significant factors to predict massive transfusion in the SICUs.
ABSTRACT
no abstract
ABSTRACT
Background : The KKU coaxial circle circuits, which have been used in Srinagarind hospital since 1994, are simply constructed from available materials in the operating theatre. They are 100-120 cms long, light weight that make them easy and convenient to use. This study call them type II. The other types in this study are different in length, there are 70 and 150 cm long, called type I and type III respectively. In case control study arterial blood gases of 3 types of circuit in all surgical patients. Statistical significance was set at the 0.05 level. The paired t-test was used to determine if there were any differing values adjusting for study effects.Objective : To use either the short or long circuit in appropriate surgery.Design : Experimental study.Setting : The study was done at operating room in Srinagarind Hospital.Subjects : The study was done in 30 surgical patients of Srinagarind Hospital, who have physical status I. The mean age and body weight were 32.97 ± 10.33 yrs and 55.27 ± 7.81 kgs respectively. The circuits were used in patients who were operated under general anesthesia with controlled ventilation.Intervention : N.AMeasurements : Total gas flow, tidal volume and respiratory rate were fixed at 6 lpm (N2O:O2=4:2), 10 ml/kg and 12 bpm respectively. The study was started with type I then changed to type II and type III at interval of 20 minutes. Arterial blood gases were analysed at time 20 minutes after the use of each circuit.Results : The result between type I and type II had no significant difference for pH, pCO2,pO2 and O2 saturation. But for type II and type III, they were significantly different in pO2 (175.190 ± 33.552 and 167.733 ± 35.408) and
ABSTRACT
Background : The Center for Disease Control Infection of Sringarind Hospital recommended using sterile reusable gloves during tracheal suction to reduce the incidence of infection; however, this method is expensive and requires several steps to make the gloves reusable.Objective : To assess the incidence of positive culture from a catheter tip after endotracheal tube suctioning using disposable gloves (aseptic by not touching the end 6 inches of the catheter tip) vs. sterile reusable gloves.Study design : Prospective, randomized, double-blind, controlled trial.Method : We included 1}502 patients undergoing general anesthesia with an endotracheal tube. The patients wetre computer-randomized to two groups : Group 1 was the control performed with sterile gloves; whereas Group 2 was performed with disposable gloves and an aseptic technique. Tracheal suctioning was performed before extubation. The catheter tip was removed (using an aseptic technique) and sent for culturing.Results : There was a significantly (P
ABSTRACT
In PDF file
ABSTRACT
Background: Regional anesthesia is the common anesthetic procedure for patients undergoing lower abdomen and lower extremity surgery. Anesthesia-personnel should be aware of the common complications for patient safety.Objective: To survey anesthesia-personnel’s knowledge of complications from regional anesthesia.Design: Descriptive studySetting: Srinagarind Hospital, Department of Anesthesiology, Faculty of Medicine.Population: 51 anesthesia-personnel : 39 nurse- anesthetists and 12 residents.Methods: Anesthesia-personnel answered the questionnaire (13 items, created by the research team) during a one-hour classroom period. The answer sheets were analyzed for difficulty index (“p”), and the discrimination index (“r”). The data were analyzed using descriptive statistics.Results: Fifty anesthesia-personnel answered the questionnaire: 39 nurse - anesthetists (78.00%) and 11 residents (22.00%). Respondents averaged 36.18 ± 7.23 years of age and 7.70 ± 6.26 years of experience in anesthesia. We found that the anesthesia-personnel had averaged 80.31%(or had a good level of knowledge). Age and years of experience did not correlate with the level of knowledge. Residents scored significantly higher than nurse-anesthetists (88.08 vs. 78.08%, respectively)(p=0.01). Conclusion: The knowledge of complications from regional anesthesia was of a good level among anesthesia-personnel practising at Srinagarind Hospital.
ABSTRACT
In PDF file
ABSTRACT
Objective : To assess the level of satisfaction among all registered nurse(RNs) (excluding anesthetic nurses) with the provision of anesthetic service at Srinagarind Hospital, Khon Kaen University,Thailand.Materials and Medthods : Using purposive sampling, we selected 200 RNs from all wards at Srinagarind Hospital. Questionnaires comprised of three parts: Part 1 - demographic and work place data; Part 2 - level of satisfaction among ward RNs vis-à-vis the provision of anesthetic service with focuses on: a) administration ,b) service , c) knowledge, and d) personnel; and Part 3 -2 open- ended questions. The reliability was 0.92.The data were analyzed by percentage , mean and standard deviation.Results: The satisfaction among RNs from all of the wards vis-à-vis the provision of anesthetic service was high, namely: a) administration 2.72 + 0.50; b) service 3.30 + 0.46; c) knowledge 2.90 + 0.45; and d) personnel 3.22 + 0.46. The open-ended questions indicated that RNs expected better communications and relationship amongst all of the members of the anesthetic team. They felt that the distributing of knowledge about anesthesiology was inadequate and would like to be better informed before serving postoperative patients.Conclusion: Overall RNs-satisfaction with anesthetic service in all wards was high (3.03 + 0.36). RNs valued good communications among the whole team and would like to be informed about each patient’s anesthesiology needs. In so doing, the RNs believed the delivery of anesthetic service would improve.Keywords: anesthetic service; registered nurse; satisfaction
ABSTRACT
Background : Punctuality and responsibility are disirable virtues to incalcate in Thai medical students beginning from the fundamental level for both the students themselves and the families and the society at large.Objective : To make the students realize the basic virtue of punctuality. They practise to possess the qualities of punctuality and responsibility. Both qualities must be fulfilled at the self-entities before they could be applied to the larger scale of family and society.Method : The 5th year students in Anesthesiology rotation block of 3 weeks were divided into 2 groups, the first group was taught the integrated contents, virtues and professional ethics. The method of leaching is by way of active discussions on the content. This is to concentrate the student on student on what they are practicing to learn the technique of handling the model and the patient. The students were taught to meditate after discussion and before the actual practice and evaluation took place. The second group was taught the same technique without a discussion and meditation to serve as control group.Result : The experiment group was impressed and interested in the integrated teching approach. They judged the method as being relevant to the time and situation. Ninety seven point two percent of them were punctually coming to classes. The control group of students was 83.3 percent punctual. The Video record of the practical classes illustrated that the experimental group was gental and careful in handling the models whereas the opposite is true with the control group.Conclusion : It could be said is inferred that the integrated method of teaching is rather successful as expected. We, therefore, suggest the adoption of the method to further develop the learning teaching technique.
ABSTRACT
Background : The content in the comprehensive examination which is the graduation exam for the KKU medical students has to be the minimal essential knowledge. The post-test item analysis will be able to reflect this qualification of the test examination for further development.Objective :To assess the overall reliability—as well as the difficulty index and discrimination power for all the questions—of two MCQ exam papers (150 items/paper) used as comprehensive examinations for 6th-year clinical sciences by medical students at Khon Kaen University, Thailand.Design : Descriptive studySubjects : 300 MCQ items of the comprehensive examination for the 6th-year Khon Kaen Medical studentsResults : Most of the questions were of a ‘moderate’ to an ‘easy’ degree of difficulty, corresponding to the objective of the comprehensive exam, which is to assess the minimal but essential knowledge of medical students before they can graduate. Notwithstanding, the overall reliability of each paper was low compared to the recommended values for summative evaluations (i.e. \>0.7 for a teacher prepared test and 0.9 for a standardized test). Conclusion : This assessment will be used as a guideline by the Comprehensive Examination Committee to improve the quality of future tests. Additionally, since we analysed the achievement of the students in different disciplines, this baseline data can also be used as a feedback for each Department when reviewing the curriculum, setting teaching objectives and improving the learning context.
ABSTRACT
Abstract not available
ABSTRACT
Background: Urinary retention is a common postoperative complication associated with multifactorial risk factors such as types of anesthesia, surgery, analgesics, anticholinergics, and underlying medical conditions.Objective: The goal of this study was to surveillance of the incidence of urinary retention following the single use of spinal and epidural anesthesia in Srinagarind Hospital.Methods: A retrospective study was performed by reviewing the medical records of 1,538 surgical patients undergoing spinal or epidural anesthesia from January 1, 2005 to December 31, 2006. We defined urinary retention as occurring when intermittent urinary catheterization was performed after surgery within 24 hours. We collected variables including age, gender, type of surgery and anesthesia. Descriptive analysis was used to determine the incidence and associated risk factors.Results: The overall incidence of urinary retention after the single use of spinal and epidural anesthesia were 11.2% (95%CI, 9.7-12.9). The study showed a positive correlation between male patients with ascending age. The incidence of urinary retention after spinal anesthesia was 9.9% (95%CI 8.4-11.6). Increasing age (odds-ratio [OR] is 1.7; p-value is 0.002) was found to be the only factors significantly associated with postoperative urinary retention. Gender, type of surgery and choice of anesthesia were not found to be significantly associated with urinary retention.Conclusion: In our patient population, male patients and increasing age are at increased risk of developing urinary retention following single dose spinal or epidural anesthesia. Key words: urinary retention, incidence, spinal and epidural anesthesia,
ABSTRACT
Background: Nowadays surgery is one choice of therapeutic and diagnosis. The impact of surgery may affect behavior of the patients and their family in manyways. They must adjust the perception to acquire an appropriate attitude and/or mind preparation. They consequently can re-plan to lead a normal life after surgery. The anesthesiologists and teams can be aware of the patients perception and behavior in preoperation, intraoperation, and postoperation that they can managed effectively.Objective: The aim of this research was to explore perception of Northeast Thailand patients who undergo surgery Study Design: Qualitative researchTarget population: The patients waited for surgery and the family, and the ones who already had surgery and amounted to 26, 10 men and 16 women.Methods: The participants in the Northeast Thailand, inpatient department of Srinagarind hospital were in-depth interviewed by using semi-structured interview form (SSI) prior to focus group discussion. The data were collected between September 2003 and April 2004. Content analysis and analytical description were presented.Results: This study revealed that their perception about surgical meaning and adjusting the attitude towards the operation are as follows. As to the meaning they though that 1) surgery will help the patients live longer, 2) surgery will cure their illnesses, 3) surgery is a matter of faith in the surgeons to cure the disease, 4) Both general and regional anesthesia are included in surgery, 5) surgery causes fear, 6) surgery is a means to perceive information and experience the pain sensation, and 7) surgery is a last resort of the illness that the patients must accept.Conclusion: The over-all results could be advantageous for the health professional team to realize perception and need of the patients. There are points that could be incorporated in the planning of holistic care to satisfy the patients.Key words: perception of patients, surgery, anesthetic service
ABSTRACT
Abstract not available
ABSTRACT
In the majority of mothers who are delivering the babies; it is able to anticipate and plan to manage the primary obstetric hemorrhage by considering the risk factors before delivery. All of which we can enhance our careful observations of the mother preoperatively. The successful prevention and control of primary hemorrhage after delivery depend on the corporation of multidisciplinary experts. The delivery must be performed by an active management of the third stage of labor. It must be made sure that there is no retained placenta. This is done along with the re-evaluation of the applications of both uterotonic and non-surgical haemostatics. The appropriate management for the primary obstetric hemorrhage by massive blood transfusion and the possible coagulopathy of the mother are complicated matter that is directly dependent upon the clinical decision. Such decision must be made carefully after the examination of each patient. The obstetric anesthesiologists’ part is to be the organizer for different departments concerned beginning from the delivery-room, operating room, blood bank, and laboratories to the supporting personnel.