Comparison of coaxial circle circuit with carbon dioxide absorber and coaxial D circuit without carbon dioxide absorber in general anesthesia.

 This  clinical  study  is  to  compare  the  use  of  coaxial  circle  circuit  with  CO2  absorber  and  coaxial  D  circuit  without   CO2  absorber  in  20  patients  of  physical  status  ASA  class  I  and  II. The  mean  age,  body  weight,  and  hemoglobin  concentration  are  40 ± 9.94  years  old,  56.77 ± 7.33 kgs.,  11.76 ± 1.22  gms/dl  respectively.  Fresh  gas  flow  (FGF)  and  arterial  blood  gas  was  taken  after  stabilizing  period  of  15 – 30 minutes.  Coxial  D  circuit  without  CO2 absorber  was  used  secondly  and  arterial  blood  gas  was  taken  in  the  same  manner.  The  pH,  PaCO2,  PaO2  values  were  compared  by  paired  T-test  statistical   analysis.  It  is  concluded  that  at  6  lpm.  Of  FGF  and  minute  ventilation,  there  is  statistically  significant  difference  (P

Patient satisfaction with postoperative pain management at recovery room in Srinagarind Hospital

Background: The assessment of patient satisfaction is one of the most significant indicators for the improvement of anesthetic service, especially postoperative pain relieving service. We fully realized its importance. In order to improve its performance and health service, this survey on patient satisfaction has been conducted. Objective: To study patient satisfaction with postoperative pain management and also other additional outcomes relating to patient’s pain in recovery room.Design: Both prospective and descriptive studies Setting: Surgical ward at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University.Materials \& methods: A total of 200 patients have been self-administered questionnaire and interviewed in the survey within 24 hrs after surgery in surgical ward at Srinagarind Hospital. The level of patient satisfaction (5 scales) was assessed. Other pain related outcomes such as pain scores (NRS; 0-10) and pain relief were also assessed.Results: The level of patient satisfaction with pain management was rated as fair and satisfied about 36% and 35% respectively. Forty–six percent of the patients reported pain after surgery. Among these patients, moderate and severe pain were reported as 36.96% and 29.35% respectively. Regarding the level of pain relief after treatment, we found that 52.94% had moderate pain relief and 23.53% had mild pain relief. Conclusion: The satisfaction level in terms of pain management was rated as fair and satisfied in 71% of the patients; however it was quite difficult to survey on patient satisfaction at recovery room. As some residual effects from anesthesia and patients impaired memory in recovery room, we found it very difficult to get the exact results. After this study, we found a number of possible ways to improve our pain service. Key words: Satisfaction, postoperative pain management, recovery room

A Development of Pain Assessment and Pain Documentation as a Fifth Vital Sign in a University Hospital

Background: Pain assessment and documentation can be used as vital sign for the improvement of postoperative pain management; however, these systems have never been adopted for use at Srinagarind Hospital.Objectives:1.     To develop a systematic postoperative pain assessment and documentation as the fifth vital sign; and,2.     To implement a revised graphic sheet for pain documentation at Srinagarind Hospital.Design:  Descriptive studySetting:  Srinagarind Hospital, Faculty of Medicine, Khon Kaen UniversityMethods:  Researchers explored the ward nurses’ attitudes and practices vis-à-vis the pain assessment and documentation in a pilot ward.  Subsequently, systematic pain assessment and documentation using the old graphic sheet, originally developed for recording four other vital signs, were re-designed to include the new sign, tested and revised for its practicality.  The revised graphic sheet was re-tested in two other wards and finally the system was implemented throughout the hospital.Measurement:  Pain assessment tools, frequency of pain documentation and the number of patients assessed before and after the study were recorded.  The ward nurses were asked to give their comments on the practicality of the new system for pain assessment and documentation.Results:  In the pilot ward, misunderstanding regarding the pain assessment tools was found among some ward nurses. The frequency of pain assessment and documentation significantly increased after using the revised graphic sheet (43.2% vs. 57.3%, p=0.039).  The prevalence of no pain assessment also decreased significantly (12.1 vs. 2.2%, p=0.008).  Most of the nurses (87.5%) could complete the pain record form within one minute.  The new system, as reported by 62.5% of the ward nurses, nominally increased their workload.  Re-testing this system in the other two wards increased the number of pain assessments and documentations on the first post-operative day from 67% to 98 %.  The revised graphic sheet was then accepted by the policy makers for use throughout the hospital.Conclusion:  The system of post-operative pain assessment as the fifth vital sign was developed.  A revised graphic sheet was used for pain documentation and accepted for routine use.  The new system increased the number of pain assessments and documentations of post-operative patients.