ABSTRACT
Objective: To survey the times to critical actions (defibrillator and doctor presence, initiation of chest compression) of in-hospital simulated cardiopulmonary resuscitation (CPR). Methods: A 1-year retrospective simulated audit 2009 in a 2,400-bed university hospital in Thailand. Results: A total of 57 adult wards (around a third of all wards in the hospital), including intensive care units, critical wards, procedural units, general wards and out-patient units were audited. Overall, the median time of initiation of chest compression and defibrillator presence among CPR teams were 1.27 (0.35-7.19) and 1.16 (0.00-26.00) minutes, respectively. The median time of the first doctor presence was 3.45 (0.00-15.15) minutes. However, there were significant differences in time to defibrillator and doctor presence among wards. The longer time of these critical managements were recorded in non-monitored areas (general wards and out-patient units) (p = 0.004 and 0.007, respectively). Conclusion: In our CPR simulated survey, delayed initiation of critical managements commonly occurred in non-monitored areas. Better management should be concerned for favorable outcomes.
ABSTRACT
OBJECTIVE: To determine the occurrence and associated factors of awareness in the patients undergoing elective surgery under general anesthesia. METHODS: A prospective cohort study of 802 patients, scheduled for elective general and gynecological surgery under endotracheal anesthesia was performed at Siriraj Hospital. Balanced general endotracheal anesthesia was performed as routine practice. Standard monitoring and clinical observation for movement, tear, sweat, and eye-lid opening were obtained. They were interviewed during the first 12 hours after a surgical completion. If the patient was suspected to have awareness, then a second interview was performed on postoperative day 3. RESULTS: The ages of the study population were 16-84 years. There were 659 females and 143 males. Awareness was found in 5 patients (3 females, 2 males) as an occurrence of 0.62 per cent. The only positive clinical observation found was hand movement. The cause of awareness should be inadequate anesthesia. Apart from that, data gathered from interviews with the group who had no awareness (797 patients), the last thing they could remember before unconsciousness was auditory perception. Also hearing someone calling was the first thing upon awakening. Most of the patients did not dream during anesthesia. No serious psychological disorder occurred. CONCLUSION: The occurrence of awareness was 0.62 per cent in the patients undergoing surgery under anesthesia. Inadequate anesthesia was the most likely cause of awareness. No postoperative sequelae of awareness occurred.