Survey of Factors that Influence Doctors’ Selection of Anaesthesiology as Professional Specialty and Opinion Regarding Being Anaesthesiologists.

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.

Comparative study of effective-site target controlled infusion with standard bolus induction of propofol for laryngeal mask airway insertion

Background: The laryngeal mask airway (LMA) is widely used in emergency medicine and surgical anesthesia. Several studies demonstrated induction of anesthesia with different plasma target-controlled infusion (TCI) of propofol for LMA insertion. However, there has been no study to compare the standard bolus propofol induction with the effective site TCI for LMA insertion. Objective: Compare the efficacy of induction of anesthesia with propofol for LMA insertion between the effective-site TCI, using 6 μg/mL, and the standard bolus propofol dose of 2.5 mg/kg in elective surgical patients. Methods: A randomized, prospective, single-blinded, clinical study was used for this study. Seventy-eight unpremedicated patients, American Society of Anesthesiologists (ASA) physical status I and II undergoing elective surgical procedure were randomly allocated between two groups. Group 1 received the standard bolus propofol dose of 2.5 mg/kg. Group 2 received effective site TCI (Schnider model) dose of 6 μg/mL for LMA insertion. The hemodynamics and anesthetic depth (Bispectral index score) were monitored and recorded during and immediately after LMA insertion. The number of insertion attempted, insertion quality score, induction time, and propofol doses used were recorded and compared between groups. Results: The success rate of first insertion attempt was equal in both groups (92.3%). There was no significant hemodynamic response difference between the groups during pre-induction, induction, insertion, and post insertion period. The BIS score was significantly lower during post insertion period in group 1 (51.4+11.0) than group 2 (58.4+3.2) (p=0.013). The propofol doses in group 2 were significantly lower than in group 1 (110.6+14.8 vs. 153.5+21.5) (p <0.001). Patients in group 2 required significantly more induction time than group 1 (146.9+42.3 vs. 103.4+33.6 (p <0.001). Conclusion: Propofol induction with TCI provided equal success rate as compared with standard bolus propofol induction for LMA insertion and insertion quality score. TCI significantly lowered the propofol consumption when compared with the standard 2.5 mg/kg propofol dose.

Hypotension in spinal anesthesia for cesarean section: a comparison of 0.5% hyperbaric bupivacaine and 5% hyperbaric lidocaine.

Hypotension is a common side effect associated with spinal anesthesia. However, there is no previous report comparing the incidence of hypotension between two commonly used local anesthetic agents, bupivacaine and lidocaine. The objective of this study was to compare the incidence of spinal hypotension induced by bupivacaine and lidocaine in parturients undergoing cesarean section. A double blind, randomized controlled trial was conducted in 142 parturients scheduled for cesarean section. The patients were randomized into two groups, 71 each. After receiving 10 ml/kg of normal saline intravenously, patients in the first group were given 2.2 ml of 0.5 per cent hyperbaric bupivacaine plus 0.2 mg of morphine as a spinal anesthetic agent while in the other group, 1.2 ml of 5 per cent hyperbaric lidocaine plus 0.1 mg of epinephrine and 0.2 mg of morphine were administered. Hypotension, defined as 30 per cent less systolic blood pressure than baseline value, was recorded and the patients were treated with 6 mg of ephedrine every 2 minutes until normotension was achieved. There was no statistically significant difference of incidence, onset, duration, and severity of hypotension between the two groups (p > 0.05). The amount of ephedrine used in both groups was also not significantly different. Late onset hypotension occurred after delivery (20-22 minutes after spinal anesthesia was performed) in 17 patients (12%). As such, the rate of hypotension in lidocaine group was comparable to bupivacaine group. Delayed onset hypotension occurring after delivery was noted and these events have never been described. However, the mechanism of late onset hypotension remains unidentified. Thus, bupivacaine and lidocaine can be used interchangeably for spinal anesthesia for elective cesarean section without significant difference in the incidence of hypotension.

Learning manual skills in spinal anesthesia and orotracheal intubation: is there any recommended number of cases for anesthesia residency training program?

Wide variability exists in the number of anesthetic procedures to which anesthesia residents are exposed during their training. The number of attempts at various procedures before a trainee becomes proficient at performing each anesthetic procedure is not known. To determine the learning process of 150 attempts of spinal anesthesia and 100 attempts of orotracheal intubation, the two most frequent anesthetic procedures, we evaluated 9 first-year anesthesia residents according to their rate of success or failure. The learning curves of both procedures revealed an initial rapid improvement of success during the first 20 attempts. Spinal anesthesia was more difficult to learn (p=0.0002) but the learning curves of spinal anesthesia and orotracheal intubation reached a nondifferent high success rate of 82 per cent and 88.9 per cent respectively (p=0.13). According to this study the institutional recommended number of cases for spinal anesthesia and orotracheal intubation were 112 and 27 cases respectively.

Effect of national seminar on AIDS and anesthesia upon knowledge, attitude and practice concerning HIV among Thai anesthesia personnel.

In the national seminar of AIDS and Anesthesia which was a short course educational program in all aspects of HIV medicine, 195 questionnaires about knowledge, attitude and practice concerning HIV were distributed among the participants (anesthesiologists and nurse anesthetists) in 3 periods, pretest, post test (at the end of 2 days seminar) and post test 2 (at 4 months after the seminar). There were 177 (90.76%) respondents who completed both pretest and post test 1 questionnaires. About 12 questions of knowledge; mean scores were statistically significantly increased; 7.95 (0.98) vs 9.5 (0.78), P < 0.001. Two thirds (8 out of 12 questions) were answered correctly in post test 1 more than in the pretest by Mc Nemar Chi-square test; P < 0.05. About attitude; 2 out of 5 answers changed significantly by Mc Nemar Chi-square test; P < 0.05. The post test 2 questionnaires were mailed to all 177 participants twice asking to reply only once. All questionnaires were to be completed anonymously. The post test 2 with a response rate of 65.5 per cent revealed that universal precautions were frequently used among Thai anesthesia personnel but not universally followed. At least one-third of the respondents admitted recapping before disposal of used needles. Fifty six per cent of respondents (vs 22.8% in pretest) admitted re-using one syringe for more than one patient. In conclusion, this study showed that a short course educational program may improve knowledge about HIV and partly change attitude, but can not change behaviour. Changing the practice of anesthesia health care workers needs continual education and appropriate training.

Cardiovascular and respiratory changes in laparoscopic cholecystectomy.

Although laparoscopic cholecystectomy has several advantages over the traditional open cholecystectomy, it may however cause some adverse cardiovascular and respiratory effects associated with intraperitoneal insufflation of CO2. It is, therefore, recommended that appropriate hemodynamic and respiratory monitorings should be used routinely in order to prevent deleterious complications, especially in high risk patients.