Routine preoperative chest roentgenogram and its impact on intraoperative complications.

Routine preoperative chest X-rays and operative complications were studied in the patients at Songklanagarind Hospital from January 1990 to December 1991. Preoperative chest X-rays was performed in 9583 patients (87.5%). Only patients over 15 years old are included in our studies. Patients undergoing Caesarean section, cardiothoracic surgery and emergency patients were excluded. The studied population were 6347. Chest X-rays abnormalities were found in 9.8 percent of the investigated patients (625 from 6347). The percentage of patients with chest X-rays abnormalities increase 4 folds in patients in those with age group greater than 45 years when compared to the other young groups. The prevalence of tuberculosis in our patients was 1.2 per cent (76 over 6347). Age could be one of the important factors associated with the risk of intraoperative respiratory and cardiovascular complications. Chest X-rays abnormalities did not associated with respiratory complication. The risk of intraoperative cardiovascular complications (arrhythmia, hypertension and/or hypotension) increased in group with chest film abnormalities and age over 45 years. Chest X-rays investigation is not necessary for routine preoperative investigations in patients under 45 years except those with previous history of heart and lung diseases or clinical indications.

Comparison of morphine slow release tablet (MST) and morphine sulphate solution (MSS) in the treatment of cancer pain.

A cross-over, single blind trial of MST and MSS in relieving pain of advanced cancer patients is described. Forty-nine cases completed the study. Both MST and MSS gave equally excellent pain relief in the patients as judged by the pain score of VAS and pain rating scale by a nurse, and the duration of sleep. The daily effective dose was 55.5 +/- 19.7 mg for MST and 61.0 +/- 11.0 mg of MSS.

Comparison among 3 techniques of spinal and epidural anesthesia for caesarean section.

When comparing spinal block and epidural block groups, spinal block is simpler, easier and more reliable and it is useful for urgent Caesarean sections because of its rapid onset. In the spinal group, 0.4 per cent heavy bupivacaine is more reliable than 0.5 per cent plain bupivacaine. Spinal lidocaine can also be used for Caesarean section requiring an operation time of not more than 1 hour. If the operation time is expected to be more than an hour, spinal block with 0.4 per cent heavy is preferred. In epidural block with 2 per cent lidocaine (20 ml) time to get to T4 was more than 20 minutes after block and failure rate was higher. It should then be used in elective cases and by an experienced anesthesiologist.