Differences in perception of online anesthesiology between Thai medical students and teachers during the COVID-19 pandemic / 한국의학교육

Purpose@#Traditional anesthesiology learning was disrupted by the coronavirus disease 2019 pandemic and replaced by online learning. Students and teachers did not prepare well for this change. Determining the differences in perceptions can close the gap and develop more effective curricula. Our study aims to compare students’ and teachers’ perceptions of online anesthesiology learning. @*Methods@#We conducted a prospective descriptive study, a cross-sectional survey between July 2020 and January 2021 in the Anesthesiology Department, Faculty of Medicine, Khon Kaen University, Thailand. Our participants were fifth-year medical students and teachers participating in online anesthesiology. We compared the perception of the teaching process, support system, learning outcomes, satisfaction, and preference. Using an online structured questionnaire survey with a 4-point Likert scale to measure the degree of agreement with each item. We analyzed the difference between students’ and teachers’ perceptions by topic. @*Results@#We received responses from 174 students and 24 teachers. Students had a significantly higher proportion of positive perceptions than teachers on the teaching process (theoretical teaching, problem-based learning, feedback, and response system), on a support system (technological support, connectivity, and learning materials), on learning outcomes (clinical practice readiness, critical thinking, long-term memory, and enthusiasm), satisfaction score, and online learning preference (p<0.05). @*Conclusion@#Differences in perception were high in many aspects of online anesthesiology learning. This perception gap was particularly evident in the teaching process, support system, and learning outcomes. And Thai students had more preference for online learning than teachers. Strategies to reduce the gap should focus on teachers’ training and supporting online learning should be concerned.

Nurse’s Advanced Cardiac Life Support (ACLS) Knowledge in Srinagarind Hospital

Background and Objective: Cardiac arrest is the emergency event and need the effective cardiopulmonary resuscitation. Nurses are required to possess ACLS knowledge and skills. This study aims to determine ACLS knowledge in nurses including factors that influence ACLS knowledge in Srinagarnd hospital.Methods: A prospective, descriptive, study of nurses who worked at Srinagarind Hospital, Khon Kaen University, Thailand, between May to July, 2007. We randomized nurses using stratified random sampling technique by department. The test (25 questions that composed of concept of BLS and ACLS, ECG interpretation, medication, and application) was given to nurses and collected in 20 minutes. We recorded demographic data and factors that may influence the knowledge. Total score and score in each part were recorded. Total score that more than 60% was classified as sufficiency knowledge.Results: We enrolled 116 nurses. Mean (95%CI) of total score was 40.4 (37.1-43.6), concept of BLS and ACLS score was 39.7 (35.5-43.9), ECG interpretation score was 46 (41.4-50.6), medication score was 31 (27.2-34.7), and application score was 49.4 (43.9-54). Sufficiency knowledge was 16.4% (95% CI 10.2-24.4). Frequency of participation in ACLS the previous year, duration since the last ACLS training, and high risk working area influenced ACLS knowledge.Conclusions: The number of nurses who had sufficient knowledge was low. It is recommended that ACLS training program should be appropriated into the routine works of nurses in our hospital in order to increase frequency of ACLS training.Keywords: advanced cardiac life support; knowledge; nurses

Insertion of Preformed flexible endotracheal tubes through the Intubating LMA on a Manikin

Objective:  To assess the success rate of blind tracheal intubation with flexible endotracheal tube through the intubating laryngeal mask airway (ILMA) on a manikin. Design: Descriptive study.Methods:  Thirty unskilled volunteers were assigned to insert a preformed flexible endotracheal tube (SheridanTM) through the inserted ILMA on the manikin which optimal positioning was already confirmed by fiberoptic bronchoscope. The success rate and time of the insertion were recorded, also difficulty of the insertion was graded by both intubator using VAS and by observer using 3- point rating scale as well.Results: Blind tracheal intubation through the ILMA was successful in all intubators. The time for intubation ranged from 7.50 to 13.28 sec. (mean 10.14 + 1.58 sec.) and the intubation was graded as easy either assessed by the observer (grade 1) or by the intubators (mean VAS =2.39+ 1.20).     Conclusion: Blind tracheal intubation through the optimal position of ILMA using a preformed flexible endotracheal tube is easy to perform by unskilled personnel with high success rate. This technique may be useful for patients whose airway management is expected to be difficult. Keywords: 1. Intubating LMA, 2. Techniques, 3. Preformed endotracheal tubes,                  4. Unskilled personnel,  5. Manikin

Evaluation of an ACLS training program for nurse anesthetist aims at role and satisfaction

Background : Anesthesiology patients have a high risk of cardiac arrest and staff must be prepared for CPR.  CPR must be performed quickly and correctly to benefit patients.  Not only do nurses anesthetists need adequate skills and knowledge of CPR but also need an understanding of and satisfaction with their work.   Objective : Compare knowledge with responsibility of CPR before and after an educational campaign among nurses anesthetists.Sample : 27 nurses anesthetists working in OR at Srinagarind Hospital, Khon Kaen.Methods : Descriptive study which assessed nurses anesthetists knowledge and responsibilities before, immediately and three months after training.  Following training nurses were given assigned roles and responsibilities, narrated documents, a video and practical experience before being retested after three months. Results : The study revealed there was a difference in satisfaction levels before and after training.  Satisfaction was divided into six parts. Participation in Hospital Accreditation was a difference in satisfaction levels before and after training. In peer support, personal CPR skills, and practice of CPR, study of practical hindrances and roles and responsibilities, satisfaction over the other five sections did not change over the testing period.Conclusions : Nurses anesthetists must have more information and knowledge about their roles and responsibilities regarding CPR.  Knowledge from the training when coupled with practical experience can last for at least three months.  Keyword : cardiopulmonary resuscitation, role, satisfaction, nurse anesthetist

Surveillance of Drug Error during Anesthesia at Srinagarind Hospital, Khon Kaen University

Objective:  To identify the incidence and causes of drug error during anesthesia .Design: Prospective descriptive studyMethods:  Our research was a part of a multi-center study conducted by the Thai Royal College of Anesthesiologists aimed at surveillance of anesthetic related complications in Thailand in 2003.  We collected the data from all the cases receiving anesthesia service at Srinagarind Hospital between January 1 and December 31, 2003, in order to enumerate drug errors during anesthesia and to determine the cause of the error in order to improve the quality of service.  Drug error was reported by anesthesia personnel and attenuated anesthesiologists.  A drug administration error is defined as, “a mistake in the administration of a drug”.  Errors include:  the incorrect medication, the incorrect route, the incorrect time, drug overdose, wrong patient, omitted medication and medications given but no record of the drug. We had record about patient’s sex, age and ASA physical status, type of operation, place and time of event, type of the mistake and the outcome.Results: Drug error during anesthesia incidence was 12.26:10,000 (based on 10,607 patients).  While the highest rate occurred in the neonatal patient group (newborns to 1 month of age), most drug errors occurred during daytime and among patients with an ASA status of between I and II.  Only minor physiological disturbances occurred in most patients.  The most common causes of errors was the lack of double checking before administration and miscommunication among members of the anesthetic team.Conclusion:  The medication error rate was relatively low and primarily due to inattention. The anesthetic team should take steps to ensure double-checking before administering medications.

Surveillance of and Risk Fztors for Difficult Intubation At Srinagarind Hosipital

Objective:  To identify the incidence of, and risk factors for, difficult intubation during anesthesia at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.Design:  Descriptive, prospective study.Methods:  Our study was part of a multi-center study conducted in 2003 by the Thai Royal College of Anesthesiologists aimed at surveillance of anesthetic-related complications in Thailand.  We collected the data from all of the cases receiving anesthesia service at Srinagarind Hospital between January 1 and December 31, 2003, to document cases of difficult intubation during anesthesia and to determine the cause(s), that the quality of service might be improved.  Patient data, corrective method, contributing factors, factors minimizing incidence and suggested corrective strategies were recorded on the ‘Difficult Intubation Record Form’.Results:  A total of 10 607 patients were included.  The incidence of difficult intubations during anesthesia was 20 (18.86 per 10 000; 95%CI 11.52, 29.11).  Corrective methods included:  stylet use, straight laryngoscope blade and intubation laryngeal mask airway.  Only minor physiological disturbances occurred in most patients.  The common contributing factors were:  insufficient knowledge, inexperience and insufficient equipment.  Suggested corrective strategies could include:  additional training, quality assurance activity, and purchase of equipment.Conclusion:  The incidence of difficult intubation was 18.86 per 10 000.  None of the patients experienced any major complications, perhaps because of standard anesthesia care.  The causes and corrective strategies comprised: patient character, personnel-associated, knowledge and equipment.  Additional equipment and training as well as quality assurance activity would probably help to reduce the incidence of difficult intubation. 

Incidence of Anesthesia-Associated Cardiac Arrest And Related Factors At Srinagarind Hospital

Objective:  To identify the incidence of anesthesia-related cardiac arrest complications and related factors.Design:  Prospective, descriptive study.Methods:  This was part of a multi-center study conducted by the Thai Royal College of Anesthesiologists for surveillance of anesthetic-related complications in Thailand in 2003.  We collected data from all of the cases receiving anesthesia service at Srinagarind Hospital between January 1 and December 31, 2003, to report the incidence of cardiac arrest and analyze the causes in order to improve the quality of service.  Events of cardiac arrest were reported by the attending anesthesia personnel and anesthesiologists.  All the forms were checked and verified by the principal author then included in the study.Results:  10,601 patients were included in this study.  The incidence of cardiac arrest was 47 (44.33 per 10,000 95%CI 32.59, 58.91).  The most common cause was hypotension (53.19%) while contributing factors included emergency situation (29.67%), poor patient preparation (16.48%), lack of experience (15.38%) and inappropriate decision-making (12.09%). The suggested corrective strategies were quality assurance activity and additional training.Conclusion:  The most common cause of cardiac arrest during anesthesia at Srinagarind Hospital was hypotension from massive blood loss.  Preventive and corrective strategies would include quality assurance activities that involve personnel development and the provision of sufficient equipment.

Survey the problems with daily anesthetic machine-checking at Srinagarind Hospital

Objective:  1) To study the process of daily checking the anesthetic machine in the Department of Anesthesiology at Srinagarind Hospital; and 2) to assess what might be interfering with the standard daily checking of the equipment including problems and opinions about guideline.Design:  Descriptive study.Methodology:  The Anesthesiology Department personnel included in the study were anesthetic residents, nurse anesthetists and training anesthetic nurses (working between October and December, 2004.) The questionnaire used asked for:  1) frequency of daily anesthetic machine-checking; 2) problems in checking and the causes of those problems; and, 3) suggestions.  The data were analyzed for percentages.Results:  Most (92.9%) of the personnel in the Department of Anesthesiology were concerned about the daily anesthetic machine checking before anesthetizing patients so most checked the equipment by themselves.  The most common check was the “leakage of circuit test” (85.7%) followed by the “O2, Air, N2O bobbin and APL valve” (83.9%).  The least checked aspect was the “O2 cylinder supply check” (37.5%).  The most common causes for not checking the equipment were: 1) forgetting, 2) busy, 3) thinking it unnecessary, 4) thinking it already done by other staff and 5) insufficient equipmentConclusion:  Personnel in the Anesthesiology Department were concerned about the daily checking of the anesthetic equipment and most checked it by themselves before using it on patients.  Some staff, however, did not check the equipment for a number of untenable reasons. The most common causes were: forgetting, busy, thinking it unnecessary and thinking it already done by other staff. In order to guarantee high quality service by the Department a more systematic approach to daily checking must be implemented.Keywords:   Anesthesia, anesthetic machine; daily checking 

Bacterial Contamination of the Laryngoscope Blades After 4% Hibiscrub and 70% Alcohol Decontamination Under Plastic Bag Covering

Background: Contaminated laryngoscope blades may be the cause of respiratory tract infection in patients intubated under general anesthesia. In a previous study done at Srinagarind Hospital (2002)1, a high incidence of contaminated laryngoscope blades was found. Methods for effective cleaning of laryngoscope blades are needed to improve patient safety.Objective: To determine the incidence of microbial contamination of laryngoscope blades after decontamination with 4% hibiscrub and 70% alcohol with a plastic bag covering.Design: Descriptive studyMethods: We collected curved laryngoscope blades (number 3) after use in the surgery at Srinagarind Hospital between June 2004 and January 2005. All of the blades were sterilized with 4% hibiscrub followed by a wiping with 70% alcohol while covered with a plastic bag. Swabs samples were then taken by wiping a cotton bud along the base to the tip of blade then cultured. The results were recorded as positive or negative findings.Results: Ninety-nine samples from laryngoscope blades were collected. The incidence of positive findings among the sterilized laryngoscope blades after using the chemical method was 2.02 % (95%CI 0.25, 7.11) (2 samples). The organisms were Staphylococcus coagulase negative and Streptococcus spp. Contamination of laryngoscope blades used in the ENT operation room and the Gynecological operation room.Conclusion: Our technique for laryngoscope blade sterilization resulted in a low incidence of contamination (2.02%) . Consideration should be given this approach to sterilization, especially for patients with compromised immunity.Keywords: Contamination, laryngoscope blade, sterilization 

Anesthesiology Improvement using the result of evaluation in Faculty of Medicine, Khon Kaen University

Objective:  To improve the instruction of integrated anesthesiology to medical and dentistry students using the evaluations of both students and lecturers as a basis for changes.Design:  Descriptive studyMethods:  We included 161 and 87 fifth-year medical and dentistry students (academic year 2003-2004), respectively.  We collected evaluation forms before and after improvement.  The data evaluated comprised lectures, skills-teaching, practice teaching, and discussions by students and lecturers.  The scoring range was:  1 (very poor), 2 (poor), 3 (good) and 4 (excellent).  We also evaluated MCQ, MEQ, OSCE, and anesthesia reporting using reliability testing, and difficulty and discrimination indices.Results:  The before and after improvement testing of 13 lecture topics, 3 skills-teachings and practice teaching were not significantly different (i.e. 3.81-3.91 and 3.80-3.91, 3.89-3.94 and 3.88-3.95, 3.94-4.00 and 3.90-3.98, respectively).  The OSCE and anesthesia reporting checklist had poor reliability because of ambiguity in some of the checklist items and standardization.  Ultimately, the dentistry student's evaluation had a higher post-improvement score.Conclusion:  Both before and after improvement, both students and lecturers had a high level of satisfaction vis-?-vis the integrated anesthesiology course.  We had chance to an improvement in the OSCE checklist, anesthesia reporting, and the instruction of this subject to dentistry students.

Unexpected Cardiac Arrest and Anesthesia

Abstract not available

A Study of Retained Endotracheal Tube After Neurosurgical Anesthesia : Incidence and Associated Factors

Background and objectives: Anesthesia technique for neurosurgery always requires rapid recovery post operative. However, some patients have a delay recovery from anesthesia after the operation which requires retained endotracheal tube. Aim of this study is the retained endotracheal tube incidence after neurosurgical anesthesia and the associated factors.Methods: The authors studied the records (anesthetic records, in-patient records, and investigation data) of patients who received anesthesia for neurosurgery at Srinagarind Hospital, Khon Kaen, Thailand during April to December 2004. The authors looked out for the incidence of retained endotracheal tube after neurosurgical anesthesia (we could not remove endotracheal tube in operation room or post anesthetic care unit) and looked for the associated factors (i.e. surgical associated factors, anesthetic associated factors, and patient associated factors).Results: The authors gathered the information of 325 patients who received anesthesia for neurosurgery. The incidence of the retained endotracheal tube after neurosurgery was 57.8% (95% CI 52.3, 63.3). The incidence was more common in patients who obtained ASA physical status \> 2, who had an emergency surgery, the operation time \> 2 hrs, tumor removal operations, undergone aneurysm surgery, multiple blood transfusion, and their body temperature \< 35oC. Conclusion: This study found the high incidence of the retained endotracheal tube after neurosurgical anesthesia (57.8%). Some conditions could be prevented to reduce the incidence. We could improve postoperative care by controlling preventable causes and appropriate post operation care management for unpreventable cause.Key words: anesthesia, extubation, neurosurgical anesthesia, postoperative period, retained endotracheal tube

Advanced Cardiac Life Support Knowledge among Medical Staff and Residents in University Hospital

Background and Objective: Advanced cardiac life support (ACLS) is an important knowledge among physicians to deal with cardiac arrest. Medical staff and residents who practice in high risk areas are required to possess ACLS knowledge and skills. To determine knowledge about ACLS in physicians including factors that influence ACLS knowledge in university hospital.Methods: A descriptive of study of medical staff and residents who have been working at Srinagarind Hospital, Khon Kaen University, Thailand, between May-July, 2008 was performed by stratified random sampling from the participated 12 clinical department. The test questions were modified from Advanced Cardiovascular life support guideline (American Heart Association). The total score more than 80% was classified as being with sufficient knowledge whereas below 80% was lacking sufficient knowledge.Results: Seventy physicians were enrolled to take the test. Up to 15.7% (95% CI 8.1-26.4) of those participants have scored over 80%. Mean±SD of percent of the total score, concepts of BLS and ACLS score, ECG interpretation score, medication score, and application score were 58.4±21.5, 55.9±26.5, 73.4±26.0, 51.0±23.5, and 57.5±30.3, respectively. The statistical analysis suggests that physicians with higher frequency of ACLS practice and training had more knowledge on the issue than those with lower frequency of ACLS practice and training (p\< 0.05).Conclusions: The number of physicians who had sufficient knowledge was low. Factors that influence the ACLS knowledge appeared to be the frequency of ACLS practice and training. From the data gathered, the others recommend that ACLS training program should be incorporated into the routine works of physicians in our hospital in order to increase frequency of ACLS training.Key words: advanced cardiac life support; knowledge; physicians; university hospitals

Volatile Induction and Maintenance Anesthesia; VIMA

Volatile induction and maintenance anesthesia technique is simple, safe, and cost effectiveness. However, inhalation anesthetics pharmacologic knowledge, appropriate patient selection, and equipment preparation play role of successful. High concentration and low concentration inhalation induction are two accepted induction techniques with low complication. Peri and post anesthetic care also influence the successful.