ABSTRACT
Background: Acute pain is a common postoperative problem, especially among pediatric patients (between 1 and 6 years of age). Since children cannot report their pain to health care providers, pain needs to be promptly assessed as untreated pain may lead to sustained changes in the central neural system. Behaviour is also a useful measure and indicator of pain in children. In the Post Anesthetic Care Unit (PACU) at Srinagarind Hospital, the Face, Legs, Activities, Cry, Consolability (FLACC) scale is used for pain assessment.Objectives: To determine the proportion of pediatric patients who have undergone the FLACC pain assessment scale in the PACU and the correlation between FLACC scale and treatment.Design: Retrospective descriptive studySetting: PACU, Department of Anesthesiology, Srinagarind Hospital, Khon Kaen UniversityMaterials \& method: 180 pediatric (under 6 years of age) patients’ records in the PACU were reviewed since June 2005. Outcome measurements including sex, age, ASA status, type of operation and procedure, type of pain assessment, number of FLACC scale (0-10) used for pain assessment, causes of non-assessment and number of assessment were recorded. The results were analyzed using descriptive statistics and presented as means and percentages.Results: Among the 180 pediatric patients, 65% were male and 34% were in middle childhood. 67% of pediatric patients in the PACU were assessed by FLACC pain scale. Almost all nurses (98%) used FLACC scale to assess pain in their pediatric patients. It was found that patients’ sleep (46%) at the time of admission to the PACU was the common cause of non-assessment. In term of pain treatment, 61% of the patients were assessed for their pain before treatment, however 21% of the patients having pain (FLACC\>2) did not receive any pain treatment. The most common cause (89%) of non-assessment was due to patients’ crying. The mean of FLACC scale before and after treatment were 3.64 + 6.25 and 3.27 + 8.26, respectively.Conclusion: The pediatric pain assessment was used in the PACU more frequently than previously surveyed; however the use rate was not 100% (as expected) and some of patients having pain (FLACC\>2) did not receive any treatment. As a result, education and personnel support might be useful in order to improve the quality of pain assessment and treatment in the PACU.Key words : Pediatric pain assessment, FLACC scale, PACU
ABSTRACT
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
ABSTRACT
Background: Currently, post-operative pain management is considered an integral part of recovering and reducing complications related to pain. Acute pain service (APS) has been established worldwide in order to improve the effectiveness of patient care. The Departments of Anesthesia at Khon Kaen and Chiang Mai Universities (KKU and CMU, respectively) developed an APS system each at approximately the same time. Collaboration of the two institutions to benchmark their APS data will help them move forward vis-à-vis post-operative pain management.Objectives: Comparing the results of the respective APS systems between Khon Kaen and Chiang Mai Universities.Design: Retrospective, descriptive studyMethods: The 2005 calendar year data, from the respective APS databases, were reviewed, allowing a comparison of post-operative pain management at KKU and CMU hospitals. We focused on the percentage of post-operative orthopedic patients care through the APS system compared with (1) APS service, (2) days of service, (3) method of pain management, (4) pain assessment, (5) complications, (6) the APS system and (7) patient satisfaction. The data were analyzed using descriptive statistics.Results: Patients who received APS accounted for 12.3 and 7.2 percent of KKU and CMU patients, respectively. The greatest proportion of patients at KKU receiving APS was for intra-abdominal surgery (60%) while at CMU it was for cardiovascular and thoracic surgery (76%). Both institutions provided an average 2.0+1.0 days of service. Surgery on extremities (orthopedics) ranked second at both institutions (26.8 and 20.7 percent, respectively). KKU used variety techniques for controlling pain among orthopedic patients: viz., IV PCA (59%), IV opioid infusion (30%), epidural (6.8%) and spinal morphine with PCA (5.2%), while the primary modality for pain control at CMU was IV PCA (97%). Resting pain for CMU patients was less than that reported by KKU patients (6 vs. 9.5 percent, respectively); however, dynamic pain was not assessed at CMU. Serious complication was not found and patient rated satisfy with APS approximately 94% and 97% (CMU, KKU).Conclusion: The delivery of APS for orthopedic surgery patients at two regional university hospitals in Thailand were studied and benchmarked. There was some difference in the strengths of the APS system between the two institutions; such as, techniques of pain treatment, pain scores and system for pain management. Strengths and weaknesses observed during this benchmarking exercise will be used to improve the delivery of APS at both institutions.Keywords: Acute Pain Service; Benchmark; Post-Operative Pain; University Hospital