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Background and Objective: During anesthesia and the post-operative period, standard equipment and monitoring are essential. Srinagarind hospital has over one thousand items of equipment for its 20 operating rooms and 2 post-anesthesia care units (PACU). Based on a survey between October 2007 and September 2008, it was discovered that 18 items of anesthetic equipment went missing, worth between 30,000 and 40,000 Baht. The objectives of this study were to identify the factors related to equipment loss and to find strategies to prevent or mitigate losses.Methods : We conducted qualitation research, using basic data regarding equipment losses derived from a problem-solving fishbone diagram that emerged during a departmental seminar in November 2008. Our responsive study ran between March and August 2009. The department provided the anesthetic equipment in all of the operating rooms and PACUs with checklist logs. When equipment went missing, researchers invited related personnel to discuss the loss and to find strategies for prevention (Focus group discussion). The summary of the data collected and response protocols were later presented at a departmental conference.Results : The focus group discussions during study period involved 150 personnel, comprising anesthesia personnel (60/150, 40%), operating room personnel (30/150, 20%), intensive care personnel (20/150, 13.3%) and laundry personnel (40/150, 26.7%). The study revealed that the intradepartmental factors related to equipment loss were personnel, work pattern, management, time of work, the involved equipment and the budget. But extradepartmental factors had specific differences depend on personnel groups. The process resulted in four intradepartmental preventive guidelines and some activities within and outside the department.Conclusions : The factors related to anesthetic equipment loss involved both within and outside the department. Preventive guidelines have been established, including some activities both within and outside the department.Keywords : Anesthetic Equipment Loss
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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
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Background: Urinary retention is a common postoperative complication associated with multifactorial risk factors such as types of anesthesia, surgery, analgesics, anticholinergics, and underlying medical conditions.Objective: The goal of this study was to surveillance of the incidence of urinary retention following the single use of spinal and epidural anesthesia in Srinagarind Hospital.Methods: A retrospective study was performed by reviewing the medical records of 1,538 surgical patients undergoing spinal or epidural anesthesia from January 1, 2005 to December 31, 2006. We defined urinary retention as occurring when intermittent urinary catheterization was performed after surgery within 24 hours. We collected variables including age, gender, type of surgery and anesthesia. Descriptive analysis was used to determine the incidence and associated risk factors.Results: The overall incidence of urinary retention after the single use of spinal and epidural anesthesia were 11.2% (95%CI, 9.7-12.9). The study showed a positive correlation between male patients with ascending age. The incidence of urinary retention after spinal anesthesia was 9.9% (95%CI 8.4-11.6). Increasing age (odds-ratio [OR] is 1.7; p-value is 0.002) was found to be the only factors significantly associated with postoperative urinary retention. Gender, type of surgery and choice of anesthesia were not found to be significantly associated with urinary retention.Conclusion: In our patient population, male patients and increasing age are at increased risk of developing urinary retention following single dose spinal or epidural anesthesia. Key words: urinary retention, incidence, spinal and epidural anesthesia,
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Background: Nowadays surgery is one choice of therapeutic and diagnosis. The impact of surgery may affect behavior of the patients and their family in manyways. They must adjust the perception to acquire an appropriate attitude and/or mind preparation. They consequently can re-plan to lead a normal life after surgery. The anesthesiologists and teams can be aware of the patients perception and behavior in preoperation, intraoperation, and postoperation that they can managed effectively.Objective: The aim of this research was to explore perception of Northeast Thailand patients who undergo surgery Study Design: Qualitative researchTarget population: The patients waited for surgery and the family, and the ones who already had surgery and amounted to 26, 10 men and 16 women.Methods: The participants in the Northeast Thailand, inpatient department of Srinagarind hospital were in-depth interviewed by using semi-structured interview form (SSI) prior to focus group discussion. The data were collected between September 2003 and April 2004. Content analysis and analytical description were presented.Results: This study revealed that their perception about surgical meaning and adjusting the attitude towards the operation are as follows. As to the meaning they though that 1) surgery will help the patients live longer, 2) surgery will cure their illnesses, 3) surgery is a matter of faith in the surgeons to cure the disease, 4) Both general and regional anesthesia are included in surgery, 5) surgery causes fear, 6) surgery is a means to perceive information and experience the pain sensation, and 7) surgery is a last resort of the illness that the patients must accept.Conclusion: The over-all results could be advantageous for the health professional team to realize perception and need of the patients. There are points that could be incorporated in the planning of holistic care to satisfy the patients.Key words: perception of patients, surgery, anesthetic service
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Introduction: Doing research about routine patient care, so-called Routine to Research or R2R, can increase both the quantity of articles and quality of care. Objective: To determine the number of R2R-related articles by anesthesia providers at the Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, and their utilization.Study Design: descriptive studyMethods: Questionnaires to the corresponding authors of papers published between 2002 and 2005. We excluded case reports from the study and focused on basic data of researchers, number of articles that received funding, the number of R2R-related articles and their utilization. The data were analyzed and presented using descriptive statistics.Results: All 40 questionnaires were returned, representing 22 anesthesiologists’ articles (55%) and 18 nurse anesthetists’ articles (45%). Eighteen articles (45%) received funding. Thirty-six articles (90%) were classified as R2R-related articles: 12% have already been applied to routine patient care; 6 had potential for application provided they received suitable encouragement; 10% had less potential for application; and, 8% were non-applicable because of an unavailability of medications or equipment.Conclusion: Based on articles published by anesthesia providers at the Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, between 2002 and 2005, R2R-related articles comprised 90%, but only one-third have been applied to routine patient care while another 16.7% (or 15% of all articles) have potential for applications were they to receive suitable encouragement.
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Background and Objective: During general anesthesia, inhaled anesthetic delivery system problems may contribute to anesthetic morbidity and mortality. The magnitude and pattern of these problems had not been established at Srinagarind Hospital. The objectives of this study are to identify the incidence and severity of common problems of inhaled anesthetic delivery system and find strategies for prevention.Methods: Prospective, descriptive study at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. All patients received general anesthesia in the year 2005. Details of anesthetic management in all patients were recorded on the anesthetic charts on a routine basis. When inhaled anesthetic delivery system problems had occurred, the anesthesia provider responsible for the cases wrote a short description of the event on the anesthetic charts and reported to the authors to record more details in the incidence form for further analysis about the incidence and severity.Results: There were 8,904 consecutive general anesthetic patients in 2005. Sixteen inhaled anesthetic delivery system problems were recorded (0.18 %). One-third of problems involved the anesthetic ventilators. Human error was a contributing factor in a half of the cases. No patient suffered any lasting morbidity. Conclusions: The incidence of inhaled anesthetic delivery system problems was very low and not severe during the study period. This was probably due to the improvement in routines for preoperative equipment checks, regular equipment calibration and good monitoring system in our hospital. However, there is still a potential for serious problems and strategies to prevent human error should be implemented. In addition, an improved check between cases should be encouraged to reduce the occurrence of the problems. Keywords: anesthesia, complications, inhaled anesthetic delivery system