Multicentered study of model of difficult endotracheal intubation by incident reports from university and non-university hospitals.

OBJECTIVE: To compare the characteristics, causative factors, outcomes, prevention, and suggested preventive strategies of difficult intubation between university (U) and general community (non-U) hospitals. MATERIAL AND METHOD: One thousand nine hundred and ninety-six reports were reviewed from Thai anesthesia incident monitoring study (Thai AIMS) conducted in 51 hospitals nationwide between January and June 2007. Thirty-four cases ofDI were reported from U hospitals and 69 cases from non-U hospitals. The described details on each report on dfficult intubation (DI) in adults undergoing general anesthesia were thoroughly reviewed by three reviewers to give their consensus opinions on causative factors, outcomes, contributing preventive factors, and strategies for corrections. Descriptive statistics were used for data analysis. RESULTS: Patient factors were the most common cause of DI (88% in U and 87% in non-U hospitals). Fifty percent of U and 51% of non-U DI cases were consequences of human errors, which were preventable and mostly based on knowledge (88% vs. 71%) and rules of practice (23% vs. 51%). Substitution of an intubating anesthesiologist, reducing the size of endotracheal tubes, and stylet guided technique were the three commonly used methods after DI. MacCoy laryngoscope, fiber optic-aided intubation, laryngeal mask airway and Frova introducer were commonly used as substitutes for the standard laryngoscope. Inadequate experience was the major problem of U hospitals, which required additional training to gain more skill. The most common problem ofDI in non-U hospitals was inadequate preanesthetic evaluation. Therefore, they required practice guidelines and experienced assistants in difFicult situations. CONCLUSION: Half of DI cases were preventable. DI cases in Non-U hospitals were mostly caused by inadequate preanesthetic evaluation. This indicates the necessities of providing practice guidelines and experienced assistants. In U hospitals, in-training practice of intubation should be performed under supervision. More advanced substitution techniques were applicable in U hospitals.

Completion and accuracy in charting of anesthetic records in Songklanagarind Hospital.

OBJECTIVE: To audit the completeness and accuracy in charting of anesthetic recorded by hand. MATERIAL AND METHOD: A retrospective descriptive study from 890 checklist forms. The classification of complete record as good level and incomplete record including level of fair, poor or no data. The frequency, percentage and the difference of completeness and accuracy in charting of anesthetic records were analyzed by Chi-squared test. RESULTS: The item of vital signs during anesthesia was one of 44 items that were 100% complete and accurate. The overall average of completeness and accuracy in terms of good, fair, poor quality, and no data was 94.5, 3.1, 0.4, and 2%, respectively. Twenty-two of 44 items had statistically significant difference between complete and incomplete records. CONCLUSION: The charting of anesthetic record remained incomplete and inaccurate in 43 from 44 items, except the item of vital signs. The average of good anesthetic record was 94.5%. The incomplete anesthetic records were caused by illegibility, incorrect data filling, no data, or incomplete detail of each item such as incorrect ASA classification, or problem list etc. Handwritten records should be carefully filled-in to increase completion so that the data could be used as legal evidence.

Attitudes, beliefs, and expectations of gynecological patients toward postoperative pain and its managementt.

OBJECTIVE: To examine the attitudes, beliefs, and expectations of gynecological patients regarding postoperative pain and management. MATERIAL AND METHOD: A prospective study performed in 112 patients undergoing major gynecological surgery, using a preoperative questionnaire regarding expectations toward postoperative pain and management and a postoperative questionnaire regarding actual pain experience, attitudes, and beliefs about pain and management. RESULTS: The majority expected (92%) and experienced (89%) postoperative pain at moderate to very severe levels. The median visual analog scales (VAS) of expected and maximum experienced pain were 6.4 and 6 6, respectively. Ninety-eight percent reported at least moderate pain relief from the analgesics administered. Ninety-two percent were satisfied with their pain management. A significant number held misconceptions about postoperative pain and its management. CONCLUSION: Patients should be preoperatively advised regarding postoperative pain and management. Misunderstandings should be corrected to improve the quality and adequacy of postoperative pain management.