Perioperative control of blood sugar in diabetic patients

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Pediatric Pain Service In Srinagarind Hospital

Background:\  Compared to adults, pain in children is under-treated; however, the need to improve pain service to the pediatric population is receiving greater attention.\  We retrospectively reviewed our pain service for children in our hospital in order to ascertain the current service and to improve it where inadequate.Objective:\  To study the characteristics of pediatric pain service in Srinagarind Hospital.Design:\  Retrospective descriptive study.Subjects:\  Pediatric patients receiving pain service from the Department of Anesthesiology between September 2002 and August 2003.Method:\  We reviewed medical records of the patients.\  Outcome measurements including age, sex, admission ward, pain type, pain treatment, pain assessment, result of treatment, complications and problems occurring during service were recorded.\  The results were analyzed using descriptive statistics and presented as means and percentages.Results:\  Service was rendered 42 times for 39 patients; 21 of whom were male.\  The children averaged 7.14  4.83 years of age.\  Twenty six patients (66%) were from the Pediatric Ward, 8 (12.8%) from the Surgical Ward and 5 (12.8%) from Orthopedic Ward.\  Seventy-nine and 21% of the services provided were for acute and chronic pain management, respectively.\  The most common drug used was opioids (fentanyl).\  The technique used for acute pain management was continuous infusion, PCA or intermittent injection.\  By comparison, chronic pain was managed using a combination of methods.\  Most pain assessment (54.76%) was observation by nurses.\  Complications from pain management occurred in 9.5% of cases, mostly nausea and vomiting or sedation, which were successfully controlled.\  Pain control was considered satisfactory in 90.5% of the patients.\  Four patients (9.5%) died due to disease progression.\  The shortage of opioids was the greatest problem we encountered.Conclusion:\  Pediatric pain service at Srinagarind Hospital was established in September 2002.\  Over the one-year study, 39 patients were served, most for acute pain.\  The duration of service was usually between 1 and 3 days.\  Fentanyl was the most commonly used medication.\  We encountered no serious complications from pain management.Keywords: Pain Service; Pediatric

Integrated Medical Ethic Teaching for The 5th Medical Students

Background : Punctuality and responsibility are disirable virtues to incalcate in Thai medical students beginning from the fundamental level for both the students themselves and the families and the society at large.Objective :  To make the students realize the basic virtue of punctuality.  They practise to possess the qualities of punctuality and responsibility.  Both qualities must be fulfilled at the self-entities before they could be applied to the larger scale of family and society.Method : The 5th year students in Anesthesiology rotation block of 3 weeks were divided into 2 groups, the first group was taught the integrated contents, virtues and professional ethics.  The method of leaching is by way of active discussions on the content.  This is to concentrate the student on student on what they are practicing to learn the technique of handling the model and the patient.  The students were taught to meditate after discussion and before the actual practice and evaluation took place.  The second group was taught the same technique without a discussion and meditation to serve as control group.Result :  The experiment group was impressed and interested in the integrated teching approach.  They judged the method as  being relevant to the time and situation.  Ninety seven point two percent of them were punctually coming to classes.  The control group of students was 83.3 percent punctual.  The Video record of the practical classes illustrated that the experimental group was gental and careful in handling the models whereas the opposite is true with the control group.Conclusion : It could be said is inferred that the integrated method of teaching is rather successful as expected.  We, therefore, suggest the adoption of the method to further develop the learning teaching technique. 

Survey of Leaked Pressure in Anesthetized Pediatric Patients with Uncuffed Endotracheal Tube

Background: Generally, an uncuffed endotracheal tube is used for general anesthesia in pediatric patients; thus, an inappropriate tube size intubation can lead to complications. In clinical practice, tube size selection can be done using a formula then adjusting for each patient. An appropriate tube size should allow a leak at airwaypressures (leak pressure) between 20-40 cmH2O, but leak pressure is not routinely monitored.Objective: To study the incidence of inappropriate tube size used in pediatric patients receiving general anesthesia by using leak pressure test.Design: Prospective, descriptive study. Setting: Operating room, Srinagarind Hospital Subject: Pediatric patients between 0 and 8 years of age undergoing general anesthesia with uncuffed endotracheal tube.Methods: After anesthesia was induced and the patient was intubated, leaked pressure was measured. Leak pressure between 20 and 40 cmH2O was considered appropriate. We recorded each patient’s characteristics, number of attempts to intubate, leak pressure, duration of intubation, and respiratory complication. The results were analyzed using descriptive statistics and were presented as means, percentages and 95% confidence intervals (95% CI).Results: We enrolled 98 patients averaging 2.3 + 2.2 years of age (67 males and 31 females). Patients with inappropriate leak pressure numbered 39 (39.80%), of which 24.49% (95% CI: 17,33) were in the group where leak pressure was \> 40 cmH2O and 15.31% (95% CI: 10,23) in the group where leaked pressure was \< 20 cmH2O. The most frequent complication was hoarseness 27.55% (95% CI: 20,37). No patients had any serious respiratory complications.Conclusion: Pediatric patients between 0 and 8 years of age, undergoing general anesthesia with an uncuffed endotracheal tube had a 39.80% incidence of inappropriate endotracheal size used. Hoarseness was the most common complication (27.55%). Tube size selection should be done carefully and include leak pressure test.Keywords: Uncuffed endotracheal tube; Leak pressure; General anesthesia; Pediatric patients