Factors related to intraoperative oxygen desaturation in geriatric patients in a Thai university hospital.

BACKGROUND: As a site of the Thai Anesthesia Incidents Study (THAI Study) of anesthetic adverse outcome, the authors continued the institutional data collection to determine the incidence of intraoperative oxygen desaturation of geriatric patients (age 65 years and over) and relative factors representing a Thai university hospital. MATERIAL AND METHOD: Between July 1, 2003 and March 31, 2007, an anesthesia registry was conducted at King Chulalongkorn Memorial Hospital. Anesthesiologists and anesthesia residents were requested to record perioperative variables and adverse outcomes including oxygen desaturation (SpO2 < or = 90% for 3 minutes or SpO2 < 85%) on a structured data record form. Univariable analysis was used to identify factors related to intraoperative oxygen desaturation. Multivariable generalized linear regression for risk ratio was used to investigate independent factors with significant association to intraoperative oxygen desaturation. A forward stepwise algorithm was chosen. A p-value < 0.05 was considered as statistically significant. RESULTS: Among 54,419 cases in the registry, 8,905 geriatric patients underwent non-cardiac surgery receiving anesthesia. Among these, 21 patients developed intraoperative oxygen desaturation with an incidence of 23.6 (95% CI 10, 30):10000 anesthetics. Variables that predict intraoperative oxygen desaturation by multivariable analysis were ASA physical status 3 [RR 4.6 (95% CI 1.6, 13.6)], ASA physical status 4-5 [RR 29.8 (95% CI 8.7, 102.8)], history of difficult airway [RR 13.1 (95% CI 1.7, 102.2)], recent respiratory failure [RR 6.0 (95% CI 1.2, 29.3)], and anesthetic agents used such as: pethidine [RR 6.2 (95% CI 1.9, 19.9)], and ketamine [RR 5.6 (95% CI 1.2, 25.9)]. CONCLUSION: The incidence of intraoperative oxygen desaturation of geriatric patients who underwent non-cardiac surgery in a Thai university hospital was 23.6:10000 anesthetics, which was comparable to others. The higher ASA physical status, history of difficult intubation and recent respiratory failure were risk factors of intraoperative oxygen desaturation. Pre-anesthetic evaluation particularly airway evaluation and identification of high-risk patients are crucial for prevention of oxygen desaturation.

Factors related to 24-hour perioperative cardiac arrest in geriatric patients in a Thai university hospital.

BACKGROUND: As a site of the Thai Anesthesia Incidents Study (THAI Study) of anesthetic adverse outcome, the authors continued the institutional data collection to determine the incidence and factors related to 24-hour perioperative cardiac arrest in geriatric patients (aged 65 years and over) representing a Thai university hospital. MATERIAL AND METHOD: Between July 1, 2003 and March 31, 2007, an anesthesia registry was conducted at King Chulalongkorn Memorial Hospital. Anesthesiologists and anesthesia residents were requested to record perioperative variables and adverse outcomes including 24-hour perioperative cardiac arrest on a structural data record form. Univariable analysis was used to identify factors related to 24-hour perioperative cardiac arrest. A multivariable generalized linear regression for risk ratio was used to investigate independent factors with significant association to 24-hour perioperative cardiac arrest. A forward stepwise algorithm was chosen. A p-value < 0.05 was considered as statistically significant. RESULTS: Among 54,419 cases in the registry, 8,905 geriatric patients underwent a non-cardiac surgery under anesthesia. Thirty-six patients experienced cardiac arrest. The incidence of intra-operative cardiac arrest, within 24 hours postoperative cardiac arrest, and overall 24-hours perioperative cardiac arrest were 18:10000 (mortality rate of 62.5%), 22.5:10000 (mortality rate of 90%), and 40.4:10000 (mortality rate of 77.8%), respectively. By multivariable analysis, age of 76-85 [RR 2.6 (95% CI: 1.2,5.4)], age > or = 86 [RR 4.4 (95% CI: 1.7, 11.8)], recent respiratory failure [RR 6.6 (95% CI: 1.9, 22.3)], ASA physical status 3-5 [RR 19.9 (95% CI: 4.6, 86)], emergency surgery [RR 2.8 (95% CI: 1.4, 5.6)], intrathoracic surgery [RR 3.7 (95% CI: 1.4, 9.9)], upper abdominal surgery [RR 2.8 (95% CI: 1.3, 5.7)], and administration of ketamine [RR 5.4 (95%CI: 1.8, 15.9)] were factors related to 24-hour perioperative cardiac arrest. CONCLUSION: The incidence of 24-hourperioperative cardiac arrest of geriatric patients in a Thai university in the present study was 40.4:10000 anesthetics, which was comparable to others with high mortality rate. Risk factors for 24-hour perioperative cardiac arrest were older age, ASA physical status 3-5, emergency surgery, intrathoracic surgery, upper abdominal surgery, recent respiratory failure, and administration of ketamine. Pre-anesthetic evaluation is important for finding the risks and optimal preparation for preventing perioperative cardiac arrest in these aging patients.

Estimating glomerular filtration rate in Asian patients with chronic kidney diseases from bioelectrical impedance analysis.

BACKGROUND: Estimation of glomerular filtration rate (GFR) is usually determined from 24-hour urine collection, but it is time-consuming, and difficult in clinical practice. The authors attempted to select an accurate and safe, but more convenient test to obtain an estimated GFR. Objective: To compare estimation of GFR by Bioelectrical impedance analysis (BIA) with GFR calculated by 24-hour urine averaged creatinine clearance and urea clearance (Ccr-Cu-GFR). MATERIAL AND METHOD: The authors examined 79 non-diabetic chronic kidney disease (CKD) patients that had estimated GFR between 15 and 89 ml/min/1. 73 m(2). Subjects were categorized into three subgroups according to K/DOQI-CKD classification: GFR of 60-89 m/min/1. 73m(2) (stage 2, 5 subjects), 30-59 ml/min/ 1.73m(2) (stage 3, 31 subjects), and 15-29 ml/min/1.73m(2) (stage 4, 43 subjects). RESULTS: The mean value of Ccr-Cu-GFR was 33.79+/-14.78 ml/min/1. 73 m(2) and GFR by BIA (BIA-GFR), 34.63 +/- 14.86 ml/min/1. 73 m(2) with no overall statistical differences (p = 0.838). In stage 3 CKD patients, the mean BIA-GFR and Ccr-Cu-GFR were similar (38.84+/-12.47 vs 41.16+/-9.17, p = 0. 399) while in stage 2 CKD, BIA-GFR tended to underestimate (63.50+/- 19.35 vs 70.94+/-7.82, p = 0.407) and in stage 4 CKD, BIA-GFR significantly overestimated Ccr-Cu-GFR (27.31+/-9.11 vs 23.76+/-5.68, p = 0.040). CONCLUSION: The findings suggest that BIA-GFR in non-diabetic CKD patients closely resembled with Ccr-Cu-GFR especially in stage 3 CKD patients. BIA-GFR may be considered as a more convenient test for an assessment of GFR in non-diabetic CKD patients.

Validation of risk scoring scheme for cesarean delivery due to cephalopelvic disproportion in Lamphun Hospital.

OBJECTIVE: To validate the risk scoring scheme for cesarean delivery due to cephalopelvic disproportion in Lamphun Hospital. MATERIAL AND METHOD: A case-control study was conducted between January 1st, 2005 and April 30th, 2006, including, prospectively collected, 132 women who had cesarean delivery due to cephalopelvic disproportion (CPD) as cases and 394 women who delivered by normal labor as controls. Cases and controls were evaluated for risk scores, the scoring scheme of which had previously been developed. The prediction by the risk score was tested with an area under the receiver operating characteristic (ROC) curve of a logistic regression. Another independent set of obstetric cases referred form community hospitals in Lamphun were also evaluated for the risk scores. RESULTS: The risk scores explained 84.5% of the probability of CPD as demonstrated by the area under the ROC curve. The scores of pregnant women referred from rural hospital underwent cesarean delivery were higher than those with vacuum extraction and with normal delivery (mean = 9.2 +/- 2.4, 7.5 +/- 3.2 and 6.4 +/- 2.3 respectively). The score of cesarean delivery was significantly higher than normal delivery (p < 0.001) while the score of vacuum extraction was in between and only slightly higher (p = 0.116). CONCLUSION: Risk scores obtained form this scoring scheme predicted cesarean delivery with high precision. The scores also discriminated cesarean deliveries from normal deliveries among cases referred from community hospitals. Community hospitals may gain benefit by adopting this simple scoring scheme into their practices.

Risk indicators for cesarean section due to cephalopelvic disproportion in Lamphun hospital.

OBJECTIVE: To investigate risk indicators for cesarean section due to cephalopelvic disproportion. SETTING: Department of Obstetrics & Gynecology, Lamphun Hospital. DESIGN: Case-control study. MATERIAL AND METHOD: Cases were 87 pregnant women delivered by cesarean section due to cephalopelvic disproportion at Lamphun Hospital between October 1st, 2003 and June 30th, 2004. Controls were 113 pregnant women delivered by normal labour during the same period. Maternal age, gravidity, parity, maternal height, pre-pregnancy weight, gestational age, weight before delivery, weight gain, symphysis-fundal height, birthweight and newborn gender were mainly focused. Information were obtained from medical records. Groups were compared by t-test and exact probability test as appropriate. Risk indicators were analyzed by odds ratio from univariable and multiviariable logistic regression. RESULTS: Risk indicators significantly associated with cesarean section due to cephalopelvic disproportion included symphysis-fundal height greater than 35 cm. (OR = 9.38, 95% CI = 3.42-25.73); nulliparity (OR = 5.36, 95%CI = 2.24-12.82); maternal height less than 152 cm. (OR = 3.65, 95%CI = 1.63-8.17) and weight gain more than 15 kg. (OR = 2.67, 95%C1 = 1.32-5.39). CONCLUSION: Risk factors for cesarean section due to cephalopelvic disproportion included symphysis-fundal height greater than 35 cm, nulliparity, maternal height less than 152 cm. and weight gain more than 15 kg. Early detection of these risk indicators before delivery helps obstetricians and nurses to recognize potential obstructed labor and prepare for safe delivery in advance.