Influence of the Coronavirus Disease 2019 Pandemic and Bystander-victim Relationship on the Willingness of Laypeople and Health-care Providers to Perform Cardiopulmonary Resuscitation.

Introduction: Bystander cardiopulmonary resuscitation (CPR) reduces mortality from out.of.hospital cardiac arrest. The willingness to perform CPR (W-CPR) is also critical. Uncertain effects of the coronavirus disease 2019 (COVID-19) pandemic on W-CPR were reported. Our objectives aim to examine W-CPR during the COVID-19 pandemic, including the influence of the bystander-victim relationship, bystander characteristics, and CPR background on the W-CPR of laypeople and healthcare providers (HCPs). Methods: A cross-sectional online survey was conducted between August 2020 and November 2020 among Thai laypeople and HCPs. A structured questionnaire was given to volunteers as an online survey. We recorded W-Conventional CPR (W-C-CPR), W-Compression.only CPR (W-CO-CPR), chest compression, automated external defibrillator (AED), mouth.to.mouth, face shield, and pocket mask ventilation on family members (FMs), acquaintances, and strangers during the study (pandemic) and in nonpandemic situation and analyzed. Results: We included 419 laypeople and 716 HCPs. During the pandemic, laypeople expressed less willingness in all interventions (P < 0.05) except W-CO-CPR in FMs and AED in FMs and acquaintances. HCPs were less willing to any interventions (P < 0.05). Laypeople showed comparable W-C-CPR and W-CO-CPR between FMs and acquaintances but less among strangers (P < 0.05). HCPs' W-CPR differed significantly depending on their relationship (P < 0.05), except W-CO-CPR between FMs and acquaintances. CPR self.efficacy, single marital status, CPR experience, and HCPs reported higher W-CO-CPR in FMs. Conclusion: Participants were less W-CPR during the COVID-19 pandemic on all recipients (laypeople: 2.8%-21.0%, HCPs: 7.6%-31.2%), except for laypeople with FMs. The recipient's relationship was more critical in W-C-CPR than in W-CO-CPR, especially in HCPs.

Effect of Contact-Restricted Basic Life Support Training During the Nation's Contact Restriction Policy on Learning Outcomes.

Objective: Basic life support (BLS) training aimed at building knowledge and skills in cardiopulmonary resuscitation. During training, there is the possibility of airborne COVID-19 transmission. The aim was to evaluate students' knowledge, skills, and course satisfaction following contact-restricted BLS training under the contact restriction policy. Methods: From July 2020 to January 2021, a prospective, descriptive study was conducted among fifth-year dental students. Contact-restricted BLS training consisted of online learning, online pre-testing, non-contact training with automated real-time feedback manikins, and remote monitoring. The participants' skills, knowledge through online testing, and course satisfaction were all evaluated after training. At three months and six months after training, their knowledge was re-evaluated through online testing. Results: Fifty-five participants were included in this study. Their mean (SD) knowledge scores after training, at three and six months, were 81.5 (10.8)%, 71.1 (16.4)%, and 65.8 (14.5)%, respectively. The percentage of participants, who passed the skills test on their first, second, and third attempts had been 83.6%, 94.5%, and 100%, respectively. The mean (SD) satisfaction score with the course was 4.87 (0.34) on a five-point Likert score. After training, no participants had COVID-19 infection. Conclusion: Training in contact-restricted BLS had produced acceptable knowledge, skills, and satisfaction results. Knowledge tests, competence tests, and course satisfaction were comparable to conventional pre-pandemic trainings with similar participants. Due to the significant dangers of aerosol disease transmission, it became a viable training alternative. Trial Registration: TCTR20210503001 (Thai Clinical Trials Registry).

Differences in perception of online anesthesiology between Thai medical students and teachers during the COVID-19 pandemic.

PURPOSE: Traditional anesthesiology learning was disrupted by the coronavirus disease 2019 pandemic and replaced by online learning. Students and teachers did not prepare well for this change. Determining the differences in perceptions can close the gap and develop more effective curricula. Our study aims to compare students' and teachers' perceptions of online anesthesiology learning. METHODS: We conducted a prospective descriptive study, a cross-sectional survey between July 2020 and January 2021 in the Anesthesiology Department, Faculty of Medicine, Khon Kaen University, Thailand. Our participants were fifth-year medical students and teachers participating in online anesthesiology. We compared the perception of the teaching process, support system, learning outcomes, satisfaction, and preference. Using an online structured questionnaire survey with a 4-point Likert scale to measure the degree of agreement with each item. We analyzed the difference between students' and teachers' perceptions by topic. RESULTS: We received responses from 174 students and 24 teachers. Students had a significantly higher proportion of positive perceptions than teachers on the teaching process (theoretical teaching, problem-based learning, feedback, and response system), on a support system (technological support, connectivity, and learning materials), on learning outcomes (clinical practice readiness, critical thinking, long-term memory, and enthusiasm), satisfaction score, and online learning preference (p<0.05). CONCLUSION: Differences in perception were high in many aspects of online anesthesiology learning. This perception gap was particularly evident in the teaching process, support system, and learning outcomes. And Thai students had more preference for online learning than teachers. Strategies to reduce the gap should focus on teachers' training and supporting online learning should be concerned.

A randomized controlled, non-inferiority trial of Moodle online learning for basic life support training on learning outcomes among dental students.

OBJECTIVES: Dental students require basic life support (BLS) training to build their competency in cardiac arrest response. Online learning differs from the types of learning commonly practiced in Asia. We compared online learning and didactic lecture for BLS training in Thai dental students on knowledge, skill, and satisfaction. METHODS: This was a randomized controlled, single-blinded, non-inferiority trial in fifth-year students from Khon Kaen University's Faculty of Dentistry from August 2015 to February 2016. Online learning was conducted using Modular Object-Oriented Dynamic Learning Environment (Moodle) 2.9 and required 90 min. Those in the didactic lecture group received a 90-min lecture covering similar content. Both groups received 2 h of skill training. After training, we evaluated their ability to pass a skills test, knowledge scores (immediately after training and 3 months later), and course satisfaction (5-point Likert scale). RESULTS: We included 78 students and randomized them to online learning (39) or didactic lecture (39). The difference in proportion (95% confidence interval [CI]) of students passing the skills test on their first attempt was -1.5 (-20.8, 23.8), and all passed on their second attempt. The mean differences (95% CI) between the groups' immediate and 3 months knowledge scores were -2.5 (-6.2, 1.2), and -1.3 (-4.9, 2.3), respectively. The mean difference (95% CI) in satisfaction score was 0.02 (-0.28, 0.32). CONCLUSION: Online learning and didactic lectures yielded comparable knowledge and skills, including satisfaction in Thai dental students. Online BLS training may alternatively aim for self-paced learning and increase flexibility. The recommendation is to increase online BLS learning in Thai culture.

Simulation-based medical education in Thailand: a cross-sectional online national survey.

BACKGROUND: Simulation-Based Medical Education (SBME) is a teaching method commonly used in undergraduate medical education. Although Thai medical schools have developed a system that incorporates SBME, various aspects of that system require improvement. We surveyed medical school administrators, instructors, and students about SBME in their institutions and the obstacles involved in its implementation, as well as their experiences, expectations, and attitudes regarding the current system. METHODS: We conducted a cross-sectional online survey between August 2019 and July 2020 among administrators, instructors, and 6th-year medical students. A structured questionnaire was developed and distributed to volunteers as an online survey. We recorded details about the SBME system as well as participant characteristics, obstacles, experiences, expectations, and attitudes. We used descriptive statistics as appropriate. RESULTS: We received responses from 15 (68.2%) administrators, 186 instructors, and 371 (13.7%) sixth-year medical students. SBME was commonly used in teaching and evaluation but less so in research. It was mainly used to improve psychomotor tasks, knowledge, patient care, and communication skills. The expected outcomes were improvements in students' performance, knowledge, and practice. The clinical courses were longer and had fewer participants than the pre-clinical courses. Obstacles encountered included shortages of faculty and simulators, time and space limitations, inadequate faculty training, and insufficient financial support. The administrators surveyed had positive attitudes toward SBME. Medical students reported having experience with SBME and strongly agreed that it was beneficial; however, they expected fewer students per class and more learning time to be devoted to these methods. CONCLUSIONS: SBME in Thailand is focused on teaching and assessment. The system could be improved through better-trained faculty, greater available space, more simulators, and sufficient funding. There were also some aspects that failed to meet students' expectations and need to be addressed. However, participants expressed positive attitudes toward SBME. TRIAL REGISTRATION: TCTR20210524003 (Thai Clinical Trials Registry).

Deliberate hypotension with propofol under anaesthesia for functional endoscopic sinus surgery (FESS).

BACKGROUND: Functional endoscopic sinus surgery (FESS) is a minimally invasive technique that is used to treat chronic sinusitis. Small bleeding areas can reduce operative visibility and result in destruction of surrounding structures. Deliberate hypotension (lowering the mean arterial blood pressure to between 50 and 65 mm Hg in normotensive patients) using a range of pharmacological agents during general anaesthesia reduces blood loss in many operations. This review was originally published in 2013 and updated in February 2016. OBJECTIVES: We aimed to compare the use of propofol versus other techniques for achieving deliberate intraoperative hypotension during FESS procedures with regard to blood loss and operative conditions. SEARCH METHODS: We searched the following databases in the updated review: the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE (1950 to February 2016), Embase (1980 to February 2016), LILACS (1982 to February 2016), and ISI Web of Science (1946 to February 2016). We also searched the reference lists of relevant articles and conference proceedings and contacted the authors of included trials. SELECTION CRITERIA: We sought all randomized controlled trials comparing propofol with other techniques for deliberate hypotension during FESS with regard to blood loss and operative conditions in both adults and children. Our primary outcome was total blood loss (TBL). Other outcomes included surgical field quality, operation time, mortality within 24 hours, complications, and failure to reach target blood pressure. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors independently extracted details of trial methodology and outcome data from the reports of all trials considered eligible for inclusion. We made all analyses on an intention-to-treat basis where possible. When I2 was less than 40% and the P value from the Chi2 test was higher than 0.10, we pooled data using the fixed-effect model. Otherwise, we pooled data using the random-effects model. MAIN RESULTS: We found no new studies. This updated review therefore includes four studies with 278 participants. Most analyses were based on data from few participants and low-quality evidence, so our results should be interpreted with caution. Deliberate hypotension with propofol did not decrease TBL (millilitres) when compared with inhalation anaesthetics in either children (1 study; 70 participants; very low-quality evidence), or adults (1 study; 88 participants; moderate-quality evidence). Propofol improved the quality of the surgical field by less than one category on a scale from 0 (no bleeding) to 5 (severe bleeding) (mean difference -0.64, 95% CI -0.91 to -0.37; 4 studies; 277 participants; low-quality evidence), but no difference in operation time was reported (3 studies; 214 participants; low-quality evidence). Failure to lower blood pressure to target was less common in the propofol group (risk ratio of failure with propofol 0.24, 95% CI 0.09 to 0.66; 1 study; 88 participants; moderate-quality evidence). AUTHORS' CONCLUSIONS: Using propofol to achieve deliberate hypotension probably improves the surgical field, but the effect is small. Deliberate hypotension with propofol did not decrease TBL and the operation time. However, due to the very low quality of the evidence, this conclusion is not definitive. Randomized controlled trials with good-quality methodology and large sample size are required to investigate the effectiveness of deliberate hypotension with propofol for FESS.

High initial concentration versus low initial concentration sevoflurane for inhalational induction of anaesthesia.

BACKGROUND: Sevoflurane induction for general anaesthesia has been reported to be safe, reliable and well accepted by patients. Sevoflurane induction uses either low or high initial concentrations. The low initial concentration technique involves initially administering a low concentration of sevoflurane and gradually increasing the concentration of the dose until the patient is anaesthetized. The high initial concentration technique involves administering high concentrations from the beginning, then continuing with those high doses until the patient is anaesthetized. This review was originally published in 2013 and has been updated in 2016. OBJECTIVES: We aimed to compare induction times and complication rates between high and low initial concentration sevoflurane anaesthetic induction techniques in adults and children who received inhalational induction for general anaesthesia. We defined 'high' as greater than or equal to and 'low' as less than a 4% initial concentration. SEARCH METHODS: For the updated review, we searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE (1950 to February 2016), EMBASE (1980 to February 2016), Latin American Caribbean Health Sciences Literature (LILACS) (1982 to February 2016) and the Institute for Scientific Information (ISI) Web of Science (1946 to February 2016). We also searched the reference lists of relevant articles and conference proceedings and contacted the authors of included trials. The original search was run in September 2011. SELECTION CRITERIA: We sought all published and unpublished, randomized controlled trials comparing high versus low initial sevoflurane concentration inhalational induction. Our primary outcomes included two measures of anaesthesia (time to loss of the eyelash reflex (LOER) and time until a weighted object held in the patient's hand was dropped), time to successful insertion of a laryngeal mask airway (LMA) and time to endotracheal intubation. Other outcomes were complications of the technique. DATA COLLECTION AND ANALYSIS: We used standardized methods for conducting a systematic review as described in the Cochrane Handbook for Systematic Reviews of Interventions. Two review authors independently extracted details of trial methods and outcome data from reports of all trials considered eligible for inclusion. We conducted all analyses on an intention-to-treat basis, when possible. We estimated overall treatment effects by using a fixed-effect model when we found no substantial heterogeneity, whereas we applied the random-effects model in the presence of considerable heterogeneity. MAIN RESULTS: We reran the searches and included one new study (100 participants) in this updated review. In total, we included 11 studies with 829 participants, although most analyses were based on data from fewer participants and evidence of low quality. We noted substantial heterogeneity in the included trials. Thus, our results should be read with caution. It was not possible to combine trials for the primary outcome (LOER), but individual trials reported faster induction times (typically 24 to 82 seconds faster, 41 seconds (31.37 to 50.62)) with high initial concentration sevoflurane (six studies, 443 participants, low-quality evidence). Apnoea appeared to be more common in the high initial concentration sevoflurane group (risk ratio (RR) 3.14, 95% confidence interval (CI) 1.72 to 5.7, two studies, 160 participants, low-quality evidence). We found no evidence of differences between the two groups in the incidence of cough (odds ratio (OR) 1.23, 95% CI 0.53 to 2.81, eight studies, 589 participants, low-quality evidence), laryngospasm (OR 1.59, 95% CI 0.16 to 15.9, seven studies, 588 participants, low-quality evidence), breath holding (OR 1.16, 95% CI 0.47 to 2.83, five studies, 389 participants, low-quality evidence), patient movement (RR 1.14, 95% CI 0.69 to 1.89, five studies, 445 participants, low-quality evidence) or bradycardia (OR 0.8, 95% CI 0.22 to 2.88, three studies, 199 participants, low-quality evidence), and the overall incidence of complications was low. AUTHORS' CONCLUSIONS: A high initial concentration sevoflurane technique probably offers more rapid induction of anaesthesia and a similar rate of complications, except for apnoea, which may be more common with a high initial concentration. However, this conclusion is not definitive because the included studies provided evidence of low quality.

Deliberate hypotension with propofol under anaesthesia for functional endoscopic sinus surgery (FESS).

BACKGROUND: Functional endoscopic sinus surgery (FESS) is a minimally invasive technique that is used to treat chronic sinusitis. Small bleeding areas can reduce operative visibility and result in destruction of surrounding structures. Deliberate hypotension (lowering the mean arterial blood pressure to between 50 and 65 mm Hg in normotensive patients) using a range of pharmacological agents during general anaesthesia reduces blood loss in many operations. OBJECTIVES: We aimed to compare the use of the intravenous anaesthetic agent propofol versus other techniques for deliberate hypotension during FESS with regard to blood loss and operative conditions. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE (1950 to April 2012), EMBASE (1980 to April 2012), LILACS (1982 to April 2012) and ISI Web of Science (1946 to April 2012). We also searched the reference lists of relevant articles and conference proceedings and contacted the authors of included trials. SELECTION CRITERIA: We sought all randomized controlled trials (RCTs) conducted to compare propofol with other techniques. Our primary outcome was total blood loss (TBL). Other outcomes included surgical field quality, operation time, mortality within 24 hour, complications and failure to reach target blood pressure. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted details of trial methodology and outcome data from reports of all trials considered eligible for inclusion. All analyses were made on an intention-to-treat basis where possible. When I(2) was < 40% and the P value from the Chi(2) test was > 0.10, we pooled data by using the fixed-effect model. Otherwise we pooled data by using the random-effects model. MAIN RESULTS: We included four studies with 278 participants in the review. Deliberate hypotension with propofol did not decrease TBL (millilitres) when compared with inhalation anaesthetics in either children or adults. Propofol improved the quality of the surgical field by less than one category on a scale from 0 (no bleeding) to 5 (severe bleeding) (mean difference (MD) 0.64 better with propofol, 95% confidence interval (CI) 0.37 to 0.91 better), but no difference in operation time was reported. Failure to lower blood pressure to target was less common in the propofol group (relative risk of failure with propofol (RR) 0.24, 95% CI 0.09 to 0.66). AUTHORS' CONCLUSIONS: Using propofol to achieve deliberate hypotension may improve the surgical field, but the effect is small. Deliberate hypotension with propofol did not decrease TBL and operation time. RCTs with good quality methodology and large sample size are required to investigate the effectiveness of deliberate hypotension with propofol for FESS.

High initial concentration versus low initial concentration sevoflurane for inhalational induction of anaesthesia.

BACKGROUND: Sevoflurane induction for general anaesthesia has been reported to be safe, reliable and well accepted by patients. Sevoflurane induction uses either low or high initial concentrations. The low initial concentration technique involves initially administering a low concentration then gradually increasing the dose until the patient is anaesthetized. The high initial concentration technique involves administering high concentrations from the beginning, continuing until the patient is anaesthetized. OBJECTIVES: We aimed to compare the induction times and complications between high and low initial concentration sevoflurane induction in patients who received inhalational induction for general anaesthesia. We defined 'high' as greater and 'low' as less than a 4% initial concentration. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 9); MEDLINE (1950 to September 2011); EMBASE (1980 to September 2011); LILACS (1982 to September 2011) and ISI Web of Science (1946 to September 2011). We also searched the reference lists of relevant articles, conference proceedings; and contacted the authors of included trials. SELECTION CRITERIA: We sought all published and unpublished, randomized controlled trials comparing high versus low initial sevoflurane concentration inhalational induction. Our primary outcomes were two measures of anaesthesia (time to loss of the eyelash reflex (LOER) and time until a weighted object held in the patient's hand was dropped), time to successful insertion of a laryngeal mask airway (LMA), and time to endotracheal intubation. Other outcomes were complications of the technique. DATA COLLECTION AND ANALYSIS: We used the standardized methods for conducting a systematic review as described by the Cochrane Handbook for Systematic Reviews of Interventions. Two authors independently extracted details of trial methodology and outcome data from reports of all trials considered eligible for inclusion. All analyses were made on an intention-to-treat basis, where possible. The overall treatment effects were estimated by using a fixed-effect model when there was no substantial heterogeneity, whereas the random-effects model was applied in the presence of considerable heterogeneity. MAIN RESULTS: We used data from 10 studies with 729 participants in the review, though most analyses were based on data from fewer participants. There was substantial heterogeneity in the trials. Thus, our results should be read with caution. It was not possible to combine the trials for the primary outcome (LOER) but individual trials found faster induction times (typically 24 to 82 seconds faster) with high initial concentration sevoflurane. Apnoea appeared to be more common in the high initial concentration sevoflurane group (two trials,160 participants). There was no evidence of a difference in the incidence of cough, laryngospasm, breath holding, bradycardia, salivation and hypotension between the two groups, with the overall incidence of complications being low. AUTHORS' CONCLUSIONS: A high initial concentration sevoflurane technique probably offers more rapid induction of anaesthesia and a similar rate of complications except for apnoea, which may be more common with a high initial concentration. However, this conclusion is not definitive.

Epidural blood patching for preventing and treating post-dural puncture headache.

BACKGROUND: This is an update of a Cochrane Review first published in Issue 2, 2002. Dural puncture is a common procedure, but leakage of cerebrospinal fluid (CSF) from the resulting dural defect may cause post-dural puncture headache (PDPH) after the procedure, and this can be disabling. Injecting an epidural blood patch around the site of the defect may stop this leakage. OBJECTIVES: To assess the possible benefits and harms of epidural blood patching in both prevention and treatment of PDPH. SEARCH STRATEGY: We searched the Cochrane PaPaS Group Trials Register; CENTRAL; MEDLINE and EMBASE in April 2009. SELECTION CRITERIA: We sought all randomised controlled trials (RCTs) that compared epidural blood patch versus no epidural blood patch in the prevention or treatment of PDPH among all types of participants undergoing dural puncture for any reason. The primary outcome of effectiveness was postural headache. DATA COLLECTION AND ANALYSIS: One review author extracted details of trial methodology and outcome data from studies considered eligible for inclusion. We invited authors of all such studies to provide any details that were unavailable in the published reports. We performed intention-to-treat (ITT) analyses using the Peto O-E method. We also extracted information about adverse effects (post-dural puncture backache and epidural infection). MAIN RESULTS: Nine studies (379 participants) were eligible for inclusion. Prophylactic epidural blood patch improved PDPH compared to no treatment (OR 0.11, 95% CI 0.02 to 0.64, one study), conservative treatment (OR 0.06, 95% CI 0.03 to 0.14, two studies) and epidural saline patch (OR 0.16, 95% CI 0.04 to 0.55, one study). However, prophylactic epidural blood patch did not result in less PDPH than a sham procedure (one study). Therapeutic epidural blood patch resulted in less PDPH than conservative treatment (OR 0.18, 95% CI 0.04 to 0.76, one study) and a sham procedure (OR 0.04, 95% CI 0.00 to 0.39, one study). Backache was more common with epidural blood patch. However, these studies had very small numbers of participants and outcome events, as well as uncertainties about trial methodology, which preclude reliable assessments of the potential benefits and harms of the intervention. AUTHORS' CONCLUSIONS: The review authors do not recommend prophylactic epidural blood patch over other treatments because there are too few trial participants to allow reliable conclusions to be drawn. However, therapeutic epidural blood patch showed a benefit over conservative treatment, based on the limited available evidence.

Parents' satisfaction with pediatric ambulatory anesthesia in northeast of Thailand.

OBJECTIVE: Study the satisfaction of parents with ambulatory anesthesia and associated factors, including characteristics of the patients and their parents. MATERIAL AND METHOD: This was a prospective, descriptive, observation study. The authors included children who were scheduled for ambulatory anesthetic service between birth and 14 years of age and attended at Srinagarind Hospital, Khon Kaen, Thailand. The authors excluded patients whose parents could not be reached by telephone. Before anesthesia, the authors recorded the patients and parents' characteristics, level of information perception (pre-, peri- and post-anesthesia and complications). After anesthesia, the anesthesia technique and any complications were recorded. The day after anesthesia, the authors made phone calls to the patients to record the parents' satisfaction score (viz, of overall, pre-, peri- and post-anesthesia care, and information about the level of patient care at home), and any anesthesia related complications. RESULTS: Ninety-two patients and their parents were included in the present study. Overall parents 'satisfaction with the anesthesia service was 96.7% (i.e., 89/92) (95% CI 90.8-99.3). Parents' satisfaction with pre- and peri-anesthesia care was 100% (95% CI 96.1-100) and 97.9% (95% CI 92.4-99.7), respectively. Parents' satisfaction with the PACU care and information of patient care at home was 96.7% (95% CI 90.8-99.3) and 91.3% (95% CI 83.6-96.2), respectively. Associated factors where parents were dissatisfied included PACU care satisfaction (i.e., relative risk 22.5 (95% CI 3.2-158)) and patient care information at home (i.e., relative risk 13.3 (95% CI 1.3-136.0)). CONCLUSION: The present study showed a high level of parents' satisfaction. Parents' dissatisfaction associated with PACU care and information about post anesthesia care at home. Additionally information on parents' characteristics provides invaluable data for improving pediatric ambulatory anesthesia in Srinagarind Hospital.

Trauma care audit using Srinagarind hospital's audit filter.

BACKGROUND: To audit trauma care (including the mortality rate and obstacles faced by the authors) at Srinagarind (University) Hospital using the trauma audit filter. MATERIAL AND METHOD: Conduct a prospective, descriptive, study of trauma patients who received trauma medical care at Srinagarind Hospital, Khon Kaen University, Thailand, between January and May 2006. Srinagarind Hospitals trauma audit filter was used to audit trauma care. The audit filter comprised 14 criteria (i.e., 1) emergency medical service; 2) accident and emergency out-patient service; 3) in-patient service). Any filter that generated a "Yes" response was investigated to find the reason(s). The obstacles and mortality were also recorded. RESULTS: The authors enrolled 3209 patients. The mortality rate was 0.5% (95% CI 0.3-0.8). Emergency medical service, accident and emergency out- and in-patient service were rated satisfactorily. The reported obstacles were lack of hospital beds, inappropriate locale for trauma care, financial process, admission process, and lack of equipment. CONCLUSIONS: Srinagarind Hospital's audit filter had the capability to audit trauma care. Overall trauma care at Srinagarind Hospital was satisfactory albeit improvements are needed.

Comparison of intrathecal morphine plus PCA and PCA alone for post-operative analgesia after kidney surgery.

OBJECTIVE: To study the use of intrathecal morphine plus PCA for reducing morphine consumption, pain scores, and improving patient-satisfaction. MATERIAL AND METHOD: The authors included patients who had received a flank incision for elective kidney surgery. The patients were random into the intrathecal and control groups by block randomization using the sealed envelop technique. The intrathecal group received 0.3 mg of intrathecal morphine before general anesthesia. Patients and providers were not apprised of the treatment. After the operation, both groups received morphine in a PCA pump. Morphine consumption, numeric rating score (NRS, range 0-10) at rest and while coughing, sedation score, nausea vomiting score, and itching score were evaluated at 1, 2, 6, 12, 24, and 48 hr. Patient satisfaction for pain control was recorded. RESULTS: The authors enrolled 80 patients in the present study. Demographic data was comparable between groups. The intrathecal group had less cumulative morphine consumption (p-value < 0.001), less NRS at rest (p-value < 0.001) and while coughing (p-value < 0.001) than the control group. The intrathecal group had a greater itching score than the control group (p-value < 0.001). The sedation score and patient satisfaction for pain control were not significantly different between groups (p-value = 0.55). CONCLUSION: Intrathecal morphine plus PCA could reduce morphine consumption and improve the analgesic effect over PCA alone postoperatively. Itching was more common in the intrathecal group. Overall, patient satisfaction for pain control was not improved.

Surveillance of anesthetic related complications at Srinagarind Hospital, Khon Kaen University, Thailand.

OBJECTIVE: To identify the incidence of common anesthetic complications in 2003 at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand and find the strategies for prevention. MATERIAL AND METHOD: The study was part of a multi-center study conducted by the Thai Royal College of Anesthesiologists to survey anesthetic related complications in Thailand in 2003. The authors collected data from all the cases receiving anesthesia service at Srinagarind Hospital between January 1 and December 31, 2003, to report the incidence of common anesthetic complications and to assess the need to improve the quality of service. This was a prospective, descriptive study. When any anesthetic complications occurred, they were reported by anesthesia personnel and anesthesiologists. The reporting forms comprised four categories of complications, viz.: respiratory, cardiovascular, neurological and others. Each category of complications has a guidebook for reference in order to correctly fill out the form. All the forms were verified by the principal author then included in the present study. RESULTS: A total of 10,607 patients were included and among these 268 incidents were recorded. The common incidents per 10,000 were desaturation (95.22), cardiac arrest (44.31), re-intubation (29.23), equipment failure (19.80) and difficult intubation (18.86). Main contributing factors were insufficient knowledge and inappropriate decisions. Suggested corrective strategies included quality assurance activities, additional training and improved supervision. CONCLUSION: Despite practical prevention guidelines being in place, the most common anesthesia incident at Srinagarind Hospital was respiratory incident. Continuing quality improvement is needed.

An experience with intubating laryngeal mask airway for difficult airway management: report on 38 cases.

A retrospective study was performed on 38 patients (23 males and 15 females) in whom the intubating laryngeal mask airway (ILMA) was used for airway management at Srinagarind and Siriraj Hospital in 2003. The patients 'age and weight ranged between 12 and 75 years and 40 and 94 kg, respectively. Difficult tracheal intubation was suspected before starting general anesthesia in 17 patients, whereas it was found difficult after induction of general anesthesia in 21. The ILMA was successfully placed in all patients with airway patency classified as 'good' and 'acceptable' in 36 patients (94.7%), and 'poor' in two. Oxygen saturation during intubation was maintained above 95 percent in all patients. Tracheal intubation through the ILMA was successful in 34 patients (89.5%), which was described as 'easy' in 27 of 34 patients (79.4%). In the remaining 7, 2-5 attempts were required for successful tracheal intubation. The types of endotracheal tubes used were: 1) the pre-formed silicone tube in 55.9 percent, 2) the pre-formed flexible tube in 41.2 percent; and, 3) the standard polyvinyl tube in 2.9 percent. In the four patients with failed tracheal intubation through the ILMA, three were successfully intubated with conventional laryngoscopy and one with gum elastic bougie. There were no serious complications following the use of the ILMA in these patients. The ILMA proved a safe, very useful and easy to use device with a high success rate for difficult airway management.

Knowledge and skill after brief ACLS training.

OBJECTIVES: To determine the knowledge level and skill base in nurse anesthetists before and after brief ACLS training, and again three months later. METHOD: Thirty nurse anesthetists were tested for knowledge and skill before ACLS training comprising 1-hr lecture and handout, and 1-hr simulation training. Concepts included ABCD, primary and secondary survey, management, medications, and algorithms for common problems. Skill practice comprised airway management, chest compression and practice with equipment. After the training, the nurse anesthetists were immediately tested and again three months later. RESULTS: Age of participants averaged 39.33 + or - 3.14 years and working experience 10.04 +/- 3.23 years. The knowledge and skill scores pre- vs post-training vs three-months-later was 50.32 +/- 15.24 vs 75.40 +/- 10.29 (p < 0.001) vs 60.48 +/- 11.80 (p < 0.001) and 65.00 + 16.07 vs 79.67 +/- 10.80 (p < 0.001) vs 75.67 +/- 14.53 (p < 0.001), respectively. The pre-training vs three-months-post-training skill scores was not statistically different (p = 0.255). CONCLUSION: After the briefACLS training knowledge and skills were significantly improved, but knowledge was not retained at the post-training test levels until the 3-month check, albeit skills had persisted. More frequent ACLS education is necessary.