Surgical correction of vascular ring in Thai patients at a tertiary hospital.

BACKGROUND: Vascular ring is a rare congenital vascular disease. The result of vascular ring surgery in Thailand remains unknown as it lacks serial data. The purpose of the present study was to evaluate the result of vascular ring surgery at Siriraj Hospital and demonstrate the usefulness of the computed tomograph angiographic scanning (CTA) for preoperative anatomical diagnosis of the vascular ring for planning the surgical correction. MATERIAL AND METHOD: We reviewed our experiences for all patients that underwent vascular rings surgery at our institute between 1979 and 2009, about preoperative diagnostic imaging, operative technique, and clinical outcome. RESULTS: Twelve medical records of patients that underwent vascular rings surgery were reviewed. The age at time of operation ranged from one month to two years (median 3 months). The surgical approaches were eight median sternotomies, three left thoracotomies, and one right thoracotomy. There were two cases ofpostoperative complication (residual tracheal and left pulmonary artery stenosis and surgical bleeding). There was one hospital mortality (pneumonia and sepsis). CONCLUSION: Surgical correction of vascular ring is effective and safe. CTA can give the precise anatomic diagnosis of the vascular rings, lead to good surgical planning, proper surgical approach, and good outcome.

Low-dose spinal morphine for post-thoracotomy pain: a prospective randomized study.

OBJECTIVE: To compare the results of 0.2 mg and 0.3 mg of spinal morphine in patients with post-thoracotomy pain. DESIGN: A prospective, randomized, double-blind study. SETTING: A university hospital and a tertiary referral center. PARTICIPANTS: Forty patients undergoing thoracotomy for lung resection. INTERVENTIONS: Spinal morphine: 0.2 mg or 0.3 mg. METHODS AND MAIN RESULTS: Patients were randomly allocated to receive either 0.2 mg or 0.3 mg of spinal morphine for post-thoracotomy pain prior to general anesthesia. Cumulative 24- and 48-hour intravenous patient-controlled analgesia meperidine consumption and numeric rating scale score for pain were recorded. The severity score (4-point scale) of sedation, nausea, vomiting, and pruritus was assessed for interval during the postoperative period. The times to first drinking/eating/sitting/walking were recorded. There was no statistically significant difference in 24-hour postoperative meperidine usages between the 2 groups, which were 110 (interquartile range 90-180) and 95 (interquartile range 57.5-175) mg, respectively. The median pain free times, time to first drinking, eating, sitting, and walking showed no differences between the 2 groups. The numeric rating scale score for pain and incidences of side effects were not different between the 2 groups. One patient who received 0.3 mg of spinal morphine developed respiratory acidosis with a respiratory rate of 10 per minute at 44 minutes after extubation. CONCLUSIONS: In patients who underwent elective thoracotomy, 0.2 mg of spinal morphine was as effective as 0.3 mg. Increasing the dosage of spinal morphine does not decrease postoperative meperidine consumption, but may lead to respiratory depression in rare cases.

Validation of EuroSCORE for coronary artery bypass grafting at Siriraj Hospital.

OBJECTIVE: To access the performance of the EuroSCORE when applied to CABG patients at Siriraj hospital. MATERIAL AND METHOD: One thousand five hundred forty nine patients diagnosed with coronary artery disease (CAD) who underwent isolated CABG between January 2007 and December 2009 was prospectively studied. RESULTS: The patients included 1,102 men and 447 women and had a mean age of 67 years old. The mean additive score in expired and survived groups were 9.65 +/- 5.14 and 3.87 +/- 3.06. In logistic, score were 25.43 +/- 26.31 and 4.88 +/- 7.88 respectively (p < 0.001). The best cut-off value of EuroSCORE for prediction of a death rate was 6 for additive score and 10 for logistic score. Area under the curve was 0.831 for the additive score and 0.823 for the logistic score. The observed overall mortality rate was 2.0% while the predict mortality was 5.27%. The difference between observed and predicted deaths was significant with additive score and logistic score (p < 0.001). CONCLUSION: Our results suggest that EuroSCORE is not valid for CABG in Thai patient due to over prediction.