Comparison of minimal fresh gas requirements of baby enclosed afferent reservoir and Jackson Rees anesthetic circuit for general anesthesia in spontaneously breathing children.

OBJECTIVE: The authors compared the baby enclosed afferent reservoir (Baby EAR) with the Jackson-Rees (JR) anesthesia circuit for the minimal fresh gas flow (FGF) requirement with no and clinically acceptable rebreathing in spontaneous breathing anesthesia among pediatric patients. MATERIAL AND METHOD: The present study was a randomized crossover study. Twenty patients, weighing 5 to 20 kg with ASA physical status I-II were enrolled. They were allocated to group 1 (EAR-JR) starting with Baby EAR then switching to JR or group 2 (JR-EAR), reversedpattern. After induction and intubation, anesthesia was maintainedwith a N2O/O2 combination with sevoflurane 1 to 3% and fentanyl. Starting with the first circuit, all patients were spontaneously ventilated with FGF 500 mL/kg/min for 10 minutes, and then gradually decreased by 50 mL/kg/min every five minutes. End-tidal CO2 (ETCO) and inspired minimum CO2 (imCO) were recorded until rebreathing (imCO2 >2 mmHg) occurred and continued until rebreathing was not clinically acceptable (imCO2 >6 mmHg). The anesthesia breathing circuit was switched and the procedure repeated. RESULTS: The minimal FGF at no rebreathing of Baby EAR and JR were 192.5±76.6 and 347.5±108.2 mL/kg/min; p<0.001. At acceptable rebreathing, the values were 117.5±46.7 and 227.6±90.6 mL/kg/min; p< 0. 001. CONCLUSION: Baby EAR can be used safely, effectively, and requires less FGF than JR in pediatric anesthesia in patients weighing 5 to 20 kg.

Nursing care system development for patients with cleft lip-palate and craniofacial deformities at Srinagarind Hospital.

BACKGROUND: A holistic nursing care system for patients with cleft lip-palate (CLP) and/or craniofacial deformities was arranged by the Nursing Department, Srinagarind Hospital, which provides tertiary nursing care. The nursing care system was developed as per system theory via participating management with action research following the Deming Cycle (PDCA) divided into 3 phases. Participants included 117 nurses from 8 divisions caring for patients with CLP and 128 parent caregivers. The research instruments included: 1) situation analysis, 2) meeting and planning and 3) self-administered questionnaire. Groups were divided according to the age, physical and mental aspects of the patients. RESULTS: 1) The nursing care system under study comprised psychosocial care, breastfeeding, counseling, providing assistance in various ways in order to respond to problems of patients/families by the multidisciplinary team. There was also follow-up to evaluate the results and in order to give patients/families longitudinal and continuing care. 2) Minor research of 4 nursing sections was initiated. 3) Nursing care standards, manuals, regulations and innovations for the organization of eight nursing sections were created and implemented. CONCLUSION: The present study on developing a nursing care system for patients with CLP helped the team to (a) understand the overall nursing care system (b) to develop the organization of nurses by conducting research and (c) to create 12 works for developing care. The latter aimed to establish or create standards, nursing manuals, caring manuals, regulations, innovations, CDs, portfolios and informative cartoons to be applied systematically and shared across and between communities. The model for nursing care for patients with CLP in tertiary hospitals was clearly demonstrated.

Baby EAR circuit: a clinical determination of optimal fresh gas flow in spontaneous breathing anesthesia.

BACKGROUND: Baby EAR circuit is a new modified enclosed afferent reservoir anesthetic breathing system invented to use in pediatric patients. By following His Majesty the King of Thailand's self-sufficiency philosophy, the circuit is simplymade of low-cost and easy-to-find materials in the operating room. OBJECTIVE: Investigate clinical use of the circuit and to find the optimal fresh gas flow in spontaneous breathing anesthesia. MATERIAL AND METHOD: A prospective descriptive study was conducted in pediatric patients, who weighed 5-20 kg, anesthetized for surgery and divided into three groups of body weight: groups I (5 - <10 kg), groups II (10 - <15 kg), groups III (15-20 kg). The Baby EAR circuit was used for general anesthesia with endotracheal tube and spontaneous breathing. Different fresh gas flow of 4, 3.5, 3, 2.5, 2, and 1.5 liter per minute (LPM) was used consecutively The authors recorded end-tidal carbon dioxide (EtCO) and mean inspiratory carbon dioxide (ImCO2) while using fresh gas flow at 4, 3.5, 3, 2.5, 2, and 1.5 LPM. EtCO2 of 35-60 mmHg and ImCO2 of <6 mmHg were considered clinically acceptable. RESULTS: Thirty-five patients were enrolled in the present study Mean value (95% CI) of EtCO2, ImCO2 and fresh gas flow rate in group I were 42 +/- 3.2 (39.8, 44.2), 3 +/- 1.2 (2.2, 3.8) mmHg, and 1.7 +/- 0.6 (1.2, 2.1) LPM respectively. Mean value (95% CI) of EtCO2 ImCO2 and fresh gas flow rate in group II were 50 +/- 5.6 (47.2, 52.8), 3 +/- 0.9 (2.6, 3.4) mmHg, 2 +/- 0.4 (1.8, 2.2) LPM respectively. Mean value (95% CI) EtCO, ImCO2 and fresh gas flow rate in group III were 51 +/- 7.2 (46.7, 55.3), 2 +/- 1 (1.4, 2.6) mmHg, and 2 +/- 0.3 (1.8, 2.2) LPM respectively. No patients had serious complications in the present study. CONCLUSION: Baby EAR circuit can be made economically and used safelyfor general anesthesia with spontaneous breathing in pediatric patients who weighed 5-20 kg at optimal fresh gas flow rate of > or = 2.5 LPM