Maliwan Oofuvong - Academia.edu (original) (raw)

Papers by Maliwan Oofuvong

Trials, Mar 21, 2022

Background: The effective dose during ultrasound-guided rectus sheath block (URSB) for reducing p... more Background: The effective dose during ultrasound-guided rectus sheath block (URSB) for reducing pain after laparoscopic tubal ligation is reported to be 100 mg of 0.25% bupivacaine. We examined the minimal effective dose of 0.25% bupivacaine for URSB on oral analgesic requirement after ambulatory single-port laparoscopic tubal resection. Methods: A prospective, randomized controlled, superiority trial was conducted among patients who had been scheduled for ambulatory laparoscopic tubal resection between September 2015 and January 2019 at a tertiary care hospital in southern Thailand. Anesthesia was induced following protocol. The intervention group was allocated to receive a bilateral URSB using 10 ml of 0.25% bupivacaine on either side after intubation (total 50 mg) while the control group did not receive the sham block. Patients and assessors were blinded to the study intervention. All patients received a multimodal analgesia regimen as follows: fentanyl and ketorolac intraoperatively and fentanyl and oral acetaminophen at the post-anesthetic care unit. Postoperative oral analgesic requirement (acetaminophen and/or ibuprofen) at home was the primary outcome. Postoperative time to first analgesic requirement, oral analgesia (acetaminophen/ibuprofen), and pain score at 6 and 24 h were accessed via telephone interviews. Percentage, effect size (ES), and 95% confidence interval (CI) were presented.

Journal of the Medical Association of Thailand, Sep 15, 2021

Objective: The authors assessed whether anesthesia residents who acted as a scenario creators wou... more Objective: The authors assessed whether anesthesia residents who acted as a scenario creators would have better knowledge retention than their juniors 90 days after participating in a simulation-based anesthetists’ non-technical skills (ANTS) workshop. Materials and Methods: A prospective observational study via simulation ANTS workshop was conducted at a university hospital in southern Thailand in November 2017. Seven third-year post-graduate (PGY-3) residents volunteered as scenario creators, while the remaining anesthesia residents were randomly selected to participate in or observe three case scenarios, which were cardiac arrest, hypotension, and difficult ventilation. Resident’s knowledge was assessed before, immediately after, and 90 days after the workshop using a 20-item multiple-choice questionnaire. Predictors of change in knowledge scores were analyzed using multivariate linear regression analysis and presented as beta coefficient (β) and 95% confidence limits (CL). Results: Twenty-four anesthesia residents were recruited in the present study and included eight PGY-1, seven PGY-2, and nine PGY-3. The roles consisted of seven scenario creators, seven participants, and 10 observers. The overall immediate post-test and 90-day post-test scores increased significantly compared to the pre-test scores with a mean of 15.5 and 13.2 versus 11.7 (p<0.001 and p=0.007, respectively). The predictors of change in 90-day scores were PGY-3 versus PGY-1 (β 95% CL 4.0 [0.5 to 7.6], p=0.039), and role of participants and observers versus scenario creator (β 95% CL 5.5 [2.2 to 8.8] and 6.7 [2.8 to 10.6], p=0.004, respectively). Conclusion: Anesthesia residents who were participants or observers could improve their knowledge 90 days after a simulation-based ANTS workshop without necessarily being a scenario creator. Keywords: Anesthetists’ non-technical skill; Knowledge retention; Scenario creator; Simulation workshop

Journal of the Medical Association of Thailand Chotmaihet thangphaet, Dec 1, 2005

A reported case of postoperative bilateral brachial plexus neurapraxia associated with the use of... more A reported case of postoperative bilateral brachial plexus neurapraxia associated with the use of a Canadian frame in a patient who had thoracolumbar spinal surgery under general anesthesia. Symmetrical misposition of the upper pads of the Canadian frame underneath both shoulder heads during prolonged surgery led to direct compression on or stretching of the bilateral brachial plexus. This complication should be prevented by carefully placing the patient on this sort of frame.

British journal of medicine and medical research, Jan 10, 2015

Aims: The association between intraoperative respiratory events (IRE) and post-anesthetic care un... more Aims: The association between intraoperative respiratory events (IRE) and post-anesthetic care unit respiratory events (PARE) in children as well as the risk factors for PARE have not been described. The objectives of this study were to describe the association between IRE and PARE and to identify the risk factors of PARE in children at a tertiary care hospital in southern Thailand. Methodology: A historical cohort study based on the surveillance anesthetic database and chart review of children who received surgery at Songklanagarind Hospital during January 2005 to December 2011 was conducted. Demographic, surgery and anesthesia-related data were Original Research Article Oofuvong et al.; BJMMR, 6(11): 1101-1112, 2015; Article no.BJMMR.2015.288 1102 collected. The association between IRE and PARE and other potential risk factors were analyzed using cross tabulation. Multivariate logistic regression was employed to identify independent predictors for PARE, indicated by adjusted odds ratios (aOR) and their 95% confidence intervals (CI). Results: Overall, perioperative respiratory event (PRE) occurred in 531 out of 14153 children (315 IRE, 348 PARE). The association between PARE and IRE was strong, with adjusted odds ratios ranging from 3.1 (laryngospasm) to 18.5 (desaturation). Anesthesia-related risk factors for PARE were ASA classification 3 (aOR=3.1, 95%CI=1.9-5.0), jet ventilation (aOR=3.4, 95%CI=1.6-7.1), intubation with succinylcholine vs non-depolarizing muscle relaxant (aOR=1.9, 95%CI=1.4-2.5), use of intraoperative morphine vs fentanyl (aOR=2.4, 95%CI=1.7-3.3) and duration of anesthesia ≥ 3 hours (aOR=3.2, 95%CI=2.1-4.9). Conclusion: The magnitude of association between IRE and PARE was high. Increased vigilance and close monitoring by anesthesia personnel in high risk children and high risk surgery may prevent IRE and therefore also PARE, so that overall PRE can be reduced. Preventable risk factors for PARE such as using succinylcholine and morphine can be managed under discretion of the anesthesiologist.

PubMed, Mar 1, 2005

In this randomized, double blind placebo controlled study, the authors evaluated the effects of o... more In this randomized, double blind placebo controlled study, the authors evaluated the effects of oral clonidine premedication on very low dose epidural morphine analgesia in 50 hysterectomy patients. Patients were randomized to receive a single oral clonidine 300 microg (n = 25) or a placebo (n = 25) 90 minutes before insertion of the epidural catheter. 3 ml of 2% lidocaine with adrenaline (5 microg ml(-1) mixed with 2 mg morphine were injected via epidural, followed by an additional volume of 2% lidocaine with adrenaline (5 microg ml(-1)) titrated to T6 block height before commencing general anesthesia. The postoperative analgesia regimen was 2 mg of intravenous morphine every 10 minutes for the first 48 hr and 1 gm of oral acetaminophen every 4-6 hr after initiation of oral diet at 24-48 hr as required. Morphine consumption, acetaminophen, pain scores, and side effects were recorded thoughout 48 hr after surgery. The results show patients in the clonidine and placebo groups were not different in terms of local anesthetics dose (p = 0.27), total morphine and acetaminophen requirement (p = 0.34, p = 0.1) respectively. Pain scores at rest and movement were also not different in both groups (p = 0.83, p = 0.64) respectively. No serious adverse effects were noted. The authors concluded that oral clonidine approximately 6 microg kg(-1) does not enhance the analgesic effect of epidural morphine 2 mg after hysterectomy.

International Journal of Pediatric Otorhinolaryngology, Jul 1, 2019

Introduction: The age-based formula is commonly used to predict tracheal tube (TT) sizes although... more Introduction: The age-based formula is commonly used to predict tracheal tube (TT) sizes although its inaccuracy has been reported to reach as high as 60%. We aim to determine a practical formula using age in months and weight in kilograms to predict uncuffed tracheal tube (TT) size in children and infants. Methods: A retrospective cross-sectional study was conducted on data obtained from a prospective study on children aged less than 9 years who came for elective surgery and received general anesthesia with oroendotracheal tube intubation at Songklanagarind Hospital between September 2008 and December 2012. The uncuffed TT sizes were based on the agebased formulae and the discretion of the attending anesthesiologist. The age (in months), weight (in kg), and final TT size were measured. Univariate and multivariate linear regression analyses were used to find potential predictors of final uncuffed TT size and therefore the best formula. The correlation coefficient (r) for each model was calculated. The kappa statistic was used to measure the agreement between predicted and actual TT size. Results: A total of 668 patients were recruited. The age/weight formulae for infants aged ≤ 12 months and children aged > 12 months were 3.15 + (age [months] × 0.05) + (weight [kg] × 0.05) with r value of 0.75 (n=216) and 3.83 + (age [months] × 0.017) + (weight [kg] × 0.017) with r value of 0.85 (n=452), respectively. The formulae correctly predicted 69.0% and 65.0% of actual TT sizes for infants and children, respectively (both p < 0.001). The formulae for malnourished infants and children whose weights were less than the 3 rd percentile for age were 2.70 + (weight [kg] × 0.21) (n=43) and 3.59 + (age [months] × 0.012) + (weight [kg] × 0.056) (n=105) with r values of 0.81 and 0.87, respectively. Conclusion: The age/weight formula can be used to estimate TT size in infants and children. In failure to thrive children, our formula for malnourished children and infants provided high correlation with final TT sizes.

Scientific Reports, Sep 8, 2022

We aimed to determine the correlation between mid-glottic transverse diameter/subglottic diameter... more We aimed to determine the correlation between mid-glottic transverse diameter/subglottic diameter and outer diameter of endotracheal tube (ETT) by ultrasonography in children. Ninetyfive patients aged 1-8 years who underwent general anesthesia were included. Ultrasonography of glottic/subglottic transverse diameter was performed by two investigators after patients were anesthetized and when the train of four showed ≤ 4. The subglottic diameter was measured at the mid cricoid cartilage. The mid-glottic transverse diameter was measured at the mid-point of true vocal fold triangle whereas the distance between arytenoids was considered as the glottic transverse diameter. Linear regression models and correlation coefficients (r) were used to determine the best formula of glottic/subglottic transverse diameter to predict the outer diameter of ETT. The predicted outer diameter of ETT formula for subglottic diameter, mid-glottic transverse diameter, and glottic transverse diameter were 5.7 + (subglottic mm /3) with an r of 0.45, 5.5 + (midglottic mm /2) with an r of 0.47, and 5.7 + (glottic mm /4) with an r of 0.46, respectively. The correlation between subglottic diameter and mid-glottic transverse diameter was 0.50. Subglottic/mid-glottic/glottic transverse diameter formulae had moderate correlations with the outer diameter of ETT. The glottic/mid-glottic transverse diameter can be used alternatively to predict the ETT size. Trial registration: Thai Clinical Trial Registry: TCTR20191022002 Registered 22/10/2019-Prospectively registered, https://www.thaiclinicaltrials.org/# TCTR20191022002. Intubation is the definitive method of airway management. Inappropriate endotracheal tube (ETT) size, especially in children, may result in poor ventilation, unreliable end-tidal gas monitoring, and airway damage. Selecting the appropriate ETT size is especially important to prevent complications of intubation. Predictive formulae for appropriate ETT size in children have been based on age, weight, height, and the radius of the little finger 1-5. Agebased formulae are the simplest for physicians compared with the others. However, the correlation of age-based formulae for pediatric ETT size selection by the Cole formula was as low as 47-77% in previous studies 2,5,6. Using age-based formulae tends to predict ETT sizes that are too small 7. The diameter of the subglottic upper airway measured by ultrasonography in pediatric patients has been shown to have good correlation with ETT size 6-9. Nevertheless, the transverse diameter at the level of the vocal cord being the narrowest portion of the larynx in children, compared to the cricoid ring, has been mentioned in studies of magnetic resonance imaging (MRI) 10 and rigid video-bronchoscopy 11. Based on the anatomy of the glottis described by Eckel et al. 12 , the transverse plane of the glottis has two different parts in the vertical axis, separated by the tip of the vocal process. There are ligamental parts and arytenoid parts of the glottis 12,13. In a spontaneous breathing patient, the ligamental part, which we considered as the mid-glottic transverse diameter, might be the narrowest portion in the glottic transverse plane compared to the cricoid ring 13 .

Anesthesia & Clinical Research, 2020

Objective: In children, the grading of Bag-Mask Ventilation (BMV) difficulty and its association ... more Objective: In children, the grading of Bag-Mask Ventilation (BMV) difficulty and its association with difficult laryngoscopy/intubation has not been well established. This study aimed to evaluate the grading for BMV difficulty and determine its association with difficult laryngoscopy/intubation in a normal airway pediatric population. Methods: This prospective cohort study was conducted in children aged ≤9 years who underwent general anesthesia and oroendotracheal tube intubation between September 2008 and December 2012. Difficult laryngoscopy was defined as a Cormack-Lehane laryngoscopic view grade of 3 or 4. Difficult intubation was defined as the occurrence of at least two of the following: 1) at least three intubation attempts using direct laryngoscopy by experienced personnel (excluding first intubation attempts); 2) intubation time >300 s; and 3) occurrence of desaturation (SpO 2 <95%). The use of open airway maneuvers, including continuous positive airway pressure (CPAP), oropharyngeal airway (OPA), and two-person ventilation (TPV), or unsuccessful BMV were also considered. The association between BMV difficulty and difficult laryngoscopy/intubation was assessed using multivariate logistic regression with adjusted odds ratios (OR), 95% confidence intervals (CIs), and area under the receiver operating characteristic curve (AUC). Results: The incidence of difficult laryngoscopy/intubation was 6.4% (49/765). The categories of BMV difficulty were grade 0 (easy BMV without requiring an open airway maneuver, n=308), grade 1 (easy BMV after applying CPAP, n=368), grade 2 (successful BMV after inserting an OPA, n=16), grade 3 (successful BMV after applying TPV, n=71), and grade 4 (unsuccessful BMV after applying all airway maneuvers, n=2). Difficult BMV was defined as a BMV grade of 3 or 4 (v/s grades 0-2). After adjusting for age, body weight, history of snoring, type of operation, use of neuromuscular blocking agents, and first laryngoscopist, BMV difficulty was significantly associated with difficult laryngoscopy/intubation (adjusted OR [95% CI]=2.5 [1.1-5.5], sensitivity 0.59, specificity 0.74, AUC=0.70). Conclusion: A BMV grade of 3 (requiring TPV) or 4 (unsuccessful BMV) was associated with difficult laryngoscopy/ intubation in a pediatric population.

Pediatric Anesthesia, Aug 1, 2008

1 Vincent JL, Rossaint R, Riou B et al. Recommandations européennes pour l’utilisation du facteur... more 1 Vincent JL, Rossaint R, Riou B et al. Recommandations européennes pour l’utilisation du facteur VII activé recombinant comme thérapeutique adjuvante du saignement majeur. Ann Fr Anesth Reanim 2007; 26: 145–156. 2 Ekert H, Brizard C, Eyers R et al. Elective administration in infants of low-dose recombinant activated factor VII (rFVIIa) in cardiopulmonary bypass surgery for congenital heart disease does not shorten time to chest closure or reduce blood loss and need for transfusions: a randomized, double-blind, parallel group, placebo-controlled study of rFVIIa and standard haemostatic replacement therapy versus standard haemostatic replacement therapy. Blood Coagul Fibrinolysis 2006; 17: 389–395. 3 Boffard KD, Riou B, Warren B et al. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials. J Trauma 2005; 59: 8–15. 4 Martinowitz U, Kenet G, Segal E et al. Recombinant activated factor VII for adjunctive hemorrhage control in trauma. J Trauma 2001; 51: 431–438. 5 Clapson P, Perez JP, Debien B et al. Utilisation du rFVIIA (Novoseven) lors d’un accident des anticoagulants chez une patiente porteuse d’une prothese valvulaire mitrale. Ann Fr Anesth Reanim 2007; 26: 1063–1066. 6 Ingerslev J, Vanek T, Culic S. Use of recombinant factor VIIa for emergency reversal of anticoagulation. J Postgrad Med 2007; 53: 17–22. 7 Levi M, Peters M, Buller HR. Efficacy and safety of recombinant factor VIIa for treatment of severe bleeding: a systematic review. Crit Care Med 2005; 33: 883–890.

BMC Anesthesiology, Nov 2, 2018

Background: We aimed to construct a prediction tool for postoperative oxygen therapy and determin... more Background: We aimed to construct a prediction tool for postoperative oxygen therapy and determine predictors of duration of use among children undergoing non-cardiac surgery. Methods: Data from this case-control study was obtained from a database of 9820 children aged < 15 years who underwent general anesthesia between January 2010 and December 2013 at a tertiary care hospital in southern Thailand. The primary outcomes were the use and duration (hours) of postoperative oxygen therapy (cases). Cases were matched with controls on age group and year of surgery in a ratio of 1:4. A negative binomial hurdle model was used to obtain significant predictors of any use and number of hours of oxygen therapy. A risk score was derived from the coefficients of the significant predictors. The risk score, adjusted odds ratio (OR) for any use and count ratio (CR) for duration of postoperative oxygen therapy and 95% confidence interval (CI) were determined. Results: A total of 288 cases and 1152 controls were included. The median (inter-quartile range) duration of oxygen therapy delivered was 17 (9-22) hours. An optimal risk score for predictors of oxygen use was 12 (0-32) giving an area under the receiver operating characteristic curve of 0.93. Predictors of high risk need for oxygen therapy (score ≥ 12) were thoracic surgery (OR = 278, 95% CI = 44.6-1733) and having desaturation perioperatively (OR = 459.8, 95% CI = 169.7-1246). Intermediate risk factors (score 8-11) were having bronchospasm (OR = 92.4, 95% CI = 29.7-287.5) and upper airway obstruction/laryngospasm (OR = 61.5, 95% CI = 14.4-262.4) perioperatively. Significant predictors of duration of oxygen therapy were probably difficult airway (CR = 2.2, 95% CI = 1.4-3.5), history of delayed development (CR = 2.3, 95% CI = 1.5-3.6), airway (CR = 3.0, 95% CI = 1.6-5.8), orthopedic (CR = 2.1, 95% CI = 1.1-4.3), thoracic (CR = 4.9, 95% CI = 2.3-10.1) and abdominal surgery (CR = 4.2, 95% CI = 2.1-8.1), compared to eye surgery. Conclusions: Our risk prediction tool for the use of postoperative oxygen therapy provided a high predictive ability. Children who have thoracic surgery, desaturation, bronchospasm, upper airway obstruction or laryngospasm will most likely need postoperative oxygen therapy, regardless of other factors, while those with a probably difficult airway, history of delayed development, or thoracic/abdominal surgery will most likely need longer duration of oxygen therapy.

PubMed, Feb 1, 2012

Upper extremity deep vein thrombosis (UEDVT) is an increasingly important clinical entity with po... more Upper extremity deep vein thrombosis (UEDVT) is an increasingly important clinical entity with potential for considerable morbidity, especially pulmonary embolism (PE). Here, the authors report a fatal case of the massive PE after spinal surgery, along with the UEDVT of superior vena cava (SVC).

PubMed, Feb 1, 2012

Objective: Gabapentin has an antipruritus effect, which its efficacy in reducing pruritus induced... more Objective: Gabapentin has an antipruritus effect, which its efficacy in reducing pruritus induced by intrathecal morphine has not been well documented. The purpose of the present study was to know if a single smaller dose of gabapentin could decrease the intrathecal morphine-induced pruritus. Material and method: One hundred sixty eight patients from the 180 recruited patients fulfilled the trial requirement and were scheduled for orthopedic surgery under spinal anesthesia using 0.5% isobaric bupivacaine and 0.2 mg preservative-free morphine. The patients were divided into two groups, each of 84 subjects and received either gabapentin 600 mg or a placebo, two hours preoperatively, in a prospective, randomized, double-blind, placebo-controlled trial. The pruritus was evaluated at 1, 2, 3, 4, 6, 9, 12 and 24 hours after intrathecal morphine administration. Adverse events were noted. Results: The overall incidence of pruritus was not significantly different between the two groups while the incidence and severity of pruritus was significantly decreased in the gabapentin group at four hours after intrathecal morphine injection (18 of 84 subjects, 21.4% vs. 35 of 84 subjects, 41.7%; p = 0.008 and 0.045 respectively). The urinary retention was significantly higher in the study group compared to the placebo group (50.0% (42 of 84 subjects) vs. 33.3% (28 of 84 subjects) p = 0.042). Conclusion: Preoperative gabapentin 600 mg did not significantly reduce the postoperative intrathecal morphine-induced pruritus.

PubMed, Nov 1, 2013

Objective: To compare the incidence and severity of emergence agitation, recovery profile, and ad... more Objective: To compare the incidence and severity of emergence agitation, recovery profile, and adverse events between desflurane and sevoflurane anesthesia in unpremedicated pediatric ambulatory urologic surgery patients. Material and method: The study was conducted among 136 healthy children, aged six months to nine years, and randomized to two groups, sevoflurane and desflurane, during maintenance anesthesia with laryngeal mask airway. Recovery profile and perioperative adverse events were recorded. The emergence agitation (EA) was assessed using a 4-point scale by an anesthetist nurse in the recovery room who was blinded to the treatment. Results: The incidences of EA between sevoflurane/desflurane were not significantly different at 36.8%/41.2%, p = 0.73, and neither was the median (IQR) of severity (2 (1, 3)/2 (1, 3), p = 0.4). The awakening time in the desflurane group was 6.4 +/- 4.0 minutes, faster than in the sevoflurane group of 10.6 +/- 7.6 minutes (p < 0.001). The number of children having intraoperative respiratory events was significantly higher in the desflurane group (17), compared to the sevoflurane group (7) (p = 0.043). Conclusion: The occurrence of EA and adverse events between sevoflurane and desflurane were not different, except that the overall of intraoperative respiratory events was higher in desflurane group.

Journal of Health Science and Medical Research (JHSMR), Mar 1, 2023

Objective: We aimed to determine the plasma concentration 50 (CP 50) of propofol target controlle... more Objective: We aimed to determine the plasma concentration 50 (CP 50) of propofol target controlled infusion (TCI) for successful insertion of four types of supraglottic airway devices (SGD). Material and Methods: This prospective parallel randomized controlled, double blinded, superiority trial was conducted in June 2012 following approval by the Ethics Committee of the Faculty of Medicine,

Siriraj Medical Journal, Dec 1, 2022

Objective: We examined the association between midterm examinations and anaesthetists' non-techni... more Objective: We examined the association between midterm examinations and anaesthetists' non-technical skills (ANTS) knowledge using multiple choice questions (MCQs) for anaesthesia training. Materials and Methods: A prospective cross-sectional study was implemented based on two cohort studies conducted in November 2017 and November 2019 at the university hospital in southern Thailand. Each cohort consisted of MCQs, short answer questions (SAQs), objective structured clinical examinations (OSCEs), and MCQs after ANTS simulation workshops during the midterm examinations. The main exposure variable was the midterm examination (MCQs/ SAQs/ OSCEs) whereas the ANTS MCQs were the outcome. The potential predictors were the residents' role, sex, PGY (1-3), and competency. Associations between midterm examinations and ANTS MCQ scores were analysed using Pearson's correlation coefficients (r) and multivariate linear regression analysis, and presented as beta coefficient (β) and 95% confidence limit (CL). Results: Forty-eight anaesthesia residents were recruited for the study. After adjusting for PGY, knowledge score, and attitude evaluated by the staff, OSCE was found to be significantly associated with the pretest ANTS scores (β [95% CL]= 1.02 (0.06, 1.98)) and MCQ scores were significantly associated with the posttest ANTS scores (β [95% CL]= 0.14 (0.04, 0.24)). SAQ scores had negative associations with the pretest (β [95% CL]=-0.11 (-0.21,-0.01)) and posttest (β [95% CL]=-0.16 (-0.27,-0.05)) ANTS scores. It was found that there was a significant relationship between midterm examinations and posttest ANTS scores (r=0.52). Conclusion: Technical skills using OSCE and midterm MCQ examination scores were associated with non-technical skill knowledge in anaesthesia training.

Journal of Pain Research, Nov 1, 2021

Background: Cesarean section is the most common major surgery performed globally. Blood group O h... more Background: Cesarean section is the most common major surgery performed globally. Blood group O has been found as a factor affecting pain severity after cesarean section. We aimed to evaluate the predictive factors, including ABO blood group, for the amount of opioid consumption (measured as milligrams of morphine equivalent [MME]) within the first 24 hrs after cesarean section. Methods: This retrospective study was done in 1530 pregnant women who had a cesarean section under the same regimen of spinal anesthesia (2.2 mL of 0.5% hyperbaric bupivacaine and morphine 0.2 mg). All were prescribed regular paracetamol and ibuprofen for postoperative pain control. Univariate and multinomial regression analyses were performed to identify the predictive factors for opioid consumption in the first 24 hrs postoperatively. Results: About 2/5 of them (43.3%) received 0 mg MME, while 25.6%, 23.7% and 7.4% received 1-5, 6-10 and >10 mg MME, respectively. The majority have blood group O (40.6%), while 23.4%, 28% and 8% have blood group A, B and AB, respectively. After univariate and multinomial regression analyses, operation time, opioid consumption in PACU, maximum VNRS within the first 24 hrs and consumption of both paracetamol and ibuprofen were identified as predictive factors for postoperative opioid consumption. ABO blood group exhibited no correlation for opioid requirement postoperatively. Conclusion: ABO blood group is not a predictive factor for opioid requirement within the first 24 hrs following cesarean section. Duration of operation, opioid given in PACU, maximum VNRS on ward and consumption of both paracetamol and ibuprofen have been found to be predictive factors for postcesarean opioid requirement.

Journal of Health Science and Medical Research (JHSMR), Apr 12, 2023

Objective: We aimed to enhance the prediction of difficult intubation by using ultrasonographic p... more Objective: We aimed to enhance the prediction of difficult intubation by using ultrasonographic parameters (pre-epiglottic space (Pre-E), distance between epiglottis to middle part of vocal cord (E-VC) and Pre-E/E-VC) adjusting for traditional airway assessments. Material and Methods: This prospective cohort study was conducted at a super-tertiary care hospital in Thailand. Participants aged 18-65 years with ASA classification I-III and who required general anesthesia with endotracheal intubation were included. Preoperative traditional and ultrasonographic airway assessments were performed by two investigators. The outcome was difficult intubations as diagnosed by laryngoscopic view grade 3 or 4. Multivariate logistic regression was used to identify predictors for difficult intubation presented by adjusted odds ratio (OR) and 95% confidence interval (CI). Results: A total of 94 patients were recruited. The incidence of difficult intubation was 15%. The median Pre-E/E-VC ratio among this group was 0.8 compared with 1.0 in the control group (p-value 0.124). The cutoff point of <1.0 of Pre-E/E-VC was not associated with difficult intubation after adjusting for sex and other traditional parameters (p-value 0.11). Predictors of difficult intubation were female sex (OR [95% CI]: 13.8 [2.8, 68.3]), sternomental distance ≤175 mm (OR [95% CI]: 11.6 [1.9, 71.4]) and interincisor gap <4 cm (OR [95% CI]: 19.8 [1.1, 373.8]) with the area under the receiver operating characteristic curve at 0.88 and a specificity of 90.0%. Conclusion: There was no association between the Pre-E/E-VC in predicting difficult intubation in low-risk patients. The ultrasonographic measurements of Pre-E/E-VC were not helpful in predicting difficult intubations in our setting.

Congenital Heart Disease, 2022

Background: Studies on predictors of health-related quality of life (HRQOL) in pediatric patients... more Background: Studies on predictors of health-related quality of life (HRQOL) in pediatric patients with cyanotic heart disease who are waiting for the next stage and those who have undergone total repair are scarce. Therefore, we aimed to identify such predictors in children who received the modified Blalock-Taussig shunt (MBTS) and those who underwent total repair. Methods: In this historical cohort and concurrent follow-up study, data of children who underwent MBTS at the age of 0-3 years between January 2005 and December 2016 at a super-tertiary care hospital in Southern Thailand were obtained. Children who were alive in December 2017 were recruited to evaluate the quality of life at least 1 year after their operation. Between January and December 2018, the "Pediatric Quality of Life Inventory 4.0 Generic Core Scales" with both child self-report and parent proxy-report scores were used to examine the HRQOL. Multivariate linear regression analysis was performed to identify independent predictors of HRQOL. Beta-coefficient (β) and 95% confidence intervals (95% CIs) were calculated and considered statistically significant at p < 0.05. Results: Among the 380 enrolled children, 148 died, 122 survived and waited for total repair, and 110 survived after total repair. In the multivariate analysis, chronic lung disease was a common predictor of lower physical and psychosocial HRQOL reported by the parents (β [95% CI]: −0.42 [−0.81, −0.03] and −0.49 [−0.89, −0.09], respectively). Total repair was a predictor of higher physical HRQOL according to both parents and children (β [95% CI]: 0.33 [0.09, 0.57] and 0.70 [0.36, 1.03], respectively). A predictor of higher psychosocial HRQOL reported by the parents was younger age during MBTS surgery compared with older age (β [95% CI]: 0.012 [0.001, 0.022]). In the total repair subgroup, undergoing the Fontan procedure (vs. Glenn procedure) was a predictor for lower physical HRQOL reported by the parents (β [95% CI]: −0.82 [−1.52, −0.13]). Higher socioeconomic status was a predictor of both physical and psychosocial HRQOL (β [95%

Journal of Health Science and Medical Research (JHSMR), Nov 2, 2020

We report the first case of a patient under investigation for the 2019 novel coronavirus (COVID-1... more We report the first case of a patient under investigation for the 2019 novel coronavirus (COVID-19) who needed an open appendectomy at Songklanagarind Hospital. Spinal anesthesia was performed uneventfully. The preparation of the operating room as well as the anesthesia team and equipment are discussed.

Trials, Mar 21, 2022

Background: The effective dose during ultrasound-guided rectus sheath block (URSB) for reducing p... more Background: The effective dose during ultrasound-guided rectus sheath block (URSB) for reducing pain after laparoscopic tubal ligation is reported to be 100 mg of 0.25% bupivacaine. We examined the minimal effective dose of 0.25% bupivacaine for URSB on oral analgesic requirement after ambulatory single-port laparoscopic tubal resection. Methods: A prospective, randomized controlled, superiority trial was conducted among patients who had been scheduled for ambulatory laparoscopic tubal resection between September 2015 and January 2019 at a tertiary care hospital in southern Thailand. Anesthesia was induced following protocol. The intervention group was allocated to receive a bilateral URSB using 10 ml of 0.25% bupivacaine on either side after intubation (total 50 mg) while the control group did not receive the sham block. Patients and assessors were blinded to the study intervention. All patients received a multimodal analgesia regimen as follows: fentanyl and ketorolac intraoperatively and fentanyl and oral acetaminophen at the post-anesthetic care unit. Postoperative oral analgesic requirement (acetaminophen and/or ibuprofen) at home was the primary outcome. Postoperative time to first analgesic requirement, oral analgesia (acetaminophen/ibuprofen), and pain score at 6 and 24 h were accessed via telephone interviews. Percentage, effect size (ES), and 95% confidence interval (CI) were presented.

Journal of the Medical Association of Thailand, Sep 15, 2021

Objective: The authors assessed whether anesthesia residents who acted as a scenario creators wou... more Objective: The authors assessed whether anesthesia residents who acted as a scenario creators would have better knowledge retention than their juniors 90 days after participating in a simulation-based anesthetists’ non-technical skills (ANTS) workshop. Materials and Methods: A prospective observational study via simulation ANTS workshop was conducted at a university hospital in southern Thailand in November 2017. Seven third-year post-graduate (PGY-3) residents volunteered as scenario creators, while the remaining anesthesia residents were randomly selected to participate in or observe three case scenarios, which were cardiac arrest, hypotension, and difficult ventilation. Resident’s knowledge was assessed before, immediately after, and 90 days after the workshop using a 20-item multiple-choice questionnaire. Predictors of change in knowledge scores were analyzed using multivariate linear regression analysis and presented as beta coefficient (β) and 95% confidence limits (CL). Results: Twenty-four anesthesia residents were recruited in the present study and included eight PGY-1, seven PGY-2, and nine PGY-3. The roles consisted of seven scenario creators, seven participants, and 10 observers. The overall immediate post-test and 90-day post-test scores increased significantly compared to the pre-test scores with a mean of 15.5 and 13.2 versus 11.7 (p&amp;amp;amp;lt;0.001 and p=0.007, respectively). The predictors of change in 90-day scores were PGY-3 versus PGY-1 (β 95% CL 4.0 [0.5 to 7.6], p=0.039), and role of participants and observers versus scenario creator (β 95% CL 5.5 [2.2 to 8.8] and 6.7 [2.8 to 10.6], p=0.004, respectively). Conclusion: Anesthesia residents who were participants or observers could improve their knowledge 90 days after a simulation-based ANTS workshop without necessarily being a scenario creator. Keywords: Anesthetists’ non-technical skill; Knowledge retention; Scenario creator; Simulation workshop

Journal of the Medical Association of Thailand Chotmaihet thangphaet, Dec 1, 2005

A reported case of postoperative bilateral brachial plexus neurapraxia associated with the use of... more A reported case of postoperative bilateral brachial plexus neurapraxia associated with the use of a Canadian frame in a patient who had thoracolumbar spinal surgery under general anesthesia. Symmetrical misposition of the upper pads of the Canadian frame underneath both shoulder heads during prolonged surgery led to direct compression on or stretching of the bilateral brachial plexus. This complication should be prevented by carefully placing the patient on this sort of frame.

British journal of medicine and medical research, Jan 10, 2015

Aims: The association between intraoperative respiratory events (IRE) and post-anesthetic care un... more Aims: The association between intraoperative respiratory events (IRE) and post-anesthetic care unit respiratory events (PARE) in children as well as the risk factors for PARE have not been described. The objectives of this study were to describe the association between IRE and PARE and to identify the risk factors of PARE in children at a tertiary care hospital in southern Thailand. Methodology: A historical cohort study based on the surveillance anesthetic database and chart review of children who received surgery at Songklanagarind Hospital during January 2005 to December 2011 was conducted. Demographic, surgery and anesthesia-related data were Original Research Article Oofuvong et al.; BJMMR, 6(11): 1101-1112, 2015; Article no.BJMMR.2015.288 1102 collected. The association between IRE and PARE and other potential risk factors were analyzed using cross tabulation. Multivariate logistic regression was employed to identify independent predictors for PARE, indicated by adjusted odds ratios (aOR) and their 95% confidence intervals (CI). Results: Overall, perioperative respiratory event (PRE) occurred in 531 out of 14153 children (315 IRE, 348 PARE). The association between PARE and IRE was strong, with adjusted odds ratios ranging from 3.1 (laryngospasm) to 18.5 (desaturation). Anesthesia-related risk factors for PARE were ASA classification 3 (aOR=3.1, 95%CI=1.9-5.0), jet ventilation (aOR=3.4, 95%CI=1.6-7.1), intubation with succinylcholine vs non-depolarizing muscle relaxant (aOR=1.9, 95%CI=1.4-2.5), use of intraoperative morphine vs fentanyl (aOR=2.4, 95%CI=1.7-3.3) and duration of anesthesia ≥ 3 hours (aOR=3.2, 95%CI=2.1-4.9). Conclusion: The magnitude of association between IRE and PARE was high. Increased vigilance and close monitoring by anesthesia personnel in high risk children and high risk surgery may prevent IRE and therefore also PARE, so that overall PRE can be reduced. Preventable risk factors for PARE such as using succinylcholine and morphine can be managed under discretion of the anesthesiologist.

PubMed, Mar 1, 2005

In this randomized, double blind placebo controlled study, the authors evaluated the effects of o... more In this randomized, double blind placebo controlled study, the authors evaluated the effects of oral clonidine premedication on very low dose epidural morphine analgesia in 50 hysterectomy patients. Patients were randomized to receive a single oral clonidine 300 microg (n = 25) or a placebo (n = 25) 90 minutes before insertion of the epidural catheter. 3 ml of 2% lidocaine with adrenaline (5 microg ml(-1) mixed with 2 mg morphine were injected via epidural, followed by an additional volume of 2% lidocaine with adrenaline (5 microg ml(-1)) titrated to T6 block height before commencing general anesthesia. The postoperative analgesia regimen was 2 mg of intravenous morphine every 10 minutes for the first 48 hr and 1 gm of oral acetaminophen every 4-6 hr after initiation of oral diet at 24-48 hr as required. Morphine consumption, acetaminophen, pain scores, and side effects were recorded thoughout 48 hr after surgery. The results show patients in the clonidine and placebo groups were not different in terms of local anesthetics dose (p = 0.27), total morphine and acetaminophen requirement (p = 0.34, p = 0.1) respectively. Pain scores at rest and movement were also not different in both groups (p = 0.83, p = 0.64) respectively. No serious adverse effects were noted. The authors concluded that oral clonidine approximately 6 microg kg(-1) does not enhance the analgesic effect of epidural morphine 2 mg after hysterectomy.

International Journal of Pediatric Otorhinolaryngology, Jul 1, 2019

Introduction: The age-based formula is commonly used to predict tracheal tube (TT) sizes although... more Introduction: The age-based formula is commonly used to predict tracheal tube (TT) sizes although its inaccuracy has been reported to reach as high as 60%. We aim to determine a practical formula using age in months and weight in kilograms to predict uncuffed tracheal tube (TT) size in children and infants. Methods: A retrospective cross-sectional study was conducted on data obtained from a prospective study on children aged less than 9 years who came for elective surgery and received general anesthesia with oroendotracheal tube intubation at Songklanagarind Hospital between September 2008 and December 2012. The uncuffed TT sizes were based on the agebased formulae and the discretion of the attending anesthesiologist. The age (in months), weight (in kg), and final TT size were measured. Univariate and multivariate linear regression analyses were used to find potential predictors of final uncuffed TT size and therefore the best formula. The correlation coefficient (r) for each model was calculated. The kappa statistic was used to measure the agreement between predicted and actual TT size. Results: A total of 668 patients were recruited. The age/weight formulae for infants aged ≤ 12 months and children aged > 12 months were 3.15 + (age [months] × 0.05) + (weight [kg] × 0.05) with r value of 0.75 (n=216) and 3.83 + (age [months] × 0.017) + (weight [kg] × 0.017) with r value of 0.85 (n=452), respectively. The formulae correctly predicted 69.0% and 65.0% of actual TT sizes for infants and children, respectively (both p < 0.001). The formulae for malnourished infants and children whose weights were less than the 3 rd percentile for age were 2.70 + (weight [kg] × 0.21) (n=43) and 3.59 + (age [months] × 0.012) + (weight [kg] × 0.056) (n=105) with r values of 0.81 and 0.87, respectively. Conclusion: The age/weight formula can be used to estimate TT size in infants and children. In failure to thrive children, our formula for malnourished children and infants provided high correlation with final TT sizes.

Scientific Reports, Sep 8, 2022

We aimed to determine the correlation between mid-glottic transverse diameter/subglottic diameter... more We aimed to determine the correlation between mid-glottic transverse diameter/subglottic diameter and outer diameter of endotracheal tube (ETT) by ultrasonography in children. Ninetyfive patients aged 1-8 years who underwent general anesthesia were included. Ultrasonography of glottic/subglottic transverse diameter was performed by two investigators after patients were anesthetized and when the train of four showed ≤ 4. The subglottic diameter was measured at the mid cricoid cartilage. The mid-glottic transverse diameter was measured at the mid-point of true vocal fold triangle whereas the distance between arytenoids was considered as the glottic transverse diameter. Linear regression models and correlation coefficients (r) were used to determine the best formula of glottic/subglottic transverse diameter to predict the outer diameter of ETT. The predicted outer diameter of ETT formula for subglottic diameter, mid-glottic transverse diameter, and glottic transverse diameter were 5.7 + (subglottic mm /3) with an r of 0.45, 5.5 + (midglottic mm /2) with an r of 0.47, and 5.7 + (glottic mm /4) with an r of 0.46, respectively. The correlation between subglottic diameter and mid-glottic transverse diameter was 0.50. Subglottic/mid-glottic/glottic transverse diameter formulae had moderate correlations with the outer diameter of ETT. The glottic/mid-glottic transverse diameter can be used alternatively to predict the ETT size. Trial registration: Thai Clinical Trial Registry: TCTR20191022002 Registered 22/10/2019-Prospectively registered, https://www.thaiclinicaltrials.org/# TCTR20191022002. Intubation is the definitive method of airway management. Inappropriate endotracheal tube (ETT) size, especially in children, may result in poor ventilation, unreliable end-tidal gas monitoring, and airway damage. Selecting the appropriate ETT size is especially important to prevent complications of intubation. Predictive formulae for appropriate ETT size in children have been based on age, weight, height, and the radius of the little finger 1-5. Agebased formulae are the simplest for physicians compared with the others. However, the correlation of age-based formulae for pediatric ETT size selection by the Cole formula was as low as 47-77% in previous studies 2,5,6. Using age-based formulae tends to predict ETT sizes that are too small 7. The diameter of the subglottic upper airway measured by ultrasonography in pediatric patients has been shown to have good correlation with ETT size 6-9. Nevertheless, the transverse diameter at the level of the vocal cord being the narrowest portion of the larynx in children, compared to the cricoid ring, has been mentioned in studies of magnetic resonance imaging (MRI) 10 and rigid video-bronchoscopy 11. Based on the anatomy of the glottis described by Eckel et al. 12 , the transverse plane of the glottis has two different parts in the vertical axis, separated by the tip of the vocal process. There are ligamental parts and arytenoid parts of the glottis 12,13. In a spontaneous breathing patient, the ligamental part, which we considered as the mid-glottic transverse diameter, might be the narrowest portion in the glottic transverse plane compared to the cricoid ring 13 .

Anesthesia & Clinical Research, 2020

Objective: In children, the grading of Bag-Mask Ventilation (BMV) difficulty and its association ... more Objective: In children, the grading of Bag-Mask Ventilation (BMV) difficulty and its association with difficult laryngoscopy/intubation has not been well established. This study aimed to evaluate the grading for BMV difficulty and determine its association with difficult laryngoscopy/intubation in a normal airway pediatric population. Methods: This prospective cohort study was conducted in children aged ≤9 years who underwent general anesthesia and oroendotracheal tube intubation between September 2008 and December 2012. Difficult laryngoscopy was defined as a Cormack-Lehane laryngoscopic view grade of 3 or 4. Difficult intubation was defined as the occurrence of at least two of the following: 1) at least three intubation attempts using direct laryngoscopy by experienced personnel (excluding first intubation attempts); 2) intubation time >300 s; and 3) occurrence of desaturation (SpO 2 <95%). The use of open airway maneuvers, including continuous positive airway pressure (CPAP), oropharyngeal airway (OPA), and two-person ventilation (TPV), or unsuccessful BMV were also considered. The association between BMV difficulty and difficult laryngoscopy/intubation was assessed using multivariate logistic regression with adjusted odds ratios (OR), 95% confidence intervals (CIs), and area under the receiver operating characteristic curve (AUC). Results: The incidence of difficult laryngoscopy/intubation was 6.4% (49/765). The categories of BMV difficulty were grade 0 (easy BMV without requiring an open airway maneuver, n=308), grade 1 (easy BMV after applying CPAP, n=368), grade 2 (successful BMV after inserting an OPA, n=16), grade 3 (successful BMV after applying TPV, n=71), and grade 4 (unsuccessful BMV after applying all airway maneuvers, n=2). Difficult BMV was defined as a BMV grade of 3 or 4 (v/s grades 0-2). After adjusting for age, body weight, history of snoring, type of operation, use of neuromuscular blocking agents, and first laryngoscopist, BMV difficulty was significantly associated with difficult laryngoscopy/intubation (adjusted OR [95% CI]=2.5 [1.1-5.5], sensitivity 0.59, specificity 0.74, AUC=0.70). Conclusion: A BMV grade of 3 (requiring TPV) or 4 (unsuccessful BMV) was associated with difficult laryngoscopy/ intubation in a pediatric population.

Pediatric Anesthesia, Aug 1, 2008

1 Vincent JL, Rossaint R, Riou B et al. Recommandations européennes pour l’utilisation du facteur... more 1 Vincent JL, Rossaint R, Riou B et al. Recommandations européennes pour l’utilisation du facteur VII activé recombinant comme thérapeutique adjuvante du saignement majeur. Ann Fr Anesth Reanim 2007; 26: 145–156. 2 Ekert H, Brizard C, Eyers R et al. Elective administration in infants of low-dose recombinant activated factor VII (rFVIIa) in cardiopulmonary bypass surgery for congenital heart disease does not shorten time to chest closure or reduce blood loss and need for transfusions: a randomized, double-blind, parallel group, placebo-controlled study of rFVIIa and standard haemostatic replacement therapy versus standard haemostatic replacement therapy. Blood Coagul Fibrinolysis 2006; 17: 389–395. 3 Boffard KD, Riou B, Warren B et al. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials. J Trauma 2005; 59: 8–15. 4 Martinowitz U, Kenet G, Segal E et al. Recombinant activated factor VII for adjunctive hemorrhage control in trauma. J Trauma 2001; 51: 431–438. 5 Clapson P, Perez JP, Debien B et al. Utilisation du rFVIIA (Novoseven) lors d’un accident des anticoagulants chez une patiente porteuse d’une prothese valvulaire mitrale. Ann Fr Anesth Reanim 2007; 26: 1063–1066. 6 Ingerslev J, Vanek T, Culic S. Use of recombinant factor VIIa for emergency reversal of anticoagulation. J Postgrad Med 2007; 53: 17–22. 7 Levi M, Peters M, Buller HR. Efficacy and safety of recombinant factor VIIa for treatment of severe bleeding: a systematic review. Crit Care Med 2005; 33: 883–890.

BMC Anesthesiology, Nov 2, 2018

Background: We aimed to construct a prediction tool for postoperative oxygen therapy and determin... more Background: We aimed to construct a prediction tool for postoperative oxygen therapy and determine predictors of duration of use among children undergoing non-cardiac surgery. Methods: Data from this case-control study was obtained from a database of 9820 children aged < 15 years who underwent general anesthesia between January 2010 and December 2013 at a tertiary care hospital in southern Thailand. The primary outcomes were the use and duration (hours) of postoperative oxygen therapy (cases). Cases were matched with controls on age group and year of surgery in a ratio of 1:4. A negative binomial hurdle model was used to obtain significant predictors of any use and number of hours of oxygen therapy. A risk score was derived from the coefficients of the significant predictors. The risk score, adjusted odds ratio (OR) for any use and count ratio (CR) for duration of postoperative oxygen therapy and 95% confidence interval (CI) were determined. Results: A total of 288 cases and 1152 controls were included. The median (inter-quartile range) duration of oxygen therapy delivered was 17 (9-22) hours. An optimal risk score for predictors of oxygen use was 12 (0-32) giving an area under the receiver operating characteristic curve of 0.93. Predictors of high risk need for oxygen therapy (score ≥ 12) were thoracic surgery (OR = 278, 95% CI = 44.6-1733) and having desaturation perioperatively (OR = 459.8, 95% CI = 169.7-1246). Intermediate risk factors (score 8-11) were having bronchospasm (OR = 92.4, 95% CI = 29.7-287.5) and upper airway obstruction/laryngospasm (OR = 61.5, 95% CI = 14.4-262.4) perioperatively. Significant predictors of duration of oxygen therapy were probably difficult airway (CR = 2.2, 95% CI = 1.4-3.5), history of delayed development (CR = 2.3, 95% CI = 1.5-3.6), airway (CR = 3.0, 95% CI = 1.6-5.8), orthopedic (CR = 2.1, 95% CI = 1.1-4.3), thoracic (CR = 4.9, 95% CI = 2.3-10.1) and abdominal surgery (CR = 4.2, 95% CI = 2.1-8.1), compared to eye surgery. Conclusions: Our risk prediction tool for the use of postoperative oxygen therapy provided a high predictive ability. Children who have thoracic surgery, desaturation, bronchospasm, upper airway obstruction or laryngospasm will most likely need postoperative oxygen therapy, regardless of other factors, while those with a probably difficult airway, history of delayed development, or thoracic/abdominal surgery will most likely need longer duration of oxygen therapy.

PubMed, Feb 1, 2012

Upper extremity deep vein thrombosis (UEDVT) is an increasingly important clinical entity with po... more Upper extremity deep vein thrombosis (UEDVT) is an increasingly important clinical entity with potential for considerable morbidity, especially pulmonary embolism (PE). Here, the authors report a fatal case of the massive PE after spinal surgery, along with the UEDVT of superior vena cava (SVC).

PubMed, Feb 1, 2012

Objective: Gabapentin has an antipruritus effect, which its efficacy in reducing pruritus induced... more Objective: Gabapentin has an antipruritus effect, which its efficacy in reducing pruritus induced by intrathecal morphine has not been well documented. The purpose of the present study was to know if a single smaller dose of gabapentin could decrease the intrathecal morphine-induced pruritus. Material and method: One hundred sixty eight patients from the 180 recruited patients fulfilled the trial requirement and were scheduled for orthopedic surgery under spinal anesthesia using 0.5% isobaric bupivacaine and 0.2 mg preservative-free morphine. The patients were divided into two groups, each of 84 subjects and received either gabapentin 600 mg or a placebo, two hours preoperatively, in a prospective, randomized, double-blind, placebo-controlled trial. The pruritus was evaluated at 1, 2, 3, 4, 6, 9, 12 and 24 hours after intrathecal morphine administration. Adverse events were noted. Results: The overall incidence of pruritus was not significantly different between the two groups while the incidence and severity of pruritus was significantly decreased in the gabapentin group at four hours after intrathecal morphine injection (18 of 84 subjects, 21.4% vs. 35 of 84 subjects, 41.7%; p = 0.008 and 0.045 respectively). The urinary retention was significantly higher in the study group compared to the placebo group (50.0% (42 of 84 subjects) vs. 33.3% (28 of 84 subjects) p = 0.042). Conclusion: Preoperative gabapentin 600 mg did not significantly reduce the postoperative intrathecal morphine-induced pruritus.

PubMed, Nov 1, 2013

Objective: To compare the incidence and severity of emergence agitation, recovery profile, and ad... more Objective: To compare the incidence and severity of emergence agitation, recovery profile, and adverse events between desflurane and sevoflurane anesthesia in unpremedicated pediatric ambulatory urologic surgery patients. Material and method: The study was conducted among 136 healthy children, aged six months to nine years, and randomized to two groups, sevoflurane and desflurane, during maintenance anesthesia with laryngeal mask airway. Recovery profile and perioperative adverse events were recorded. The emergence agitation (EA) was assessed using a 4-point scale by an anesthetist nurse in the recovery room who was blinded to the treatment. Results: The incidences of EA between sevoflurane/desflurane were not significantly different at 36.8%/41.2%, p = 0.73, and neither was the median (IQR) of severity (2 (1, 3)/2 (1, 3), p = 0.4). The awakening time in the desflurane group was 6.4 +/- 4.0 minutes, faster than in the sevoflurane group of 10.6 +/- 7.6 minutes (p < 0.001). The number of children having intraoperative respiratory events was significantly higher in the desflurane group (17), compared to the sevoflurane group (7) (p = 0.043). Conclusion: The occurrence of EA and adverse events between sevoflurane and desflurane were not different, except that the overall of intraoperative respiratory events was higher in desflurane group.

Journal of Health Science and Medical Research (JHSMR), Mar 1, 2023

Objective: We aimed to determine the plasma concentration 50 (CP 50) of propofol target controlle... more Objective: We aimed to determine the plasma concentration 50 (CP 50) of propofol target controlled infusion (TCI) for successful insertion of four types of supraglottic airway devices (SGD). Material and Methods: This prospective parallel randomized controlled, double blinded, superiority trial was conducted in June 2012 following approval by the Ethics Committee of the Faculty of Medicine,

Siriraj Medical Journal, Dec 1, 2022

Objective: We examined the association between midterm examinations and anaesthetists' non-techni... more Objective: We examined the association between midterm examinations and anaesthetists' non-technical skills (ANTS) knowledge using multiple choice questions (MCQs) for anaesthesia training. Materials and Methods: A prospective cross-sectional study was implemented based on two cohort studies conducted in November 2017 and November 2019 at the university hospital in southern Thailand. Each cohort consisted of MCQs, short answer questions (SAQs), objective structured clinical examinations (OSCEs), and MCQs after ANTS simulation workshops during the midterm examinations. The main exposure variable was the midterm examination (MCQs/ SAQs/ OSCEs) whereas the ANTS MCQs were the outcome. The potential predictors were the residents' role, sex, PGY (1-3), and competency. Associations between midterm examinations and ANTS MCQ scores were analysed using Pearson's correlation coefficients (r) and multivariate linear regression analysis, and presented as beta coefficient (β) and 95% confidence limit (CL). Results: Forty-eight anaesthesia residents were recruited for the study. After adjusting for PGY, knowledge score, and attitude evaluated by the staff, OSCE was found to be significantly associated with the pretest ANTS scores (β [95% CL]= 1.02 (0.06, 1.98)) and MCQ scores were significantly associated with the posttest ANTS scores (β [95% CL]= 0.14 (0.04, 0.24)). SAQ scores had negative associations with the pretest (β [95% CL]=-0.11 (-0.21,-0.01)) and posttest (β [95% CL]=-0.16 (-0.27,-0.05)) ANTS scores. It was found that there was a significant relationship between midterm examinations and posttest ANTS scores (r=0.52). Conclusion: Technical skills using OSCE and midterm MCQ examination scores were associated with non-technical skill knowledge in anaesthesia training.

Journal of Pain Research, Nov 1, 2021

Background: Cesarean section is the most common major surgery performed globally. Blood group O h... more Background: Cesarean section is the most common major surgery performed globally. Blood group O has been found as a factor affecting pain severity after cesarean section. We aimed to evaluate the predictive factors, including ABO blood group, for the amount of opioid consumption (measured as milligrams of morphine equivalent [MME]) within the first 24 hrs after cesarean section. Methods: This retrospective study was done in 1530 pregnant women who had a cesarean section under the same regimen of spinal anesthesia (2.2 mL of 0.5% hyperbaric bupivacaine and morphine 0.2 mg). All were prescribed regular paracetamol and ibuprofen for postoperative pain control. Univariate and multinomial regression analyses were performed to identify the predictive factors for opioid consumption in the first 24 hrs postoperatively. Results: About 2/5 of them (43.3%) received 0 mg MME, while 25.6%, 23.7% and 7.4% received 1-5, 6-10 and >10 mg MME, respectively. The majority have blood group O (40.6%), while 23.4%, 28% and 8% have blood group A, B and AB, respectively. After univariate and multinomial regression analyses, operation time, opioid consumption in PACU, maximum VNRS within the first 24 hrs and consumption of both paracetamol and ibuprofen were identified as predictive factors for postoperative opioid consumption. ABO blood group exhibited no correlation for opioid requirement postoperatively. Conclusion: ABO blood group is not a predictive factor for opioid requirement within the first 24 hrs following cesarean section. Duration of operation, opioid given in PACU, maximum VNRS on ward and consumption of both paracetamol and ibuprofen have been found to be predictive factors for postcesarean opioid requirement.

Journal of Health Science and Medical Research (JHSMR), Apr 12, 2023

Objective: We aimed to enhance the prediction of difficult intubation by using ultrasonographic p... more Objective: We aimed to enhance the prediction of difficult intubation by using ultrasonographic parameters (pre-epiglottic space (Pre-E), distance between epiglottis to middle part of vocal cord (E-VC) and Pre-E/E-VC) adjusting for traditional airway assessments. Material and Methods: This prospective cohort study was conducted at a super-tertiary care hospital in Thailand. Participants aged 18-65 years with ASA classification I-III and who required general anesthesia with endotracheal intubation were included. Preoperative traditional and ultrasonographic airway assessments were performed by two investigators. The outcome was difficult intubations as diagnosed by laryngoscopic view grade 3 or 4. Multivariate logistic regression was used to identify predictors for difficult intubation presented by adjusted odds ratio (OR) and 95% confidence interval (CI). Results: A total of 94 patients were recruited. The incidence of difficult intubation was 15%. The median Pre-E/E-VC ratio among this group was 0.8 compared with 1.0 in the control group (p-value 0.124). The cutoff point of <1.0 of Pre-E/E-VC was not associated with difficult intubation after adjusting for sex and other traditional parameters (p-value 0.11). Predictors of difficult intubation were female sex (OR [95% CI]: 13.8 [2.8, 68.3]), sternomental distance ≤175 mm (OR [95% CI]: 11.6 [1.9, 71.4]) and interincisor gap <4 cm (OR [95% CI]: 19.8 [1.1, 373.8]) with the area under the receiver operating characteristic curve at 0.88 and a specificity of 90.0%. Conclusion: There was no association between the Pre-E/E-VC in predicting difficult intubation in low-risk patients. The ultrasonographic measurements of Pre-E/E-VC were not helpful in predicting difficult intubations in our setting.

Congenital Heart Disease, 2022

Background: Studies on predictors of health-related quality of life (HRQOL) in pediatric patients... more Background: Studies on predictors of health-related quality of life (HRQOL) in pediatric patients with cyanotic heart disease who are waiting for the next stage and those who have undergone total repair are scarce. Therefore, we aimed to identify such predictors in children who received the modified Blalock-Taussig shunt (MBTS) and those who underwent total repair. Methods: In this historical cohort and concurrent follow-up study, data of children who underwent MBTS at the age of 0-3 years between January 2005 and December 2016 at a super-tertiary care hospital in Southern Thailand were obtained. Children who were alive in December 2017 were recruited to evaluate the quality of life at least 1 year after their operation. Between January and December 2018, the "Pediatric Quality of Life Inventory 4.0 Generic Core Scales" with both child self-report and parent proxy-report scores were used to examine the HRQOL. Multivariate linear regression analysis was performed to identify independent predictors of HRQOL. Beta-coefficient (β) and 95% confidence intervals (95% CIs) were calculated and considered statistically significant at p < 0.05. Results: Among the 380 enrolled children, 148 died, 122 survived and waited for total repair, and 110 survived after total repair. In the multivariate analysis, chronic lung disease was a common predictor of lower physical and psychosocial HRQOL reported by the parents (β [95% CI]: −0.42 [−0.81, −0.03] and −0.49 [−0.89, −0.09], respectively). Total repair was a predictor of higher physical HRQOL according to both parents and children (β [95% CI]: 0.33 [0.09, 0.57] and 0.70 [0.36, 1.03], respectively). A predictor of higher psychosocial HRQOL reported by the parents was younger age during MBTS surgery compared with older age (β [95% CI]: 0.012 [0.001, 0.022]). In the total repair subgroup, undergoing the Fontan procedure (vs. Glenn procedure) was a predictor for lower physical HRQOL reported by the parents (β [95% CI]: −0.82 [−1.52, −0.13]). Higher socioeconomic status was a predictor of both physical and psychosocial HRQOL (β [95%

Journal of Health Science and Medical Research (JHSMR), Nov 2, 2020

We report the first case of a patient under investigation for the 2019 novel coronavirus (COVID-1... more We report the first case of a patient under investigation for the 2019 novel coronavirus (COVID-19) who needed an open appendectomy at Songklanagarind Hospital. Spinal anesthesia was performed uneventfully. The preparation of the operating room as well as the anesthesia team and equipment are discussed.