Thepakorn Sathitkarnmanee - Academia.edu (original) (raw)
Papers by Thepakorn Sathitkarnmanee
PeerJ
Background The function and viability of the brain depend on adequate oxygen supply. A decrease i... more Background The function and viability of the brain depend on adequate oxygen supply. A decrease in cerebral blood supply causing cerebral desaturation may lead to many neurological complications. Direct measurement of regional cerebral oxygen saturation (rScO2) assists in early detection and management. Near-infrared spectroscopy (NIRS) has been introduced for measuring rScO2. A pair of sensors are attached to the right and left forehead. However, there are some situations where the forehead of the patient is not accessible for sensor attachment (e.g., neurosurgery involving the frontal area; a bispectral index (BIS) sensor already attached, or a wound to the forehead); therefore, alternate sites for sensor attachment are required. The temporal area was proposed as an alternate site. The objective of this study was to assess the correlation and agreement of rScO2 measured at the forehead vs. the temporal area. Methods Adult patients undergoing cardiothoracic or vascular surgery were...
Journal of the Medical Association of Thailand, May 1, 2018
Background: Early goal-directed therapy (EGDT) using FloTrac reduced length of stay (LOS) in inte... more Background: Early goal-directed therapy (EGDT) using FloTrac reduced length of stay (LOS) in intensive care (ICU) and hospital among patients undergoing coronary artery bypass graft (CABG) with a cardiopulmonary bypass (CPB). However, this platform in off-pump CABG (OPCAB) has received scant attention, so we evaluated the efficacy of EGDT using FloTrac/EV1000 as a modality for improving postoperative outcomes in patients undergoing OPCAB.Methods: Forty patients undergoing OPCAB were randomized to the EV1000 or Control group. The Control group received fluid, inotropic, or vasoactive drugs (at the discretion of the attending anesthesiologist) to maintain a mean arterial pressure 65-90 mmHg; central venous pressure 8-12 mmHg; urine output ≥ 0.5 mL·kg-1·h-1; SpO2 > 95%; and hematocrit ≥ 30%. The EV1000 group achieved identical targets using information from the FloTrac/EV1000. The goals included stroke volume variation (SVV) < 13%; stroke volume index (SVI) of 33-65 mL·beat-1·m-2...
Copyright © 2014 Thepakorn Sathitkarnmanee et al. This is an open access article distributed unde... more Copyright © 2014 Thepakorn Sathitkarnmanee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. We propose a 1-1-12 wash-in scheme for desflurane-nitrous oxide (N 2 O) low-flow anesthesia. The objective of our study was to determine the time to achieve alveolar concentration of desflurane (FAD) at 1, 2, 3, 4, 5, and 6%.Methods. We enrolled 106 patients scheduled for elective surgery under general anesthesia. After induction and intubation, wash-in was started with a fresh gas flow (FGF) of N 2 O:O 2
BMC Anesthesiology, 2021
Background The Analgesia Nociception Index (ANI) has been suggested as a non-invasive guide for a... more Background The Analgesia Nociception Index (ANI) has been suggested as a non-invasive guide for analgesia. Our objective was to compare the efficacy of ANI vs. standard pharmacokinetic pattern for guiding intraoperative fentanyl administration. Methods This was a prospective, randomized, controlled study of adult female patients undergoing elective mastectomy under general anesthesia. The patients were randomized to the ANI-guided group receiving a loading dose of 75 μg of fentanyl followed by 25 μg when the ANI score was under 50. The Control group received the same loading dose followed by 25 μg every 30 min with additional doses when there were signs of inadequate analgesia (viz., tachycardia or hypertension). Results Sixty patients—30 in each group—were recruited. Although the actual mean ANI score was higher in the ANI-guided than in the Control group (mean difference 2.2; 95% CI: 0.3 to 4.0, P = 0.022), there was no difference in the primary outcome—i.e., intraoperative fenta...
Background: Postoperative nausea and vomiting (PONV) continues to be a significant problem in pat... more Background: Postoperative nausea and vomiting (PONV) continues to be a significant problem in patient undergoing breast surgery. Routine use of nasogastric (NG) tube or orogastric (OG) tube has been suggested to prevent PONV despite conflicting data. Objective: To determine the efficacy of intraoperative OG tube insertion for gastric decompression in reducing early PONV incidence in breast surgery. Methods: Our study was a prospective, randomized, double-blind trial. One hundred and thirty eight patients undergoing elective breast surgery in Srinagarind Hospital between October 2013 and September 2014 were enrolled into 2 groups. Group I received OG tube, while Group II did not receive OG tube after induction of anesthesia. Standard anesthetic technique, including PONV prophylactic drugs, and postoperative care were employed in all patients. PONV score, classified into grade 1 and 2, were recorded at 2- and 4-hour after the end of surgery. Incidence of grade 2 PONV at 2- and 4-hour ...
Background and objective : Customer satisfaction is an indicator for quality assurance of departm... more Background and objective : Customer satisfaction is an indicator for quality assurance of department of Anesthesiology, Srinagarind hospital. Ward nurses are internal customers of whom satisfaction has not been assessed for long time. The objective of this study was to assess satisfaction of ward nurses regarding anesthetic service during perioperative period. We also identified the subjects that need continuous quality improvement. Methods : This was a prospective, descriptive study performed during May and July 2016. Inclusion criterion were ward nurses whose job were related to anesthesia personnel for at least 1 year. The exclusion criterion were visiting ward nurses from other hospitals. We distributed questionnaire, 10 per ward, to 45 wards (total 450 questionnaires). The questionnaire comprised 2 parts; part 1 covered demographic data, while part 2 contained levels of satisfaction with score 1 to 4, as well as open-ended comments on subjects that needed improvement. The qu...
Background and objective : Postoperative nausea-vomiting (PONV) is a common postoperative complic... more Background and objective : Postoperative nausea-vomiting (PONV) is a common postoperative complication. It causes patients discomfort and morbidity. Anesthesia service at Queen Sirikit Heart Center of the Northeast has never assessed this problem. The objective of this study was to identify the incidence and related factors of PONV which will be used to develop clinical practice guideline to decrease this issue for quality improvement. Methods : This was a retrospective, exploratory and analytical study. Inclusion criteria were adult patients undergoing elective cardiovascular thoracic surgery at Queen Sirikit Heart Center of the Northeast between January 1981 and December 1983. Demographic and relevant perioperative data until 48 hr postoperatively were retrieved from medical records and analyzed to identify incidence and related factors. Results : Among 745 patients recruited, we found 108 cases of PONV. The incidence of PONV was 14.5%. Most of the patients had PONV during 6-...
Medical Devices (Auckland, N.Z.), 2021
Purpose Early goal-directed therapy (EGDT) using the FloTrac system reportedly improved postopera... more Purpose Early goal-directed therapy (EGDT) using the FloTrac system reportedly improved postoperative outcomes among high-risk patients undergoing non-cardiac surgery. This study’s objective was to evaluate the FloTrac/EV1000 platform’s efficacy for improving postoperative outcomes in cardiac surgery. Patients and Methods Eighty-six adults undergoing coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) in 2 tertiary referral centers were randomized to the EGDT or Control group. The Control group was managed with standard care to achieve the following goals: mean arterial pressure 65–90 mmHg; central venous pressure 8–12 mmHg; urine output ≥0.5 mL·kg−1·h−1; oxygen saturation >95%; and hematocrit 26–30%. The EGDT group was managed to reach similar goals using information from the FloTrac/EV1000 monitor. The targets were stroke volume variation <13%; stroke volume index 33–65 mL·beat−1·m−2; cardiac index 2.2–4.0 L·min−1·m−2; and systemic vascular resistance index...
Background and objective: Percutaneous nephrolithotomy (PCNL) is gaining popularity because of it... more Background and objective: Percutaneous nephrolithotomy (PCNL) is gaining popularity because of its advantages i.e., smaller wounds, less pain and shorter hospital stay, nevertheless, pneumothorax, hydrothorax or hemothorax cannot be avoided. Our department developed and promulgated a practice guideline (CPG) for prevention and management of these conditions in May 2012. The objective of our study is to evaluate this CPG for its effectiveness and use the information to improve the CPG for continuous quality improvement. Methods: This is a prospective, descriptive study. We recruited all cases of PCNL performed after implementation of the CPG between October 2012 and September 2013 in Srinagarind hospital. Results: There were 66 cases of PCNL with 11 cases of pneumothorax, hydrothorax or hemothorax. The incidence is 16.7%. Most of the cases were females, aged more than 15 years, and with supracostal access. Hydrothorax was 81.8% of the incidents. Eight cases had mild symptom w...
1Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thail... more 1Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand; 2Phramongkutklao Hospital, Bangkok, 10400, Thailand Purpose: Early goal-directed therapy (EGDT) using the FloTrac system reportedly improved postoperative outcomes among high-risk patients undergoing non-cardiac surgery. This study’s objective was to evaluate the FloTrac/EV1000 platform’s efficacy for improving postoperative outcomes in cardiac surgery. Patients and Methods: Eighty-six adults undergoing coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) in 2 tertiary referral centers were randomized to the EGDT or Control group. The Control group was managed with standard care to achieve the following goals: mean arterial pressure 65–90 mmHg; central venous pressure 8–12 mmHg; urine output ≥0.5 mL·kg·h; oxygen saturation >95%; and hematocrit 26–30%. The EGDT group was managed to reach similar goals using information from the FloTrac/EV1000 monitor. The targets ...
ความพงพอใจของแพทยผาตดทมตองานวสญญ ในโรงพยาบาลศรนครนทร จงหวดขอนแกน ยธดา ชยกร, สรรตน ตรพทธรตน, เทพกร... more ความพงพอใจของแพทยผาตดทมตองานวสญญ ในโรงพยาบาลศรนครนทร จงหวดขอนแกน ยธดา ชยกร, สรรตน ตรพทธรตน, เทพกร สาธตการมณ, จกรทพย สทธนรากร, อภญญา อญชล, มณรตน ธนานนต ภาควชาวสญญวทยา คณะแพทยศาสตร มหาวทยาลยขอนแกน หลกการและวตถประสงค : แพทยผาตดเปนผรบบรการภายใน (internal customer) ของภาควชาวสญญวทยาทตองใหความสำคญ และทำใหเกดความพงพอใจ ซงจะนำมาสการพฒนาคณภาพงานรวมกนเปนทมสหสาขาวชาชพ การวจยครงนมวตถประสงค เพอศกษาระดบความพงพอใจ ปญหาและความตองการของแพทยผาตดเกยวกบงานวสญญ วธการศกษา : เปนการศกษาไปขางหนาเชงพรรณนา ดำเนนการระหวางเดอนพฤษภาคมถงกรกฎาคม พ.ศ. 2559 เกณฑการคดเขาของกลมตวอยาง คอ แพทยผาตดทงอาจารยแพทย แพทยใชทนและแพทยประจำบานชนปท 1-4 ในโรงพยาบาลศรนครนทร โดยสงแบบสอบถามทงหมด 110 ชด แบบสอบถามแบงเปน 2 ตอน คอ ตอนท 1 ขอมลพนฐาน และตอนท 2 ระดบความพงพอใจของแพทยผาตดทมตองานวสญญรวมถงคำถามปลายเปดเกยวกบปญหาและอปสรรคทพบในงานวสญญ แบบสอบถามผานการตรวจสอบความแมนตรงของเนอหาจากวสญญแพทยอาวโส 2 ทาน โดยมคาคะแนน 1 ถง 4 และนำมาวเคราะหคาสถตเปนจำนวน รอยละ คาเฉลย และสวนเบยงเบนมาตรฐาน วเคราะหโดยใชโปรแกรม SPSS 16 ผลการศกษา : ไดรบแบบสอบถามคน...
Background and objective: Pulmonary aspiration is a serious anesthetic complication. The incidenc... more Background and objective: Pulmonary aspiration is a serious anesthetic complication. The incidence in our hospital was 7.6:10,000. Our department developed and implemented a clinical practice guideline (CPG) for prevention of pulmonary aspiration in July 2010. The purpose of our study is to evaluate and enhance the implemented CPG for continuous quality improvement. Methods: This was a retrospective, descriptive study. We reviewed every case which received anesthetic service in Srinagarind Hospital for perioperative pulmonary aspiration after implementation of the CPG for prevention of pulmonary aspiration between July 2010 and June 2011. The incidence and causes were identified and explored. Results: We found 17 cases of pulmonary aspiration from 28,005 cases. The incidence was 6.1:10,000. The first 3 causes were the personnel not following the CPG in the following actions in high risk patients: 1) prophylactic medication; 2) aspirating gastric content before induction; and 3) rapi...
Background and Objective : Customer satisfaction is one of the indicators for quality assurance o... more Background and Objective : Customer satisfaction is one of the indicators for quality assurance of the department of Anesthesiology, Scrub nurses and medical personnels are internal customers of whom satisfaction level has not been assessed for long time. The objective of current study was to determine satisfaction level of scrub nurses and medical personnels regarding anesthetic service during perioperative period. We also identified the subjects that need continuous quality improvement. Methods : This was a prospective, descriptive study performed during May and July, 2016. The inclusion criteria were scrub nurses and medical personnels who were related to anesthetic service at Srinagarind hospital. We distributed 60 questionnaires. The questionnaire, with score 1 to 4, comprised questions regarding satisfaction with anesthetic service during preoperative, intra operative, and immediate postoperative period. It was validated by 2 senior anesthesiologists. The data were analyze...
Background and Objective : TheMapleson A breathing system is the most efficient breathing system ... more Background and Objective : TheMapleson A breathing system is the most efficient breathing system in spontaneous breathing anaesthetized pediatric patients with economical use of gases and inhalation agent, less in operating room pollution, less respiratory complication but many anesthesiologists still use the Mapleson F or Jackson- Rees breathing system which is less efficient instead. The parallel pediatric ADE breathing system in mode Acan be functioned as the Mapleson A breathing system. In this study, we would like to compare efficiency of the parallel pediatric ADE breathing system in mode A with Jackson-Rees breathing system on fresh gas flow consumption. Material and Method : This study was a randomized cross-over study. Twenty four patients,weighing 5 to 20 kg, with ASA physical status I-II and planned to undergo surgery sunder combined caudal anesthesia with general anesthesiawere enrolled. They were allocated into group I(ADE/A-JR) starting with the parallel pediatric AD...
Background Sevoflurane is suitable for low-flow anesthesia (LFA). LFA needs a wash-in phase. The ... more Background Sevoflurane is suitable for low-flow anesthesia (LFA). LFA needs a wash-in phase. The reported sevoflurane wash-in schemes lack simplicity, target coverage, and applicability. We proposed a one-step 1-1-8 wash-in scheme for sevoflurane-nitrous oxide (N2O) LFA. The objective of our study was to identify times to achieve every alveolar concentration of sevoflurane (FAS) from 1% to 3.5%. Methods We recruited 102 adults requiring general anesthesia with endotracheal intubation and controlled ventilation. After induction and intubation, a wash-in was started using a fresh gas flow of oxygen (O2):N2O at 1:1 L·min-1 plus sevoflurane 8%. The ventilation was controlled to maintain end-tidal carbon dioxide (CO2) of 30-35 mmHg. Results The rising patterns of FAS and inspired concentration of sevoflurane (FIS) are similar and parallel. The FAS/FIS ratio increased from 0.46 to 0.72 within 260 sec. The respective times to achieve FAS of 1%, 1.5%, 2%, 2.5%, 3% and 3.5% were 1, 1.5, 2, 3...
Anesthesia & Analgesia, 2016
Background and objective: Lack’s circuit is a modified co-axial Mapleson A breathing system that ... more Background and objective: Lack’s circuit is a modified co-axial Mapleson A breathing system that is commonly used in spontaneously breathing anaesthetized adults. Lack-Plus circuit is a modified Lack circuit with additional intraluminal one-way valve and active gas scavenging system which can minimize fresh gas flow (FGF), save anaesthetic gas and decrease operating room environment pollution. Thus, the objective of this study was to compare the Lack-Plus and Lack’s circuit on the minimal FGF requirement with no and clinically acceptable rebreathing in spontaneously breathing anesthetized adults, and to invent the Lack-Plus circuit. Material and Method: Our study was a randomized cross-over study. Twenty-four adult patients with BMI ≤ 30 kg/m 2 , under elective peripheral surgery in supine position with ASA physical status I-II were enrolled. They were allocated into group 1 (LP-L) starting with Lack-Plus then switching to Lack’s circuit or group 2 (L-LP) in reversed pattern. After induction and intubation, anesthesia was maintained with 50% N 2 O/O 2 and Desflurane 4 to 6% and fentanyl titration to control optimal respiratory rate in the range of 10 to 16/min. Starting with the first circuit, all patients were spontaneously breathing with FGF 4 L/min for 10 minutes, and then gradually decreased by 0.5 L/min every five minutes. End-tidal CO 2 (ETCO 2 ), inspired minimum CO 2 (ImCO 2 ), mean arterial pressure (MAP) and oxygen saturation (SpO 2 ) were recorded until rebreathing (ImCO 2 > 0 mmHg) occurred and continued until the FGF was 2.5 L/min. The anesthesia breathing circuit was then switched to the other and the procedure repeated. Results: The minimal FGF at the point of rebreathing of Lack-Plus and Lack’s circuit were 2.7 ± 0.8 and 3.3 ± 0.5 L/min respectively; p<0.001. At the FGF 2.5 L/min, ImCO 2 were 1.5 ± 2.0 and 4.2 ± 2.6 mmHg respectively; p<0.001. Conclusion: Lack-Plus circuit can be used safely, effectively, and requires less FGF than Lack’s circuit in spontaneously breathing anaesthetized adults.
Srinagarind Medical Journal ศรีนครินทร์เวชสาร, Mar 1, 2010
Background : Regional anesthesia is the common anesthetic procedure for patients undergoing low... more Background : Regional anesthesia is the common anesthetic procedure for patients undergoing lower abdomen and lower extremity surgery. Anesthesia-personnel should be aware of the common complications for patient safety. Objective : To survey anesthesia-personnel’s knowledge of complications from regional anesthesia. Design : Descriptive study Setting : Srinagarind Hospital, Department of Anesthesiology, Faculty of Medicine. Population : 51 anesthesia-personnel : 39 nurse- anesthetists and 12 residents. Methods : Anesthesia-personnel answered the questionnaire (13 items, created by the research team) during a one-hour classroom period. The answer sheets were analyzed for difficulty index (“p”), and the discrimination index (“r”). The data were analyzed using descriptive statistics. Results : Fifty anesthesia-personnel answered the questionnaire: 39 nurse - anesthetists (78.00%) and 11 residents (22.00%). Respondents averaged 36.18 ± 7.23 years of age and 7.70 ± 6.26 years of experience in anesthesia. We found that the anesthesia-personnel had averaged 80.31%(or had a good level of knowledge). Age and years of experience did not correlate with the level of knowledge. Residents scored significantly higher than nurse-anesthetists (88.08 vs. 78.08%, respectively)(p=0.01). Conclusion : The knowledge of complications from regional anesthesia was of a good level among anesthesia-personnel practising at Srinagarind Hospital.
PeerJ
Background The function and viability of the brain depend on adequate oxygen supply. A decrease i... more Background The function and viability of the brain depend on adequate oxygen supply. A decrease in cerebral blood supply causing cerebral desaturation may lead to many neurological complications. Direct measurement of regional cerebral oxygen saturation (rScO2) assists in early detection and management. Near-infrared spectroscopy (NIRS) has been introduced for measuring rScO2. A pair of sensors are attached to the right and left forehead. However, there are some situations where the forehead of the patient is not accessible for sensor attachment (e.g., neurosurgery involving the frontal area; a bispectral index (BIS) sensor already attached, or a wound to the forehead); therefore, alternate sites for sensor attachment are required. The temporal area was proposed as an alternate site. The objective of this study was to assess the correlation and agreement of rScO2 measured at the forehead vs. the temporal area. Methods Adult patients undergoing cardiothoracic or vascular surgery were...
Journal of the Medical Association of Thailand, May 1, 2018
Background: Early goal-directed therapy (EGDT) using FloTrac reduced length of stay (LOS) in inte... more Background: Early goal-directed therapy (EGDT) using FloTrac reduced length of stay (LOS) in intensive care (ICU) and hospital among patients undergoing coronary artery bypass graft (CABG) with a cardiopulmonary bypass (CPB). However, this platform in off-pump CABG (OPCAB) has received scant attention, so we evaluated the efficacy of EGDT using FloTrac/EV1000 as a modality for improving postoperative outcomes in patients undergoing OPCAB.Methods: Forty patients undergoing OPCAB were randomized to the EV1000 or Control group. The Control group received fluid, inotropic, or vasoactive drugs (at the discretion of the attending anesthesiologist) to maintain a mean arterial pressure 65-90 mmHg; central venous pressure 8-12 mmHg; urine output ≥ 0.5 mL·kg-1·h-1; SpO2 > 95%; and hematocrit ≥ 30%. The EV1000 group achieved identical targets using information from the FloTrac/EV1000. The goals included stroke volume variation (SVV) < 13%; stroke volume index (SVI) of 33-65 mL·beat-1·m-2...
Copyright © 2014 Thepakorn Sathitkarnmanee et al. This is an open access article distributed unde... more Copyright © 2014 Thepakorn Sathitkarnmanee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. We propose a 1-1-12 wash-in scheme for desflurane-nitrous oxide (N 2 O) low-flow anesthesia. The objective of our study was to determine the time to achieve alveolar concentration of desflurane (FAD) at 1, 2, 3, 4, 5, and 6%.Methods. We enrolled 106 patients scheduled for elective surgery under general anesthesia. After induction and intubation, wash-in was started with a fresh gas flow (FGF) of N 2 O:O 2
BMC Anesthesiology, 2021
Background The Analgesia Nociception Index (ANI) has been suggested as a non-invasive guide for a... more Background The Analgesia Nociception Index (ANI) has been suggested as a non-invasive guide for analgesia. Our objective was to compare the efficacy of ANI vs. standard pharmacokinetic pattern for guiding intraoperative fentanyl administration. Methods This was a prospective, randomized, controlled study of adult female patients undergoing elective mastectomy under general anesthesia. The patients were randomized to the ANI-guided group receiving a loading dose of 75 μg of fentanyl followed by 25 μg when the ANI score was under 50. The Control group received the same loading dose followed by 25 μg every 30 min with additional doses when there were signs of inadequate analgesia (viz., tachycardia or hypertension). Results Sixty patients—30 in each group—were recruited. Although the actual mean ANI score was higher in the ANI-guided than in the Control group (mean difference 2.2; 95% CI: 0.3 to 4.0, P = 0.022), there was no difference in the primary outcome—i.e., intraoperative fenta...
Background: Postoperative nausea and vomiting (PONV) continues to be a significant problem in pat... more Background: Postoperative nausea and vomiting (PONV) continues to be a significant problem in patient undergoing breast surgery. Routine use of nasogastric (NG) tube or orogastric (OG) tube has been suggested to prevent PONV despite conflicting data. Objective: To determine the efficacy of intraoperative OG tube insertion for gastric decompression in reducing early PONV incidence in breast surgery. Methods: Our study was a prospective, randomized, double-blind trial. One hundred and thirty eight patients undergoing elective breast surgery in Srinagarind Hospital between October 2013 and September 2014 were enrolled into 2 groups. Group I received OG tube, while Group II did not receive OG tube after induction of anesthesia. Standard anesthetic technique, including PONV prophylactic drugs, and postoperative care were employed in all patients. PONV score, classified into grade 1 and 2, were recorded at 2- and 4-hour after the end of surgery. Incidence of grade 2 PONV at 2- and 4-hour ...
Background and objective : Customer satisfaction is an indicator for quality assurance of departm... more Background and objective : Customer satisfaction is an indicator for quality assurance of department of Anesthesiology, Srinagarind hospital. Ward nurses are internal customers of whom satisfaction has not been assessed for long time. The objective of this study was to assess satisfaction of ward nurses regarding anesthetic service during perioperative period. We also identified the subjects that need continuous quality improvement. Methods : This was a prospective, descriptive study performed during May and July 2016. Inclusion criterion were ward nurses whose job were related to anesthesia personnel for at least 1 year. The exclusion criterion were visiting ward nurses from other hospitals. We distributed questionnaire, 10 per ward, to 45 wards (total 450 questionnaires). The questionnaire comprised 2 parts; part 1 covered demographic data, while part 2 contained levels of satisfaction with score 1 to 4, as well as open-ended comments on subjects that needed improvement. The qu...
Background and objective : Postoperative nausea-vomiting (PONV) is a common postoperative complic... more Background and objective : Postoperative nausea-vomiting (PONV) is a common postoperative complication. It causes patients discomfort and morbidity. Anesthesia service at Queen Sirikit Heart Center of the Northeast has never assessed this problem. The objective of this study was to identify the incidence and related factors of PONV which will be used to develop clinical practice guideline to decrease this issue for quality improvement. Methods : This was a retrospective, exploratory and analytical study. Inclusion criteria were adult patients undergoing elective cardiovascular thoracic surgery at Queen Sirikit Heart Center of the Northeast between January 1981 and December 1983. Demographic and relevant perioperative data until 48 hr postoperatively were retrieved from medical records and analyzed to identify incidence and related factors. Results : Among 745 patients recruited, we found 108 cases of PONV. The incidence of PONV was 14.5%. Most of the patients had PONV during 6-...
Medical Devices (Auckland, N.Z.), 2021
Purpose Early goal-directed therapy (EGDT) using the FloTrac system reportedly improved postopera... more Purpose Early goal-directed therapy (EGDT) using the FloTrac system reportedly improved postoperative outcomes among high-risk patients undergoing non-cardiac surgery. This study’s objective was to evaluate the FloTrac/EV1000 platform’s efficacy for improving postoperative outcomes in cardiac surgery. Patients and Methods Eighty-six adults undergoing coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) in 2 tertiary referral centers were randomized to the EGDT or Control group. The Control group was managed with standard care to achieve the following goals: mean arterial pressure 65–90 mmHg; central venous pressure 8–12 mmHg; urine output ≥0.5 mL·kg−1·h−1; oxygen saturation >95%; and hematocrit 26–30%. The EGDT group was managed to reach similar goals using information from the FloTrac/EV1000 monitor. The targets were stroke volume variation <13%; stroke volume index 33–65 mL·beat−1·m−2; cardiac index 2.2–4.0 L·min−1·m−2; and systemic vascular resistance index...
Background and objective: Percutaneous nephrolithotomy (PCNL) is gaining popularity because of it... more Background and objective: Percutaneous nephrolithotomy (PCNL) is gaining popularity because of its advantages i.e., smaller wounds, less pain and shorter hospital stay, nevertheless, pneumothorax, hydrothorax or hemothorax cannot be avoided. Our department developed and promulgated a practice guideline (CPG) for prevention and management of these conditions in May 2012. The objective of our study is to evaluate this CPG for its effectiveness and use the information to improve the CPG for continuous quality improvement. Methods: This is a prospective, descriptive study. We recruited all cases of PCNL performed after implementation of the CPG between October 2012 and September 2013 in Srinagarind hospital. Results: There were 66 cases of PCNL with 11 cases of pneumothorax, hydrothorax or hemothorax. The incidence is 16.7%. Most of the cases were females, aged more than 15 years, and with supracostal access. Hydrothorax was 81.8% of the incidents. Eight cases had mild symptom w...
1Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thail... more 1Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand; 2Phramongkutklao Hospital, Bangkok, 10400, Thailand Purpose: Early goal-directed therapy (EGDT) using the FloTrac system reportedly improved postoperative outcomes among high-risk patients undergoing non-cardiac surgery. This study’s objective was to evaluate the FloTrac/EV1000 platform’s efficacy for improving postoperative outcomes in cardiac surgery. Patients and Methods: Eighty-six adults undergoing coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) in 2 tertiary referral centers were randomized to the EGDT or Control group. The Control group was managed with standard care to achieve the following goals: mean arterial pressure 65–90 mmHg; central venous pressure 8–12 mmHg; urine output ≥0.5 mL·kg·h; oxygen saturation >95%; and hematocrit 26–30%. The EGDT group was managed to reach similar goals using information from the FloTrac/EV1000 monitor. The targets ...
ความพงพอใจของแพทยผาตดทมตองานวสญญ ในโรงพยาบาลศรนครนทร จงหวดขอนแกน ยธดา ชยกร, สรรตน ตรพทธรตน, เทพกร... more ความพงพอใจของแพทยผาตดทมตองานวสญญ ในโรงพยาบาลศรนครนทร จงหวดขอนแกน ยธดา ชยกร, สรรตน ตรพทธรตน, เทพกร สาธตการมณ, จกรทพย สทธนรากร, อภญญา อญชล, มณรตน ธนานนต ภาควชาวสญญวทยา คณะแพทยศาสตร มหาวทยาลยขอนแกน หลกการและวตถประสงค : แพทยผาตดเปนผรบบรการภายใน (internal customer) ของภาควชาวสญญวทยาทตองใหความสำคญ และทำใหเกดความพงพอใจ ซงจะนำมาสการพฒนาคณภาพงานรวมกนเปนทมสหสาขาวชาชพ การวจยครงนมวตถประสงค เพอศกษาระดบความพงพอใจ ปญหาและความตองการของแพทยผาตดเกยวกบงานวสญญ วธการศกษา : เปนการศกษาไปขางหนาเชงพรรณนา ดำเนนการระหวางเดอนพฤษภาคมถงกรกฎาคม พ.ศ. 2559 เกณฑการคดเขาของกลมตวอยาง คอ แพทยผาตดทงอาจารยแพทย แพทยใชทนและแพทยประจำบานชนปท 1-4 ในโรงพยาบาลศรนครนทร โดยสงแบบสอบถามทงหมด 110 ชด แบบสอบถามแบงเปน 2 ตอน คอ ตอนท 1 ขอมลพนฐาน และตอนท 2 ระดบความพงพอใจของแพทยผาตดทมตองานวสญญรวมถงคำถามปลายเปดเกยวกบปญหาและอปสรรคทพบในงานวสญญ แบบสอบถามผานการตรวจสอบความแมนตรงของเนอหาจากวสญญแพทยอาวโส 2 ทาน โดยมคาคะแนน 1 ถง 4 และนำมาวเคราะหคาสถตเปนจำนวน รอยละ คาเฉลย และสวนเบยงเบนมาตรฐาน วเคราะหโดยใชโปรแกรม SPSS 16 ผลการศกษา : ไดรบแบบสอบถามคน...
Background and objective: Pulmonary aspiration is a serious anesthetic complication. The incidenc... more Background and objective: Pulmonary aspiration is a serious anesthetic complication. The incidence in our hospital was 7.6:10,000. Our department developed and implemented a clinical practice guideline (CPG) for prevention of pulmonary aspiration in July 2010. The purpose of our study is to evaluate and enhance the implemented CPG for continuous quality improvement. Methods: This was a retrospective, descriptive study. We reviewed every case which received anesthetic service in Srinagarind Hospital for perioperative pulmonary aspiration after implementation of the CPG for prevention of pulmonary aspiration between July 2010 and June 2011. The incidence and causes were identified and explored. Results: We found 17 cases of pulmonary aspiration from 28,005 cases. The incidence was 6.1:10,000. The first 3 causes were the personnel not following the CPG in the following actions in high risk patients: 1) prophylactic medication; 2) aspirating gastric content before induction; and 3) rapi...
Background and Objective : Customer satisfaction is one of the indicators for quality assurance o... more Background and Objective : Customer satisfaction is one of the indicators for quality assurance of the department of Anesthesiology, Scrub nurses and medical personnels are internal customers of whom satisfaction level has not been assessed for long time. The objective of current study was to determine satisfaction level of scrub nurses and medical personnels regarding anesthetic service during perioperative period. We also identified the subjects that need continuous quality improvement. Methods : This was a prospective, descriptive study performed during May and July, 2016. The inclusion criteria were scrub nurses and medical personnels who were related to anesthetic service at Srinagarind hospital. We distributed 60 questionnaires. The questionnaire, with score 1 to 4, comprised questions regarding satisfaction with anesthetic service during preoperative, intra operative, and immediate postoperative period. It was validated by 2 senior anesthesiologists. The data were analyze...
Background and Objective : TheMapleson A breathing system is the most efficient breathing system ... more Background and Objective : TheMapleson A breathing system is the most efficient breathing system in spontaneous breathing anaesthetized pediatric patients with economical use of gases and inhalation agent, less in operating room pollution, less respiratory complication but many anesthesiologists still use the Mapleson F or Jackson- Rees breathing system which is less efficient instead. The parallel pediatric ADE breathing system in mode Acan be functioned as the Mapleson A breathing system. In this study, we would like to compare efficiency of the parallel pediatric ADE breathing system in mode A with Jackson-Rees breathing system on fresh gas flow consumption. Material and Method : This study was a randomized cross-over study. Twenty four patients,weighing 5 to 20 kg, with ASA physical status I-II and planned to undergo surgery sunder combined caudal anesthesia with general anesthesiawere enrolled. They were allocated into group I(ADE/A-JR) starting with the parallel pediatric AD...
Background Sevoflurane is suitable for low-flow anesthesia (LFA). LFA needs a wash-in phase. The ... more Background Sevoflurane is suitable for low-flow anesthesia (LFA). LFA needs a wash-in phase. The reported sevoflurane wash-in schemes lack simplicity, target coverage, and applicability. We proposed a one-step 1-1-8 wash-in scheme for sevoflurane-nitrous oxide (N2O) LFA. The objective of our study was to identify times to achieve every alveolar concentration of sevoflurane (FAS) from 1% to 3.5%. Methods We recruited 102 adults requiring general anesthesia with endotracheal intubation and controlled ventilation. After induction and intubation, a wash-in was started using a fresh gas flow of oxygen (O2):N2O at 1:1 L·min-1 plus sevoflurane 8%. The ventilation was controlled to maintain end-tidal carbon dioxide (CO2) of 30-35 mmHg. Results The rising patterns of FAS and inspired concentration of sevoflurane (FIS) are similar and parallel. The FAS/FIS ratio increased from 0.46 to 0.72 within 260 sec. The respective times to achieve FAS of 1%, 1.5%, 2%, 2.5%, 3% and 3.5% were 1, 1.5, 2, 3...
Anesthesia & Analgesia, 2016
Background and objective: Lack’s circuit is a modified co-axial Mapleson A breathing system that ... more Background and objective: Lack’s circuit is a modified co-axial Mapleson A breathing system that is commonly used in spontaneously breathing anaesthetized adults. Lack-Plus circuit is a modified Lack circuit with additional intraluminal one-way valve and active gas scavenging system which can minimize fresh gas flow (FGF), save anaesthetic gas and decrease operating room environment pollution. Thus, the objective of this study was to compare the Lack-Plus and Lack’s circuit on the minimal FGF requirement with no and clinically acceptable rebreathing in spontaneously breathing anesthetized adults, and to invent the Lack-Plus circuit. Material and Method: Our study was a randomized cross-over study. Twenty-four adult patients with BMI ≤ 30 kg/m 2 , under elective peripheral surgery in supine position with ASA physical status I-II were enrolled. They were allocated into group 1 (LP-L) starting with Lack-Plus then switching to Lack’s circuit or group 2 (L-LP) in reversed pattern. After induction and intubation, anesthesia was maintained with 50% N 2 O/O 2 and Desflurane 4 to 6% and fentanyl titration to control optimal respiratory rate in the range of 10 to 16/min. Starting with the first circuit, all patients were spontaneously breathing with FGF 4 L/min for 10 minutes, and then gradually decreased by 0.5 L/min every five minutes. End-tidal CO 2 (ETCO 2 ), inspired minimum CO 2 (ImCO 2 ), mean arterial pressure (MAP) and oxygen saturation (SpO 2 ) were recorded until rebreathing (ImCO 2 > 0 mmHg) occurred and continued until the FGF was 2.5 L/min. The anesthesia breathing circuit was then switched to the other and the procedure repeated. Results: The minimal FGF at the point of rebreathing of Lack-Plus and Lack’s circuit were 2.7 ± 0.8 and 3.3 ± 0.5 L/min respectively; p<0.001. At the FGF 2.5 L/min, ImCO 2 were 1.5 ± 2.0 and 4.2 ± 2.6 mmHg respectively; p<0.001. Conclusion: Lack-Plus circuit can be used safely, effectively, and requires less FGF than Lack’s circuit in spontaneously breathing anaesthetized adults.
Srinagarind Medical Journal ศรีนครินทร์เวชสาร, Mar 1, 2010
Background : Regional anesthesia is the common anesthetic procedure for patients undergoing low... more Background : Regional anesthesia is the common anesthetic procedure for patients undergoing lower abdomen and lower extremity surgery. Anesthesia-personnel should be aware of the common complications for patient safety. Objective : To survey anesthesia-personnel’s knowledge of complications from regional anesthesia. Design : Descriptive study Setting : Srinagarind Hospital, Department of Anesthesiology, Faculty of Medicine. Population : 51 anesthesia-personnel : 39 nurse- anesthetists and 12 residents. Methods : Anesthesia-personnel answered the questionnaire (13 items, created by the research team) during a one-hour classroom period. The answer sheets were analyzed for difficulty index (“p”), and the discrimination index (“r”). The data were analyzed using descriptive statistics. Results : Fifty anesthesia-personnel answered the questionnaire: 39 nurse - anesthetists (78.00%) and 11 residents (22.00%). Respondents averaged 36.18 ± 7.23 years of age and 7.70 ± 6.26 years of experience in anesthesia. We found that the anesthesia-personnel had averaged 80.31%(or had a good level of knowledge). Age and years of experience did not correlate with the level of knowledge. Residents scored significantly higher than nurse-anesthetists (88.08 vs. 78.08%, respectively)(p=0.01). Conclusion : The knowledge of complications from regional anesthesia was of a good level among anesthesia-personnel practising at Srinagarind Hospital.