Region 11 Medical Journal

Evaluation of the anesthetic depth by Bispectral Index during Cesarean Section under general anesthesia

Ruangkhaw Thongsri, Kwanjit Ochum, Pidech Boonnam — Wed, 30 Apr 2025 00:00:00 +0700

Background: The incidence of accidental awareness in cesarean section under general anesthesia is higher than in other surgeries because we had to use a minimal dose of drugs and inhalation to avoid the side effects to the neonate. Today, we do not have data about the depth of anesthesia and the incidence of awareness during cesarean section under general anesthesia in Surat Thani Hospital.

Objective: To evaluate the depth of anesthesia by using the Bispectral index and detect the awareness during cesarean section under general anesthesia

Method: This study was conducted on 70 parturient patients undergoing elective cesarean section. A standardized anesthetic technique was applied: induction with routine anesthetic agents. Electrocardiogram, heart rate, blood pressure, SpO2, Bispectral index, and minimal alveolar concentration (MAC) of Sevoflurane in 50% Nitrogen oxide were continuously monitored and recorded during anesthesia.

Result: BIS index value was 97.09± 2.02 ,61.8±16.48 ,42.23±8.33 ,39.27± 8.53 ,36.44±7.09, 34.50±7.72, 34.50±7.72, 34.50±7.72,37.01±14.29,61.47± 9.16,68.21±6.89,79.57±5.31, and 86.90±5.85 at Baseline, Induction, Intubation, Skin incision, Uterine incision, Delivery, Suture uterus, Suture sheath, Skin closure, Open eyes, and Extubation. MAC of sevoflurane in 50% nitrous oxide was between 0.4 and 0.7. Hemodynamic profiles and Apgar scores were satisfactory. There was no case of uterine atony but one case of incidental awareness during the surgery.

Conclusion: The currently used general anesthetic technique in Surat Thani Hospital appears inadequate for depth of anesthesia because using only midazolam after delivery is not appropriate. The level of sevoflurane may be adjusted by applying BIS during surgery to prevent incidental awareness.

Effective of using guidelines for the discharge of chronic obstructive pulmonary disease patients in the male medical ward. Kanchanadit Hospital. Surat Thani Province

Sirinart Pongsawadan — Fri, 14 Mar 2025 00:00:00 +0700

Background: Chronic obstructive pulmonary disease is a major public health problem in Thailand and around the world. The World Health Organization states that for every 64 million people in the world, more than 3 million people will die from COPD. In Thailand, between 2015-2017, the number of people with COPD has been increasing every year. In Health Service Area 11, the rate of COPD in 2023 was 14,584. Kanchanadit Hospital is a 120-bed community hospital with a male medical ward. Statistics of COPD patients in 2021-2023 were 301, 241, and 254, respectively. The re-admission rate in 2021-2023 was 13.95, 12.03, and 18.11 percent, respectively, which tends to increase. It was found that there was an exacerbation of the disease. Patients lacked knowledge, misbehaved, and were unable to control risk factors for the disease. Therefore, it was related to the increase in the hospitalization rate. Increased hospital stays, increased financial burden, more severe complications, and re-admittance. The word therefore recognizes the importance of discharge planning for patients with chronic obstructive pulmonary disease.

Objective: To study the effectiveness of using discharge planning guidelines for patients with chronic obstructive pulmonary disease between the experimental and control groups.

Methods: Quasi-experimental research. The sample consisted of patients with chronic obstructive pulmonary disease who admitted to the male medical ward. A purposive sample of 60 cases was included into a control group 30 cases and experimental group of 30 cases. The instruments used for data collection were questionnaires to measure knowledge, behavior, and satisfaction. Data were analyzed using descriptive statistics and independent t-test.

Results: It was found that the experimental group had a significantly higher mean score of knowledge and behavior difference than the control group (p < 0.05). Satisfaction with the guidelines was at a high level, readmission rate was lower than the control group, and the mean satisfaction score was at a high level.

Conclusions: Discharge planning guidelines for patients with chronic obstructive pulmonary disease help promote patients’ knowledge, appropriate behaviors, and reduce the number of readmitted.

Factors related to Burnout and Resilience among personnel at Patong Hospital, Phuket Province.

Muanprae Boonlorm — Fri, 14 Mar 2025 00:00:00 +0700

Background: Burnout is a significant issue among healthcare professionals, affecting work performance and the quality of patient care. Resilience is a key factor in preventing and reducing the risk of burnout.

Objectives: To study burnout, resilience and the factors related with burnout and resilience among personnel at Patong Hospital, Phuket Province.

Method: This is a cross-sectional analytic study. Data was collected using an online questionnaire, which comprised of a general information form, Resilience Quotient (RQ) and a burnout assessment. Descriptive statistics were used to analyze the data, whereas the relationships between variables were examined using Spearman's Rank Correlation Coefficient.

Results: The majority (55.8%) of personnel demonstrated normal levels of resilience. Factors related to resilience included education level, income, perceived value of work, relationships with colleagues, compensation relative to workload, and perceived support from management. Among the participants, 44.9% had low levels of burnout. Specifically, 75.1% experienced low emotional exhaustion, 60.8% had low depersonalization, and 84.2% reported a high sense of personal accomplishment. Factors related to burnout included age, length of employment in the hospital, income, perceived value of work, relationships with colleagues, compensation relative to workload, and perceived support from management. Resilience was identified as a protective factor against burnout in all three dimensions.

Conclusion: Personnel at Patong Hospital exhibit low levels of burnout, with resilience within the normal range. Both individual and organizational factors are associated with burnout and resilience. The hospital should implement measures to prevent burnout and enhance resilience.

Ultrasonographic Measurement of the Fetal Occiput Spine Angle During the First Stage of Labor as a Predictor of Normal Labor Outcomes

Pisanu Vanitchanon — Wed, 02 Apr 2025 00:00:00 +0700

Background: Effective labor care can reduce complications for both mother and newborn. The use of ultrasonography to measure the Occiput Spine angle during the first stage of labor is one of the methods that is incorporated into labor care.

Objectives: To study the relationship between the Occiput Spine angle during the first stage of labor and the outcome of normal vaginal delivery.

Method: This is a prospective study involving a sample of 120 pregnant women with singleton pregnancies and vertex presentation, who born at Koh Samui Hospital, Surat Thani Province from June 2024 to October 2024.The Occiput Spine angle was measured during the first stage of labor, statistical analysis was performed to predict the progression of labor and the outcomes of delivery.

Results: The average Occiput Spine angle shows a statistically significant difference, with the cesarean section group having the lowest average (116.0+5.6 degrees) and normal vaginal delivery group having the highest average (123.0+8.0 degrees) (p<0.05). The Occiput Spine angle of less than or equal to 118.0 degrees was associated with a higher likelihood of cesarean section (adjust OR: 3.64, 95% CI: 1.15–12.79, p<0.05). The diagnostic performance of the Occiput Spine angle in predicting cesarean section had moderate accuracy. The average Occiput Spine angle in primiparous and multiparous women showed no statistically significant difference (121.4 degrees and 122.7 degrees, respectively, p>0.05).

Conclusion: The measurement of the Occiput Spine angle should be used alongside other parameters to improve accuracy.

The Development of a Barcode Scanning System for Recording the Processing Status of Drug Procurement Suratthani Hospital

Watana Tosing, Sairung Foontakoo — Fri, 14 Mar 2025 00:00:00 +0700

Background: The medical supplies warehouse at Suratthani Hospital has implemented a barcode scanning system to record timestamps and track the status of operational processes. The system encompasses eight main steps, starting from issuing purchase orders and receiving drugs to the final step of submitting documents to the finance department. The data collected can be utilized for analysis and workflow improvements.

Objectives: To study operational statuses and enhance workflow processes by utilizing a barcode scanning system to record timestamps and operational statuses.

Methods: The study sample consisted of drug purchase orders issued between May 1–June 30, 2023, and August 1–September 30, 2023. A barcode scanning system was used to record timestamps across eight main operational steps. The study was conducted in three phases: Phase 1: Pre-improvement, Phase 2: Problem analysis and process improvement using Lean thinking, and Phase 3: Post-improvement. This action research compared the time required before and after process improvements. The tools used included the Barcode scanning system and the INVC drug procurement program, which recorded timestamps by scanning barcodes on purchase orders. Data analysis was performed using content analysis and t-test statistics.

Results: The time required for each step in the workflow was reduced 35 days. Overall, the duration of the drug procurement process after system development was significantly lower than before, with statistical significance at the level of P < .01.

Conclusion: After developing the eight steps drug procurement system using Lean thinking and implementing a Barcode scanning system to record operational statuses, the overall duration of the drug procurement process was found to be significantly shorter compared to the pre-development phase, with statistical significance.

Factor associated with receiving thrombolytic agents within 45 minutes in acute ischemic stroke patients at emergency department, Prasat Hospital, Surin Province

Tayakorn Samart — Wed, 30 Apr 2025 00:00:00 +0700

Background: Stroke is the leading cause of death among patients with non-communicable chronic diseases in Thailand. Currently, thrombolytic therapy is the standard treatment method, which can reduce mortality and disability rates. The time from when a patient arrives at the emergency room until receiving thrombolytic treatment (Door to Needle Time) should not exceed 45-60 minutes. There are various factors that influence the time it takes to administer thrombolytic treatment.

Objective: To study the factors associated with the administration of thrombolytic drugs and the rate of receiving thrombolytic therapy in patients with acute ischemic stroke within 45 minutes.

Methods: This was a retrospective study conducted from October 1, 2017, to September 30, 2023, involving 170 patients with acute ischemic stroke who received thrombolytic drugs in the emergency department of Prasat Hospital. Statistical analysis included descriptive statistics and multivariate logistic regression analysis was used to identify factors associated with administering thrombolytic drugs within 45 minutes.

Results: A total of the 170 patients, 71 (41.8%) received thrombolytic drugs within 45 minutes. Factors significantly associated with receiving thrombolytic drugs within 45 minutes included: Hospital transfer via the emergency medical service system: OR 15.44 (95% CI 4.27–55.76) p-value < 0.001, Time waiting for a CT brain: OR 0.83 (95% CI 0.76–0.92) p-value < 0.001, Time waiting for laboratory results: OR 0.85 (95% CI 0.78–0.92) p-value < 0.001, Time consulting an internal medicine physician: OR 0.88 (95% CI 0.79–0.98) p-value < 0.001, Decision time to received thrombolytic agent: OR 0.75 (95% CI 0.65–0.85) p-value < 0.001.

Conclusion: Factors associated with thrombolytic drug administration within 45 minutes included Hospital transfer via the emergency medical service system, time waiting for a brain CT scan, time waiting for laboratory results, time consulting an internal medicine physician, and decision time to received thrombolytic agent

Study of diagnostic reference levels for digital mammography in the Radiology Department, Surat Thani Hospital

Surat Pattharachayakul — Wed, 30 Apr 2025 00:00:00 +0700

Background: Mammography can detect breast cancer at an early stage, even before symptoms appear. However, breast tissue is sensitive to radiation, so it is crucial to use an appropriate amount of radiation. To ensure compliance with diagnostic reference levels are established as guidelines.

Objective: To determine the diagnostic reference levels for digital mammography at the Radiology Department of Surat Thani Hospital.

Methodology: This was a retrospective study collecting data from patients at the Radiology Department of Surat Thani Hospital between April 1, 2024, and July 31, 2024. A quota sampling method was used to select 50 cases per month, totaling 200 cases, and 800 mammography images. The collected data included age, breast compression thickness, compression force, maximum kilovolt peak, exposure time current, average glandular dose, entrance surface dose, type of target and filter, and positioning. Data were recorded and analyzed using statistical methods.

Results: The average age of the participants receiving digital mammography was 52.25 years. The average breast compression thickness was 51.38±7.19 mm, and the average compression force was 68.14±21.38 Newtons. The average maximum kVp was 28.30±1.14 kVp, while the average exposure time current was 119.99±25.98 mAs. The median average glandular dose at the breast was 1.51 milligray (mGy).

Conclusion: The diagnostic reference levels for digital mammography at the Radiology Department of Surat Thani Hospital is 1.51 milligray, which is within an optimization. This dose is lower than the National Diagnostic Reference Levels (NDRLs) for Thailand and the recommended dose levels set by the International Atomic Energy Agency (IAEA), which are 2.04 milligray and 3.0 milligray, respectively.

Obstetrical and Neonatal Outcomes in Mothers Exposed to Amphetamines: A Retrospective Study from Thasala Hospital

Paisit Petmali — Fri, 04 Apr 2025 00:00:00 +0700

Background: Drug use among pregnant women is on the rise, leading to complications in the baby, which adversely affects various bodily systems, requires hospitalization, and increases medical expenses.

Objective: To study the effects of amphetamine, use in women on maternal and fetal complications.

Methods: This is a retrospective study of data from the medical records of Thasala Hospital. Data were collected from medical records of pregnant women who came to give birth and tested positive for amphetamine. Data was collected between June 1, 2024, and August 15, 2024, totaling 34 files. A control group was selected from pregnant women who came to give birth and had general characteristics like the study group, totaling 34 files. Data was analyzed using descriptive statistics, chi-square analysis, logistic regression analysis, and the Mann-Whitney U-test.

Results: Among mothers who used amphetamines, approximately 14.7% experienced withdrawal symptoms postpartum. For infants born to these mothers, 23.5% had sleep disturbances, and 44.1% exhibited frequent vomiting postpartum. Infants from the amphetamine-exposed group had significantly higher rates of jaundice, abnormal respiration, and need for oxygen supplementation, resuscitation, vomiting, lower birth weight and body length than those in the control group (p<0.05).

Conclusions: Amphetamine use during pregnancy is associated with lower maternal weight, anemia, lower birth weight in infants, jaundice, frequent vomiting, hypothermia, and extended hospital stays.

Keywords: Obstetrical outcomes, Maternal and child, amphetamine