Thai Journal of Anesthesiology

Differences Between Traditional and Alternative Method in Assessing Acid-Base Disturbances

2025-11-04T21:11:21+07:00

The maintenance of acid-base balance is crucial for normal physiological functioning, and it is achieved through the interaction of the respiratory, renal, and buffer systems. Acid-base disturbances can be caused by various factors, and their evaluation is critical for appropriate diagnosis and treatment. The traditional method of assessing acid-base status, the Henderson-Hasselbalch equation, is widely used to evaluate simple or mixed metabolic and respiratory acid-base disorders, and it takes into account the partial pressure of carbon dioxide, a critical factor in regulating acid-base balance. However, it has limitations in its ability to evaluate unmeasured anions and cations, particularly in the presence of non- bicarbonate buffers. The alternative method, the Strong Ion Difference, is widely used in critical care medicine as it takes into account multiple acid-base disturbances, including changes in unmeasured ions and weak acids. It is more accurate in the presence of non- bicarbonate buffers, such as lactate or albumin, which can contribute to the imbalance. However, it has limited utility in assessing respiratory disorders. Both methods have their assumptions and limitations, and the choice of method can affect treatment decisions.

Assessing Postoperative Recovery with End-Tidal CO2: Current Practices and Innovations

2025-11-04T21:15:04+07:00

End-tidal CO2 (ETCO2) monitoring has emerged as a valuable tool in this context, providing insights into a patient’s respiratory function and overall physiological status. This review aims to explore current practices and innovations in ETCO2 monitoring during postoperative recovery, assessing its role in enhancing patient care. Various measurement techniques, along with their clinical applications and emerging trends, were evaluated to provide a holistic understanding of ETCO2’s role in postoperative settings. ETCO2 monitoring is widely recognized for its ability to offer real-time data on ventilation and metabolism, thus helping to detect early signs of complications such as hypoventilation or respiratory depression. Recent innovations in capnography technology have enhanced accuracy and convenience, thereby offering new applications across different surgical procedures. However, challenges such as technical limitations, variability in patient responses, and interpretation of ETCO2 data still remain significant. Future research should focus on addressing these limitations and exploring new applications to further enhance patient outcomes.

E-cigarettes Users: Anesthesia Revisited

2025-11-04T20:27:45+07:00

E-cigarettes, also known as electronic nicotine delivery systems, have gained widespread popularity as an alternative to combustible tobacco. While often perceived as safer, emerging evidence demonstrates significant respiratory, cardiovascular, and systemic effects relevant to anesthesia. These include airway inflammation, bronchial hyperreactivity, cardiovascular stimulation, and an association with acute lung injury known as E-cigarette or vaping-associated lung injury (EVALI). For anesthetic personnel, E-cigarette use introduces unique perioperative challenges, particularly in airway management, ventilation strategies, hemodynamic stability, and postoperative recovery. This review summarizes current evidence on the physiological impact of E-cigarette use, outlines anesthetic considerations across the perioperative continuum, and provides a practical summary table to guide clinical decision-making

Effects of Dexamethasone on Blood Glucose Concentrations in Patients Undergoing Elective Surgery Under Spinal Anesthesia: a Randomized, Controlled Trial

2025-11-04T20:31:55+07:00

Background: The effect of a dose of dexa-methasone for postoperative nausea and vomiting (PONV) prophylaxis on blood glucose concentrations in spinal anesthesia has not been well studied. This study compared mean blood glucose changes within 8 h in nondiabetic patients receiving a single dose of dexamethasone 5 mg and 10 mg, compared with placebo, in surgeries under spinal anesthesia. Methods: Sixty nondiabetic patients were randomized into one of three groups. Group A was the control group. Group B and C received 5 mg and 10 mg of dexamethasone respectively. Capillary blood glucose was measured at baseline, and at 2, 4, 6, and 8 h after administration of the study drugs. The incidence of hyperglycemia and PONV scores were recorded. Results: Peak mean glucose changes occurred at 8 h in all three groups. Compared to the control group, mean glucose changes in group C were higher at 4, 6, and 8 h, while mean glucose changes in group B were higher at 6 and 8 h. Hyperglycemic events were more frequent in group C compared to group A (P = 0.035). Patients in group A had significantly higher PONV scores than those in the other groups. However, PONV scores in group B and C were not different. Conclusion: Both doses of dexamethasone significantly increased mean glucose changes. Compared with 5 mg, dexamethasone 10 mg resulted in higher blood glucose changes, but provided the same efficacy in reducing PONV.

Protamine-to-Heparin Ratio for Effective Reversal in Open-Heart Surgery Post-Cardiopulmonary Bypass

2025-11-04T20:39:11+07:00

Introduction: Heparin is routinely administered to achieve anticoagulation during cardiopulmonary bypass (CPB) in open-heart surgery. Protamine sulfate is used to neutralize heparin; however, inappropriate dosing may result in adverse events such as hypotension and paradoxical bleeding. Determining the optimal protamine-to-heparin (P:H) ratio is therefore essential to ensure effective reversal while minimizing complications. This study aims to identify the effective P:H ratio necessary for adequate heparin reversal. Methods: This retrospective study included adult patients who underwent open-heart surgery with CPB at Lampang Hospital between January 2022 and June 2023. Patients were stratified into three groups based on their P:H ratios: <1, =1, and >1. The P:H ratio was calculated using the initial heparin dose administered prior to the initiation of CPB. The primary outcome was the effective heparin reversal, defined as an activated clotting time (ACT) ≤ 10 sec above baseline or within 80-180 sec five min post-protamine administration. Secondary outcomes included determining the minimum effective P:H ratio that resulted in acceptable postoperative blood loss, and evaluating 8-h postoperative blood loss, blood product transfusion volumes, and 24-h reoperation rates due to bleeding. Results: A total of 539 patients were analyzed. Effective heparin reversal, based on post- protamine ACT values, was achieved across all groups with no significant differences observed. Eight-hours postoperative blood loss, blood transfusions, and 24-h reoperation rates were comparable among three groups, with no statistically significant differences. A P:H ratio of approximately 0.94-0.95 was sufficient to maintain acceptable postoperative blood loss and transfusion requirements, comparable to the median values observed in this study. Conclusion: This study found no significant differences in heparin reversal efficacy or blood loss among groups receiving varying protamine doses. Heparin reversal efficacy was defined as achieving an ACT of ≤10 sec above baseline or within the range of 80-180 sec, measured five min after protamine administration. However, a P:H ratio of 0.94-0.95 may indicate effective heparin neutralization

A Randomized Controlled Trial Comparing Preoperative Celecoxib vs Etoricoxib Combined with Paracetamol for Postoperative Pain Management after Total Abdominal Hysterectomy

2025-11-04T20:45:44+07:00

Background: Preemptive multimodal analgesia, particularly using COX-2 inhibitors combined with paracetamol, may effectively reduce postoperative pain and morphine consumption following abdominal hysterectomy. The study aims to compare the efficacy of preoperative celecoxib or etoricoxib combined with paracetamol in reducing postoperative pain and morphine use. Methods: A randomized controlled trial was conducted in 63 patients undergoing abdominal hysterectomy. Participants were randomized into three groups: celecoxib 400 mg and paracetamol 500 mg, etoricoxib 90 mg and paracetamol 500 mg and a control group receiving no preoperative medication. Pain scores were assessed using the numerical rating scale (NRS) at 1, 4, 8, and 24 h, postoperatively. Morphine consumption within 24 h was recorded. Statistical analysis included ANOVA, Kruskal-Wallis, and Chi-square tests. Results: Morphine consumption within 24 h differed significantly among groups (P=0.016), with the etoricoxib group using the least (3.4 ± 2.9 mg) significantly lower than the control group (P=0.012). The celecoxib group did not differ significantly from the control (P=0.220). Pain scores were not significantly different among the groups. Conclusion: Preoperative etoricoxib combined with paracetamol significantly reduces postoperative morphine use and is suitable as part of a multimodal analgesia strategy.

Factors Affecting Research Competency of Nurse Anesthetists: a Cross-Sectional Survey Study

2025-11-04T20:48:50+07:00

Introduction: Research competency is important for nurse anesthetists to stay updated with evidence-based practices and contribute to patient safety. Understanding the factors influencing research competency is essential for the development of targeted interventions and strategies. This study investigates the factors affecting the research competency of nurse anesthetists at Ramathibodi Hospital. Methods: A cross-sectional survey study was conducted with 67 nurse anesthetists. Data were collected using a structured questionnaire assessing factors influencing or limiting research competency. Analysis involved descriptive statistics and inferential statistics (t-tests). Results: Fifty-four nurse anesthetists returned the questionnaire (80.5%). The majority of participated nurse anesthetists agreed that “Relatedness” had the greatest effect on their research competency (mean score 3.9±0.77). Nurses who participated in research at least 1 study per year thought that “Extrinsic motivation” had a significantly greater effect on research competency than those who participated in less than 1 study per year (mean scores 3.82±0.61 and 3.3±0.84, respectively; P=0.017) The greatest barriers to research competency were “Inadequate availability of research training opportunities”, and “Limited accessibility to research data and tools” (average scores were similar: 4.26±0.78 and 4.26±0.73, respectively). Conclusion: This study revealed factors affecting research competency of nurse anesthetists at Ramathibodi Hospital. Results emphasize both extrinsic and intrinsic motivators’ importance. Institutions should promote career advancement and acknowledge individual skills. Establishing a research network for mutual assistance is essential.