Thai Journal of Anesthesiology

Role of Nebulization for Gastrointestinal Endoscopy

Somchai Amornyotin — 2026-01-27

Nebulization has emerged as a useful adjunct in gastrointestinal endoscopy (GIE) procedure, improving patient comfort and endoscopic visibility while maintaining a favorable safety profile. Its applications mainly include topical anesthesia and sedation for oropharyngeal and upper GIE procedures, as well as the administration of mucolytic and anti-foaming agents to enhance mucosal visualization. This review summarizes the current role of nebulization in GIE, including topical anesthesia, mucolytics, anti-foaming, and sedative agents. We also describe its clinical use, advantages, disadvantages, limitations, and cost-effectiveness of nebulization for GIE procedures.

Combined Femoral Triangle Block and Proximal Adductor Canal Block versus Proximal Adductor Canal Block Alone in Unilateral Total Knee Arthroplasty: a Prospective Randomized Controlled Trial

Numphung Sukantarat — 2026-01-27

Background: Total knee arthroplasty (TKA) frequently results in moderate to severe pain, particularly within the first 24 h following surgery. This pain is associated with delayed rehabilitation and recovery, complications, and prolonged hospitalization. Femoral triangle block (FTB) and proximal adductor canal block (PACB) are multimodal analgesic techniques known to alleviate knee pain. However, their comparative efficacy remains contentious. Methods: In this randomized controlled trial, 60 patients who underwent TKA under spinal anesthesia were randomly divided into two groups. One group received a combination of FTB and PACB, whereas the other group received PACB alone. The primary outcome measure was postoperative pain assessed via the numerical rating scale (NRS). The secondary outcomes included morphine consumption, the timing of intravenous analgesia requests, the length of hospital stay, and complications. Results: Postoperative NRS scores for resting and movement pain at 24 h, the timing of intravenous analgesic requests, the length of hospital stays, and complication rates did not significantly differ between the two groups. However, morphine consumption at 0, 4, 8, 12, 18, and 24 h postoperatively in group CB was significantly lower than in group AB. Conclusion: A combination of FTB and PACB provided broader sensory coverage and significantly reduced 24-h cumulative morphine consumption compared with PACB alone after unilateral TKA, without increasing complications. Although the clinical benefit was modest, this approach may be valuable as part of multimodal or ERAS-based analgesia.

Factors Associated with Hypotension in Patients Aged ≥ 80 Years Old with Hip Fracture Surgery Under Spinal Anesthesia at Hatyai Hospital

Amporn Thongphut — 2026-01-27

Introduction: Hip fractures are a common reason for surgery in older individuals. Spinal anesthesia is widely used for these procedures, but it is frequently associated with intraoperative hypotension, which may result in severe complications. This study aims to identify perioperative factors that increase the risk of hypotension following spinal anesthesia in extremely elderly patients undergoing hip fracture surgery. Methods: This prognostic factor research with retrospective observational cohort design included patients aged 80 yr and older who underwent hip fracture surgery under spinal anesthesia at Hatyai hospital between October 2016 and September 2023. Baseline characteristics, as well as surgical and anesthetic factors, were collected from medical records. Pre-spinal risk factors were analyzed using univariable and multivariable logistic regression to determine their association with spinal hypotension. Results: Among the 319 patients analyzed, 201 (63%) developed hypotension after spinal anesthesia. Risk factors identified included age over 85 yr, a BMI of 25 kg/m² or higher, the use of renin-angiotensin-aldosterone system antagonists on the day of surgery, the presence of an intertrochanteric fracture, and a surgery delay of more than 14 days after injury. Conclusion: In extremely elderly patients scheduled for hip fracture surgery under spinal anesthesia, careful consideration should be given to the selection of preoperative antihypertensive medications to mitigate the risk of hypotension. Moreover, minimizing surgical delays is critical to optimizing patient outcomes.

Heat Stroke: a Summertime Threat - Insights for Anesthesia Practice

Napatchanan Laotaweesuk — 2026-01-27

Heat stroke is a life-threatening condition characterized by hyperthermia and systemic dysfunction, posing significant morbidity and mortality risks, particularly during the summer time. This article examines the epidemiology, pathophysiology, clinical presentation, diagnosis, prevention strategies, management considerations in heat stroke, with a focus on implications for anesthesia practice. Anesthetic techniques, perioperative challenges and patient outcomes are explored. Emerging technologies, advancements in understanding heat stress physiology, and policy implications for public health initiatives are also addressed. This review underscores the importance of awareness, education, and interdisciplinary collaboration in mitigating the impact of heat-related illnesses and promoting patient safety. Healthcare providers, policymakers, and the public are urged to take proactive measures to prevent heat stroke, enhance clinical management, and foster resilience in the face of rising temperatures.

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

Sutatta Boonyakarn — 2026-01-27

The maintenance of acid-base balance is crucial for normal physiological functioning, and it is achieved through the interaction of the respiratory system, the renal system, and the buffer system. Acid-base disturbances can be caused by various factors. 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, which is an important factor in the regulation of acid-base balance. However, it has limitations in its ability to evaluate unmeasured anions and cations, particularly in the presence of non-bicarbonate buffers. In contrast, 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 is not useful in evaluating respiratory disorders. Both methods have their assumptions and limitations. Clinicians need to understand the underlying principles, limitations, and potential pitfalls of each to make accurate assessments.

Unmasking Occupational and Environmental Risks for Anesthesia Providers

Amornrat Aekta — 2026-01-27

This review explores occupational and environmental hazards faced by anesthesia providers, encompassing chemical exposures, infectious risks, radiation exposure, physical strain, and mental health concerns. Interconnected hazards form a complex challenge for anesthesia providers. Anesthetic agents and disinfectants not only entail chemical exposure risks but also contribute to infection control challenges. Procedures involving radiation necessitate prolonged standing and protective gear, contributing to physical strain. Mental health concerns impact safety by affecting attention, decision-making, and communication, integral to a safe working environment and patient care quality. Concluding remarks stress the need for ongoing research focusing on long-term health effects, emerging technological innovations, and collaborative global initiatives.

Beyond the Numbers: Enhancing Anesthesia Care through Comprehensive Monitoring – a Confluence of Subjective and Objective Measures

Patcharinporn Sangsawang — 2026-01-27

This article explores the transformative landscape of anesthesia care, shifting from conventional numeric monitoring to a comprehensive approach that converges both subjective and objective measures. The article delves into emerging technologies such as smart wearables, artificial intelligence, and virtual/augmented reality, presenting them as catalysts for real-time data acquisition, predictive analytics, and immersive patient experiences. The potential benefits of comprehensive monitoring are illuminated, encompassing improved patient outcomes, heightened safety, and the embodiment of patient-centered care principles. In this era where the numbers meet narratives, anesthesia practitioners are urged to embrace evolving technologies, engage with ongoing research, and keep the patient at the core of care.

Clinical Guidance for Pain Management in Pregnancy

Nuj Tontisirin — 2026-01-27

Pain management during pregnancy presents unique challenges due to physiological changes and the safety limitations of pharmacological interventions. This clinical guidance, developed by the Thai Association of the Study of Pain, provides practical recommendations for healthcare professionals in the assessment and management of pain in pregnant women. It addresses common conditions such as low back pain, pelvic pain, headache, and acute pain, as well as pain management during labor and the postpartum period. The guidance emphasizes non-pharmacological approaches, such as physical therapy, as first-line interventions. When medications are required, careful consideration is advised, guided by the Pregnancy and Lactation Labeling Final Rule and the Australian categorization system. In addition, levels of evidence and strength of recommendations are systematically presented to support clinical decision-making. The document also underscores the importance of patient education and counseling to empower pregnant women to participate in selecting the most appropriate pain management strategies. This guideline aims to facilitate practical implementation in healthcare settings across Thailand, with the ultimate goal of improving quality of care, reducing complications, and enhancing both maternal and neonatal safety and quality of life.