Thai Journal of Anesthesiology

Comparison of Intravenous Tramadol 0.25 mg/kg and 0.5 mg/kg for Prevention of Shivering in Patients Undergoing Spinal Anesthesia

Rungruedee Wichapong — 2024-10-29

Background: Tramadol 0.5 mg/kg is the least effective dose for the prevention of shivering. No studies have been done on the dose of tramadol 0.25 mg/kg to prevent shivering. This study aims to compare the efficacy of intravenous tramadol 0.25 and 0.5 mg/kg for the prevention of shivering in patients who undergoing spinal anesthesia. Methods: A prospective, randomized, double-blind study was conducted. 86 patients who were scheduled for elective surgery under spinal anesthesia were randomly assigned to receive tramadol 0.25 mg/kg (group 1) and tramadol 0.5 mg/kg (group 2). After the patients received intrathecal injection of heavy bupivacaine anesthesia, their body temperature, blood pressure, and shivering level were measured using Crossley and Mahajan scale (The Shivering Classification). Results: The effectiveness in preventing shivering of group 1 and 2 were 81.4% and 86.0% (P= 0.559), with 18.6% of grade 3 or higher of shivering in group 1 and 14.0% in group 2 (P=0.502). The side effects in both groups were not different. Conclusion: The prevention of post-anesthetic shivering by use of 0.25 mg/kg and 0.5 mg/kg of tramadol has no different results and the side effects of the two groups of drugs were not different.

2 Urgencies in Anesthesia Practice

Nisa Noocharoen — 2024-10-29

Anesthesia urgencies are critical events that demand rapid and precise interventions to ensure patient safety and optimal outcomes. This article comprehensively explores the diverse landscape of anesthesia urgencies, categorizing them into hemodynamic instability, respiratory compromise, anaphylaxis and allergies, neurological emergencies, and malignant hyperthermia. Strategies for immediate response protocols, tailored management, and vigilant monitoring are elucidated, emphasizing the critical role of teamwork and preparedness. The significance of patient-related factors, anesthetic agent selection, monitoring techniques, and preoperative assessment is highlighted in preventing urgencies.

Cyanide Toxicity in Relation to Anesthesia

Kanranach Surapom — 2024-10-29

Cyanide toxicity is a rare but potentially life-threatening complication associated with anesthesia. It disrupts cellular respiration by inhibiting cytochrome oxidase, which is crucial for the utilization of oxygen. This disruption ultimately leads to impaired oxygen consumption and tissue hypoxia. Anesthesia-related cyanide toxicity can occur through various mechanisms, including the metabolism of certain drugs or the inhalation of volatile agents. Its clinical presentation can be nonspecific and may include altered mental status, cardiovascular instability, and metabolic acidosis. Diagnosis can be aided by laboratory tests such as arterial blood gas analysis and serum lactate levels. Treatment of cyanide toxicity involves a multi-pronged approach that includes the administration of specific antidotes like hydroxocobalamin or sodium thiosulfate, as well as supportive measures to maintain oxygenation and hemodynamic stability. Additionally, the offending agent should be removed or discontinued.

Potentially Suicidal Attempts Among Anesthesia Practitioners

Aree Sangsai — 2024-10-29

This article addresses the critical issue of potential suicide attempts among anesthesia practitioners, emphasizing the intricate relationship between their mental well-being and patient care. It examines psychological, professional, and societal factors. Additionally, it discusses the prevalence of depression and burnout among anesthesia practitioners, emphasizing the need for proactive support systems and interventions. Systematic risk assessment protocols are emphasized as essential for identifying at-risk practitioners while addressing the delicate balance between privacy and patient safety. Strategies aimed at fostering a supportive workplace environment, including counseling services, therapy, and training, are presented as vital for enhancing the emotional resilience of anesthesia practitioners. Preventive measures, the promotion of work-life balance, and awareness initiatives aimed at reducing the risk of potential suicide attempts among these practitioners are outlined. The article advocates for a collaborative approach to find the right balance, ultimately underscoring the urgent need to prioritize mental well-being, reduce stigma, and provide comprehensive support, ensuring the well-being of both practitioners and patient safety.

Anesthetic Consideration of Drowning Victims: a Comprehensive Review

Alisa Wanpetch — 2024-10-29

Drowning incidents pose critical challenges in the healthcare landscape, necessitating swift and coordinated responses for successful resuscitation and management. This comprehensive review delves into the pivotal role of anesthesia practitioners within the trauma unit in optimizing care for drowning victims. It explores various facets of the care continuum, from prehospital and early hospital management to surgical interventions and postoperative care. Key takeaways include the time-sensitive nature of drowning emergencies, the unique considerations for pediatric victims, and the importance of effective communication and collaboration within the multidisciplinary trauma team. Anesthesia practitioners extend to addressing the complex challenges and potential complications associated with drowning incidents, such as delayed presentation, pulmonary and cardiovascular complications, and neurological impairment. Understanding anesthesia considerations in the context of drowning incidents is emphasized as crucial for enhancing patient outcomes and reducing the burden of these life-threatening events.

Potential Applications of ChatGPT in Anesthesia Practice

Kornnika Yangan — 2024-10-29

This article explores the transformative potential of integrating ChatGPT, an AI-powered language model, into anesthesia practice. Anesthesia practitioners grapple with the complexities of ensuring patient safety, making real-time decisions, and managing extensive medical data. ChatGPT offers a multifaceted solution by enhancing preoperative assessments, providing real-time decision support during surgery, and automating postoperative monitoring. However, the article emphasizes the importance of ethical considerations, transparency with patients, and the indispensable role of human expertise. It underscores ChatGPT’s role as a supplementary resource rather than a replacement for medical professionals. Moreover, the article discusses the future prospects of ChatGPT, including its potential for personalized anesthesia plans, integration with advanced monitoring devices, and predictive capabilities.

Key Performance Indicators for Excellence in Anesthesia Services

Papiroon Noitasaeng — 2024-10-29

This article delves into the crucial role of key performance indicators (KPIs) in optimizing anesthesia services within public healthcare systems. KPIs serve as indispensable tools for measuring and enhancing the quality, safety, efficiency, and sustainability of anesthesia care. The importance of KPIs is underscored by their ability to improve patient safety and the overall quality of anesthesia care, optimize resource allocation and cost-efficiency, support data- driven decision-making, and foster transparency and accountability in anesthesia practice. The article also explores emerging technologies such as internet of thing devices and predictive analytics, which are revolutionizing KPI monitoring in anesthesia. Additionally, it delves into evolving regulatory and accreditation standards that are shaping the future of anesthesia practice. Ethical considerations, potential pitfalls, and data quality issues associated with KPIs are carefully examined to ensure that the integration of KPIs in anesthesia services adheres to the highest ethical and data integrity standards.

Addressing Staff Burnout: a Path to Elevate Quality of Care, Optimize Resources, and Reduce Wait Times in Endoscopic Anesthesia

Papiroon Noitasaeng — 2024-10-29

This article delves into the pressing challenges facing endoscopic anesthesia units within healthcare facilities. Staff burnout emerges as a central concern, driven by high demands, long working hours, and the emotional toll of patient care. The article examines the profound impact of staff burnout on healthcare delivery, emphasizing compromised quality of care, increased medical errors, and reduced patient safety. It explores the intricate relationship between staff burnout, quality of care, resource allocation, and patient wait times, highlighting their interconnectedness. Resource optimization strategies, such as capacity planning, technology integration, and collaborative partnerships, are explored to ensure efficient resource allocation. Strategies to reduce patient wait times, including patient prioritization and technology solutions, are detailed to improve access to care. The article showcases initiatives like mental health support, resilience training, and work-life balance programs. It also advocates for policy changes and collaboration with policymakers to shape the future of endoscopic anesthesia services.

High Flow Nasal Oxygen and Gastrointestinal Endoscopy

Somchai Amornyotin — 2024-10-29

High-flow nasal oxygen (HFNO) is an innovative modality increasingly used in various medical settings, including during gastrointestinal endoscopy (GIE) procedures. This technique provides oxygen at high flow rates, delivering humidified and heated oxygen that offers significant advantages over traditional oxygen delivery systems. In high-risk patients or during prolonged procedures, HFNO has emerged as a promising tool to enhance patient safety, maintain oxygenation, and reduce complications associated with GIE sedation.