Thai Journal of Anesthesiology

A Quick Dive into Perioperative Use of Paracetamol

Suraj Kafley — 2026-04-26

Paracetamol (acetaminophen) is commonly used worldwide for the management of fever and pain. It has also been administered via multiple routes in the perioperative period. Paracetamol is an effective component of multimodal analgesia. In addition to patient- specific considerations when using paracetamol, both economic and environmental factors should also be taken into account when selecting the most appropriate route of administration in perioperative care. This approach can enhance cost-efficiency and support environmental sustainability, while maintaining optimal patient care and effective pain management.

Drug-Induced Sleep Endoscopy: Shaping the Future of Airway Diagnostics and Management in Clinical Anesthesia

Bussaba Srinimit — 2026-04-26

Drug-induced sleep endoscopy (DISE) has emerged as a transformative tool in airway diagnostics and management, offering significant advantages over traditional methods. By inducing sleep through pharmacologic agents, DISE enables real-time visualization of dynamic airway obstructions, providing valuable insights into the site, type, and pattern of airway collapse. This review explores DISE’s role in clinical anesthesia, emphasizing its importance in perioperative airway assessment, especially in patients at risk for difficult intubation or those with obstructive sleep apnea (OSA). DISE’s clinical applications include guiding surgical planning, tailoring airway management strategies, and informing non-surgical interventions, such as continuous positive airway pressure or mandibular advancement devices. The review highlights the evidence supporting DISE’s efficacy, reviewing case studies, clinical trials, and outcomes. As DISE continues to evolve, its integration into routine clinical practice holds the potential to revolutionize personalized anesthesia care, ensuring optimal airway management and enhancing patient safety during surgical procedures.

Jehovah’s Witnesses: What Anesthesiologists Need to Know

Somchai Amornyotin — 2026-04-26

Jehovah’s Witnesses (JWs) represent a unique challenge in perioperative medicine due to their refusal of blood transfusions based on religious beliefs. This poses complex clinical, ethical, and legal dilemmas, particularly for anesthesiologists responsible for perioperative hemodynamic management and patient safety. This review summarizes JW beliefs, perioperative management strategies, ethical conflicts, legal frameworks, and global variations, including the situation in Thailand. Emphasis is placed on patient autonomy, blood conservation techniques, and medico-legal risk mitigation.

Efficacy of Intraoperative Intravenous Lidocaine Infusion for Postoperative Quality of Recovery in Laparoscopic Gynecological Surgery: a Triple-Blind, Randomized Controlled Trial

Panramon Vanichivithya — 2026-04-26

Objective: To evaluate whether intraoperative continuous intravenous lidocaine infusion improves postoperative quality of recovery, pain, and opioid consumption in patients undergoing elective laparoscopic gynecological surgery. Materials and methods: This prospective, triple-blind, randomized controlled trial enrolled patients aged 18-65 yr undergoing elective laparoscopic benign gynecologic surgery. Patients were randomized to receive either lidocaine 1.5 mg/kg intravenous bolus followed by continuous infusion at 1.5 mg/kg/h until the end of surgery, or an equivalent volume of normal saline. The primary outcome was quality of recovery assessed by the Thai QoR-35 questionnaire at 24 h postoperatively. Secondary outcomes included pain scores in the post-anesthesia care unit and at 4, 8, 12, and 24 h, incidence of severe pain, total morphine consumption within 24 h, ondansetron doses, and Ramsay sedation scores. Results: Sixty-three patients completed the study. Baseline characteristics were comparable between groups. The mean QoR-35 score in the lidocaine group was 162.68 ± 8.43 versus 160.38 ± 7.60 in the saline group (P = 0.259). Pain scores, morphine consumption, and antiemetic requirements did not differ significantly. However, the incidence of severe pain was lower in the saline group than in the lidocaine group (16.1% vs. 43.8%; P = 0.035). No differences were observed in sedation scores Conclusion: Perioperative intravenous lidocaine infusion did not significantly improve postoperative quality of recovery, pain scores, and opioid consumption, but was associated with a reduced incidence of severe pain.

Spinal Myoclonus Following Neuraxial Anesthesia: an Extremely Rare Complication

Setthaporn Junhavitthaya — 2026-04-26

Spinal anesthesia is a widely employed technique for various surgical procedures. Neuraxial anesthesia is generally safe. However, it might be associated with several neurological complications, of which spinal myoclonus is an extremely rare but an important consideration.

Laryngospasm after Superior Laryngeal Nerve Block: a Case Report

Punchika Luetrakool — 2026-04-26

Medialization thyroplasty is a surgical treatment for vocal cord paralysis, a condition often associated with varying degrees of aspiration. The first step of this procedure invloves performing superior laryngeal nerve blocks using a local anesthetic agent. Performing a superior laryngeal nerve block in patients who have undergone radiation therapy and lymph node dissection can be challenging due to potential anatomical abnormalities. These abnormalities may cause the anesthetic injection, when performed using conventional landmark techniques, to penetrate deeper than the intended layer. This may lead to certain life-threatening complications, such as laryngospasm, as described in this case report. Therefore, using ultrasound guidance to perform the superior laryngeal nerve block can enhance the accuracy of the anesthetic injection. Additionally, sedation must be administered cautiously to avoid respiratory depression, as complications such as laryngospasm may occur in this patient.

Anesthetic Management of Radical Nephrectomy with Inferior Vena Cava Tumor Thrombus: a Case Report

Larissa Caroline Barbosa — 2026-04-26

Renal cell carcinoma may extend into the venous system; a condition associated with increased surgical and anesthetic complexity. Tumor thrombus involving the renal vein or inferior vena cava (IVC) poses significant perioperative challenges, including major bleeding, abrupt changes in venous return, and potential tumor embolization. We report the case of a 56-year-old patient with a large renal tumor and tumor thrombus involving the renal vein and the inferior vena cava who underwent radical nephrectomy. Perioperative management included balanced general anesthesia combined with single-shot spinal analgesia, invasive hemodynamic monitoring, vasoactive support, and goal-directed transfusion therapy guided by laboratory parameters and clinical assessment. The procedure was completed without major complications, highlighting the importance of structured perioperative preparation in high-risk oncologic surgeries.