Thai Journal of Anesthesiology

Sedation for Obese Patients

Somchai Amornyotin — Mon, 29 Jun 2026 00:00:00 +0700

Obesity has become a global health concern, with an increasing number of obese patients requiring procedural sedation in operating rooms, endoscopy suites, interventional radiology units, and ambulatory surgical centers. Sedation in obese individuals presents unique challenges due to altered respiratory physiology, difficult airway management, pharmacokinetic and pharmacodynamic changes, and a high prevalence of obesity-related comorbidities such as obstructive sleep apnea, obesity hypoventilation syndrome, cardiovascular disease, and diabetes mellitus. Sedation-related adverse events, particularly hypoxemia, airway obstruction, hypercapnia, and cardiovascular instability, occur more frequently in obese patients than in normal-weight individuals. Contemporary advances including capnography, high-flow nasal oxygen, continuous positive airway pressure, and dexmedetomidine-based sedation techniques have improved safety in high-risk populations. Appropriate preprocedural assessment, careful drug selection, optimized dosing strategies, vigilant monitoring, and advanced airway management techniques are essential to improve patient safety. This review summarizes the pathophysiological changes associated with obesity, discusses sedation-related risks, evaluates commonly used sedative agents, and provides evidence-based recommendations for peri-procedural management of obese patients undergoing sedation.

Analgesic efficacy of perioperative ultrasound-guided fascia iliaca block in geriatric patients receiving spinal anesthesia for hip fracture surgery

Saowaluk Sotananan — Mon, 29 Jun 2026 00:00:00 +0700

Introduction: Effective perioperative pain management in elderly patients undergoing hip fracture surgery remains challenging. Inadequate pain control not only increases the patient’s distress but may also lead to postoperative complications. The fascia iliaca compartment block (FICB) has been shown to enhance analgesia and improve patient comfort. This study aims to compare the analgesic efficacy of FICB when performed prior to spinal anesthesia in patients undergoing hip fracture surgery. Methods: A prospective randomized study was conducted in 54 elderly patients undergoing hip fracture surgery under spinal anesthesia. Patients were randomly assigned to receive either an ultrasound-guided FICB with 0.25% bupivacaine 40 mL (block group) or sham ultrasound without injection (control group). The prespecified primary outcome was total postoperative morphine consumption at 24 and 48 h. Secondary outcomes included pain during positioning for spinal anesthesia, postoperative pain, patient satisfaction, and adverse events. Longitudinal pain outcomes were analyzed using a linear mixed-effects model. Results: Total morphine consumption at 24 and 48 h was not significantly different between the groups. However, patients in the block group had significantly lower postoperative pain during ambulation. Mixed-effects modelling confirmed a significant overall group effect for postoperative pain on movement (P = 0.009). Pain during positioning for spinal anesthesia was significantly lower in the block group (P < 0.001). Correspondingly, the time required to perform spinal anesthesia was significantly shorter in the block group (P < 0.001). The incidence of complications was similar between groups. Conclusions: Although postoperative opioid consumption did not differ between groups, FICB improved pain during positioning for spinal anesthesia and decreased pain during ambulation without increasing complications.

Effect of Phenylephrine vs Ephedrine on Cardiac Output for Treatment of Spinal Hypotension during Cesarean Section: a Retrospective Non-Inferiority Analysis

Papishaya Thamsuaydee, Ketchada Uerpairojkit, Nawaporn Simarangsan — Wed, 01 Jul 2026 00:00:00 +0700

Objective: As the first study to evaluate maternal cardiac output in Thai parturients, we compared the hemodynamic effects of phenylephrine and ephedrine during the management of spinal-induced hypotension for elective cesarean delivery. Materials and methods: This study was a secondary analysis of a previously published randomized controlled multi-centered trial. Data from 33 parturients experiencing spinal hypotension during cesarean section wasanalyzed retrospectively; 19 received phenylephrine (group P) and 14 received ephedrine (group E). Case enrollment was done from December 2019 to September 2020. The primary aim was to compare alterations in maternal cardiac output between before and after vasopressor administration of phenylephrine and ephedrine treatment group, in healthy parturients undergoing an elective cesarean section. The secondary outcomes were to assess the changes in maternal cardiac output and systolic blood pressure, as well as to determine correlation between cardiac output and heart rate after vasopressor administration. Results: The maternal cardiac output change between pre- and post-vasopressor treatment in group P, -0.08 l/min (95%CI -0.44, 0.28), is non-inferior to group E, -0.01 l/min (95%CI -0.44, 0.41). The change in cardiac output in the phenylephrine group did not cross the pre- specified non-inferior margin of -1.17 l/min. There were no significant differences in changes of heart rate and cardiac output before after vasopressor administration between and two groups. In addition, it is found that cardiac output is positively correlated with heart rate (Pearson correlation = 0.512) after vasopressor administration. Conclusion: Cardiac output difference after vasopressor administration in the phenylephrine was non-inferior to ephedrine. Heart rate, rather than choice of vasopressor, might have a role on maternal cardiac output. Additional research focusing on high-risk pregnancies is necessary to gain insights into specific patient populations.

Effectiveness of Tube Bending along Macintosh Blade Curve Compared to Random Curve during Video Laryngoscope Intubation by Nurse Anesthetists: a Quasi Experimental Research

Chutchai Yathaputanon — Mon, 29 Jun 2026 00:00:00 +0700

The use of video laryngoscopes has gained popularity in medical practice, particularly after the COVID-19 pandemic, due to their effectiveness in minimizing the spread of infectious agents. This quasi-experimental study aimed to compare the success rates of endotracheal intubation using a video laryngoscope in patients undergoing general anesthesia for surgery. The study focused on comparing the technique of aligning the curvature of the endotracheal tube with the Macintosh blade versus the standard curvature technique. Data was collected from 11 nurse anesthetists, dividing the samples into control and experimental groups of 165 patients each. Intubation time, the number of successful attempts, perceived ease or difficulty, and complications were recorded. Data analysis was performed using IBM SPSS Statistics 22 with descriptive statistics and comparative tests to determine group differences. The results indicated that the Macintosh blade curvature technique achieved a higher success rate in endotracheal intubation compared to the standard technique. This study recommends adopting this technique in clinical practice to enhance efficiency and reduce potential complications during intubation in anesthetized patients.

The Development of a Headrest for Intubation in Patients Under General Anesthesia

Mon, 29 Jun 2026 00:00:00 +0700

Background: Optimal head positioning is crucial for successful endotracheal intubation under general anesthesia. This study assessed the efficacy of a Modified Pillow designed to improve airway alignment and intubation conditions compared to a standard pillow, focusing on laryngoscopic view, ease of intubation, and user satisfaction. Materials and methods: A total of 320 patients undergoing surgery with general anesthesia were randomly assigned to either the Regular Pillow group or the Modified Pillow group. Patients were aged 18 years or older, classified as ASA I-II, and without cervical spine injuries. Airway assessments included Mallampati classification, thyromental distance, mouth opening, and laryngoscopic view. The BURP (backward, upward, rightward pressure) maneuver was employed during intubation attempts. User satisfaction was also evaluated. Statistical analyses (t-tests, Chi-square tests, and logistic regression) compared both groups. Results: Demographics and baseline airway characteristics were similar across groups, except for mouth opening, which was significantly better in the Modified Pillow group (P = 0.001). The Modified Pillow reduced the need for the BURP maneuver (P = 0.036) and achieved higher user satisfaction scores (P < 0.001). No significant differences were noted in laryngoscopic grades or the number of intubation attempts. The ergonomic design and comfort of the Modified Pillow were highlighted as key advantages by anesthesia providers. Conclusion: The modified pillow offers significant benefits in head positioning for intubation, reducing reliance on the BURP maneuver, and improving user satisfaction. While both pillows provided effective airway management, the ergonomic advantages of the Modified Pillow enhance its value in clinical anesthesia practice.

Atypically Prolonged Duration of Spinal Anesthesia: Case Report

Natthaporn Harungsri — Mon, 29 Jun 2026 00:00:00 +0700

Spinal anesthesia is a commonly used regional anesthesia technique because it is relatively safe and highly effective. Despite its safety, it can lead to a serious complication that anesthesiologists must closely monitor. This report presented a case of a patient who underwent a bilateral salpingo-oophorectomy. The patient received a spinal injection of 15 mg of 0.5% bupivacaine combined with 0.2 mg of morphine. The patient’s sensory and motor functions returned to normal 26 h after the injection of local anesthetic in the subarachnoid space with no neurological complications