Thai Journal of Anesthesiology

Perioperative Takotsubo Cardiomyopathy: a Review Article

Varisara Charoenyingpaisal, Nalin Chokengarmwong — Sun, 30 Jun 2024 00:00:00 +0700

Perioperative Takotsubo cardiomyopathy, acute transient left ventricular dysfunction without significant coronary artery obstruction, can occur during intraoperative period and within 30-days postoperative period. It is found to be more common and more fatal than non- perioperative type. Neither the understanding of clear pathogenesis nor tools to predict the occurrence and recurrence, it is reasonable to diminish any possible triggers such as patient’s anxiety, light anesthesia, inadequate pain control and residual paralysis. In patients with history of Takotsubo cardiomyopathy, the operation should be performed with available intensive care unit and percutaneous coronary intervention. A multidisciplinary team approach is needed. The assessment of the echocardiogram and complications must be noted. The supportive management to preserve organ perfusion is still the mainstream of management while the inotrope and intra-aortic balloon pump must be cautious.

Advancements in Ambulatory Anesthesia Pain Management

Sun, 30 Jun 2024 00:00:00 +0700

This article discusses the advancements in ambulatory anesthesia pain management and their implications for modern healthcare. The importance of effective pain management in ambulatory settings is emphasized, along with the challenges of traditional pain management techniques. The article then focuses on multimodal analgesia in ambulatory anesthesia, explaining its rationale and detailing the various drugs and techniques used. Furthermore, the article discusses the role of technology in ambulatory anesthesia pain management. It focuses on advancements in pain assessment tools, drug delivery systems, and the use of virtual reality as a distraction technique. The integration of patient-centered approaches in pain management is also explored emphasizing individualized pain management plans and patient engagement. The article also addresses the management of chronic pain in ambulatory anesthesia patients, emphasizing the need to identify and develop specialized pain management strategies for this population. It also discusses strategies for addressing safety and complications in ambulatory anesthesia pain management. The future directions of ambulatory anesthesia pain management are explored, with a focus on potential areas for further research and advancements in the field.

Anesthesia Practitioners’ Inappropriate Handling with Narcotics and Psychotropics

Sun, 30 Jun 2024 00:00:00 +0700

In the complex landscape of healthcare, the phenomenon of anesthesia practitioners mishandling narcotics and psychotropics has surfaced as a pressing concern. This article delves into the enigmatic unraveling of this issue, shedding light on the implications it poses for patient safety and professional integrity. Anesthesia practitioners, entrusted with administering potent substances critical to pain management and patient well-being, stand at the intersection of ethical dilemmas and critical responsibilities. The article examines key points, emphasizing that patient safety is at immediate risk due to impaired decision-making and administration errors resulting from inappropriate substance use. Collaboration emerges as a cornerstone for addressing this challenge, necessitating cooperation among practitioners, institutions, regulatory bodies, and professional associations. Preventive measures and educational initiatives are underscored as pivotal strategies to mitigate substance abuse risks within this professional group.

Briefing Culture for Patient Safety

Khanita Kasikan, Sudta Parakkamodom, Napatsorn Tuyatiko, Somchai Amornyotin — Sun, 30 Jun 2024 00:00:00 +0700

Patients and relatives or families expect to receive treatment and surgery to cure disease safely with no complications from a team of care providers consisting of surgeons, anesthesiologists, anesthesia nurses, operating room nurses and other coordinators. In the anesthesia process, anesthesia providers briefing culture is a systematic process of communication between the team before starting the care process in the operating room or procedure. It is a critical step in ensuring the patient safety. Creating a culture of patient safety in the organization, which includes the values, beliefs, attitudes, norms, and behaviors of personnel. That will affect the attitude and behavior of personnel to improve the quality of patient health care and prevent the adverse events, discrepancies, errors, and the patient mortality rate in hospitals. Briefing emphasizes an awareness of potential patient problems and clear communication between the patient care team without increasing the delay in starting surgery.

Clinical guideline for prevention and management of perioperative hypothermia by the Royal College of Anesthesiologists of Thailand

Sun, 30 Jun 2024 00:00:00 +0700

Perioperative hypothermia is a relatively common occurrence that anesthetic providers may encounter in their daily work. Its effects can significantly impact overall treatment and outcomes, leading to issue such as coagulopathy, surgical wound infections, myocardia injury, prolonged drug actions, shivering and thermal discomfort. Thus, it is imperative for anesthetic providers to possess a comprehensive understanding of hypothermia, recognize its significance, and be well-versed in preventive measures to safeguard patients from its adverse effects. Preventing and treatment of perioperative hypothermia is highly feasible and pivotal for optimal patient care. However, the approach to managing perioperative hypothermia varies across Asia Pacific countries due to the difference in guidelines and socioeconomic factors. Some nations opt to adapt international Clinical Practice Guideline (CPGs) to align with their unique contexts. As a response to diversity, the Royal College of Anesthesiologists of Thailand has taken the initiative to develop a dedicated clinical practice guideline. The primary object of this guideline is to consolidate best practice for prevention and treatment of perioperative hypothermia in the setting in Thailand. Within the scope of this clinical practice guideline, a comprehensive framework is presented. It encompasses a clear definition of hypothermia and provides detailed clinical guidance spanning the entire perioperative continuum, including perioperative, intraoperative and postoperative care. By unifying and disseminating such standard guidance, the guideline aims to streamline practices, enhance patient safety and ensure optimal outcomes in the context of perioperative hypothermia.

Anesthesia and Drug Induced Sleep Endoscopy (DISE)

Somchai Amornyotin — Sun, 30 Jun 2024 00:00:00 +0700

Drug-induced sleep endoscopy (DISE) is a diagnostic procedure used to evaluate the upper airway in patients with obstructive sleep apnea (OSA) by mimicking natural sleep conditions. OSA is a disorder characterized by repetitive collapse of the upper airway during sleep. Standard treatment for OSA is continuous positive airway pressure therapy (CPAP). However, up to 50% of patients with OSA are unable to tolerate CPAP obligating alternative treatments. DISE allows for the direct visualization of airway dynamics, which aids in identifying the site and pattern of obstruction, thereby guiding treatment decisions. It has been the most used technique to identify specifc areas of obstruction and patterns of airway collapse that serves as a baseline screening tool for both surgical and non-surgical options.1 A variety of drugs are available for sedating patients undergoing DISE, with the goal of achieving a level of sedation that closely mimics natural sleep. The most often utilized agents are propofol, midazolam, and dexmedetomidine.2 While no absolute contraindications exist unique to DISE, relative contraindications include drug allergy to selected sedative agents, pregnancy, and medical comorbidities resulting in signifcant airway compromise. Anesthesia plays a crucial role in DISE, as it must induce a sleep-like state without compromising airway patency or patient safety.

Effects of Intravenous Lidocaine in Total Intravenous Anesthesia for Colonoscopy: a Double-Blind Randomized Controlled Study

Sun, 30 Jun 2024 00:00:00 +0700

Background: Total intravenous anesthesia (TIVA) is widely used as an anesthetic technique in patients undergoing colonoscopy. Lidocaine can reduce visceral pain and potentiates the ventilatory responses to carbon dioxide. This study aimed to evaluate the efficacy and safety of lidocaine combined with propofol during a colonoscopic procedure. Methods: Sixty-one patients underwent elective colonoscopy under TIVA with IV fentanyl 0.5 mcg/kg and propofol 1 mg/kg followed by 2 mg/kg/h as a maintenance infusion with titration as needed. The patients were also randomized to receive 1.5 mg/kg of IV lidocaine followed by 2 mg/kg/h (group L) or 0.3 mL/kg of IV normal saline followed by 0.4 mL/kg/h (group N). The primary outcome was the total dose of propofol used. The secondary outcomes were complications and adverse events. Results: Data for 60 patients were available for analysis. There was no statistically significant difference in the median total dose of propofol used between the two groups or in episodes of apnea and desaturation. The mean difference in mean arterial pressure at 5 min after scope insertion was significantly smaller in group N than in group L. There was no statistically significant between groups in terms of the decrease in heart rate from baseline, or any adverse events. Conclusion: Intravenous lidocaine 1.5 mg/kg followed by lidocaine 2 mg/kg/h did not decrease the dose of IV propofol used during a colonoscopic procedure. However, it was able to reduce the risk of hypotension in the early induction phase.

Comparison of Endotracheal Tube Cuff Pressure with Passive Release Technique for Cuff Inflation between Disposable and Loss of Resistance Syringe in Patients Undergoing General Anesthesia

Sun, 30 Jun 2024 00:00:00 +0700

Background: The standard technique to maintain optimal endotracheal tube cuff pressure is the manometer, but it is not always available. Passive release technique has been shown in previous studies to be one of the most accurate alternative methods to provide cuff pressure within an optimal range (20-30 cmH2O). The objective of the study is to compare endotracheal tube cuff pressure in patients undergoing general anesthesia by inflating the endotracheal cuff with passive release technique between two types of syringes; disposable and loss of resistance syringes. Methods: A prospective double-blinded randomized control study was conducted in Rajavithi Hospital, enrolling patients undergoing elective surgery under general anesthesia with endotracheal tube. Cuff pressure after passive release technique was measured. If cuff pressure was less than 20 cmH2O, air inflation was done until it reached 20 cmH2O. If cuff pressure exceeded 30 cmH2O, air deflation was done until it reached 25 cmH2O. Results: One hundred patients were randomized to the disposable syringe and loss of resistance syringe group, with fifty patients in each group. Mean cuff pressure after passive release technique was 29.24±6.02 cmH2O in the disposable syringe group which was statistically significantly different from the loss of resistance syringe group (19.24±6.27 cmH2O). There were 23 patients (46%) in the disposable syringe group and 15 patients (30%) in the loss of resistance group with cuff pressure within an optimal range. Conclusion: The disposable syringe group was superior to the loss of resistance syringe group in providing cuff pressure within an optimal range.

Significance of Vagovagal Reflex During Anesthesia

Sun, 30 Jun 2024 00:00:00 +0700

The vagovagal reflex, mediated by the vagus nerve, is a vital mechanism in maintaining homeostasis during anesthesia. This complex reflex involves intricate neural pathways that regulate heart rate, blood pressure, gastrointestinal motility, and respiratory function. Certain anesthetic agents can trigger vagal activation, leading to reflex responses that pose potential complications, including bradycardia, hypotension, bronchospasm and gastrointestinal disturbances. Taking into account factors such as patient age, medical conditions and medication use, a tailored approach can be developed. Proactive and vigilant monitoring of vital signs is essential in detecting and addressing any vagal reflex-mediated changes promptly. Adjusting anesthetic depth, administering intravenous fluids, utilizing pharmacological interventions and employing positive pressure ventilation techniques are effective strategies to counteract vagal reflex responses. Ongoing research efforts aim to further understand the vagovagal reflex and develop improved strategies for its management during anesthesia.