Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Randomized Controlled Trial Clinical Trial
Can ketamine potentiate the analgesic effect of epidural morphine, preincisional or postincisional administration?
A randomized controlled trial was conducted to determine the effect of adding epidural ketamine to epidural morphine comparing between giving ketamine at preincisional time and postincisional time on postoperative analgesia in patients undergoing gynecological operations. Eighty patients scheduled for gynecological operation under combined epidural-general anesthesia were randomly divided into 4 groups. Group 1 received epidural morphine 3 mg before skin incision. ⋯ The amount of pethidine and paracetamol required and the time to the first dose of analgesic requirement were not significantly different among the groups. There were no differences in the incidences of pruritus, nausea, vomiting and nightmare. We concluded that adding ketamine to epidural morphine either by preincisional or postincisional administration did not potentiate the analgesic effect of epidural morphine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of different doses of epidural morphine for pain relief following cesarean section.
Although epidural opioid analgesia after cesarean section can provide excellent postoperative pain relief, serious complications may occur after epidural morphine. Therefore, we performed this study to compare the efficacy and side effects of three different doses of epidural morphine for analgesia following cesarean section. Ninety healthy pregnant women who underwent cesarean delivery were randomly assigned to receive either 2.5, 3 or 4 mg of epidural morphine for postoperative analgesia. ⋯ Mild pruritus and nausea occurred in all three groups and there was no significant difference between them. No serious complications were observed. In conclusion low dose epidural morphine is effective in providing adequate analgesia following cesarean delivery.
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Cardiac arrest during the perioperative period is a good indicator of the quality of anesthetic management. The incidence of perioperative cardiac arrest in Siriraj Hospital hasn't been reported before. Our objectives were to determine the incidence of perioperative anesthesia-related cardiac arrest and the results of cardiopulmonary resuscitation in these cases in order to find out how to improve our anesthetic care. ⋯ Twenty-one per cent of patients experiencing a cardiac arrest were discharged from hospital. Seventy-three per cent of events occurred in patients with an ASA rating 3-5 and most often the cause of arrest was massive or uncontrolled bleeding. In those patients with an ASA rating 1-2 there were no outstanding cause of arrest.
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To determine the occurrence and associated factors of awareness in the patients undergoing elective surgery under general anesthesia. ⋯ The occurrence of awareness was 0.62 per cent in the patients undergoing surgery under anesthesia. Inadequate anesthesia was the most likely cause of awareness. No postoperative sequelae of awareness occurred.
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Case Reports
Drug-induced hyperthermia and rhabdomyolysis during the perioperative period: report of three patients.
Drug-induced hyperthermia is one condition that anesthesiologists may meet even though it is uncommon, it is life threatening. We report 3 cases of patients at Siriraj Hospital, Mahidol University who developed drug-induced hyperthermia and rhabdomyolysis from different mechanisms. In two of them, the diagnosis was suspected malignant hyperthermia. ⋯ As a result of early detection and early manangement, these three patients survived without any permanent damage to vital organs. We conclude that Thai anesthesiologists should be more aware and alert to drug-induced hyperthermia especially as nowadays many teenagers abuse stimulant drugs and "triggering" drugs as antidepressant or serotonin reuptake inhibitors are prescribed more frequently. Early detection and management will decrease morbidity and mortality.