Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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The causes and consequences of failed extubation in postoperative intensive care unit (ICU) patients were prospectively collected by clinical observation study in the surgical ICU Siriraj Hospital from 1st October 2000 to 31st March 2001. The failure rate was 1.7 per cent (9/477). Patients underwent the following types of surgery: abdominal surgery 66.67 per cent, orthopedic 22.22 per cent, and head-neck surgery 11.11 per cent. ⋯ Tracheostomy was required in 55.56 per cent. From these observations we conclude that extubation should be performed at the appropriate time for each patient. This will differ according to the patient and his/her circumstances.
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Notice of all surgical patients who need access to Siriraj post-anesthetic intensive care unit (ICU) must be given to the ICU in advance by the surgical team. However, there are some patients who present unexpectedly, and we would like to evaluate this unplanned ICU admission as a quality control. ⋯ These results indicate that the patients who are admitted to the post-anesthetic ICU without prior planning can provide insights of ICU resource management, and the standards of perioperative management in the operating theatres. It definitely offers an opportunity to implement changes in our anesthetic practice. We will continue to monitor the impact of this important indicator.
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Neural blockade has been used as the single method to anesthetize a part of the body or used in combination with general anesthesia to lessen perioperative pain. Currently, nerve blocks are used for diagnostic, prognostic, therapeutic and prophylactic proposes for management of chronic, acute and cancer pain in a Pain Clinic. Reviewing the records of the 3,349 patients at Siriraj Pain Clinic, we found 2,662 and 687 cases had chronic and acute pain problems respectively, and only 646 patients were treated with anesthetic interventions during 1990 to 1998. ⋯ This retrospective review showed that 38 per cent of them reported 50 per cent pain relief with temporary effect. 34 per cent experienced good and satisfactory pain relief while 9 per cent reported excellent pain relief. 17 per cent did not gain benefit from any technique of pain relief and about 2 per cent could not be evaluated due to they did not return for follow-up. One serious complication after thoracic sympatholysis was brachial plexus injury. The neural blockade is proven to be one of the useful adjunct in the management of chronic pain but the selection of the technique is subjected to its critical appraisal.
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Biography Historical Article
Professor Salard Tupavong, key contributor to the development of anesthesia in Thailand.
The practice of Anesthesiology by a qualified Thai national was introduced to the Kingdom of Thailand 50 years ago, when Professor Salard Tupavong graduated from the United States of America and returned to Siriraj Hospital. She made a tremendous contribution to the birth of anesthesia as a specialty, as a pioneer of modern anesthesia and pain therapy in Thailand. ⋯ She was regularly invited as an honorary speaker by the committees of both national and international congresses. We are most appreciative of everything that she has done and wish her happy and healthy days ahead.