Journal of the Medical Association of Thailand = Chotmaihet thangphaet
-
Randomized Controlled Trial Comparative Study
A comparison of dexmedetomidine and propofol in Patients undergoing electrophysiology study.
Dexmedetomidine provides profound levels of sedation without affecting cardiovascular and respiratory stability based on its pharmacological profile. It may be a valuable sedative for procedures with minimal to mild pain. Electrophysiology study (EP study) is a mildly painful procedure that requires conscious sedation. The authors hypothesized that dexmedetomidine would cause lower respiratory and cardiovascular depression than propofol during equal sedation level in an electrophysiology study. ⋯ The present study demonstrated that comparable sedation could be achieved by a combination of pethidine with either dexmedetomidine or propofol during EP study. Dexmedetomidine group provided more hemodynamic and respiratory stability than propofol group.
-
Assessment of intravascular volume status is an essential parameter for the diagnosis and management of critically-ill patients. Generally, central venous pressure (CVP), which is an invasive measure, has been recommended for this purpose. Since CVP has been associated with many complications, inferior vena cava diameter and collapsibility index (IVC-CI) were used in the present study to evaluate the intravascular volume status of critically-ill patients at Rajavithi Hospital. ⋯ The present study supported the correlation between CVP and IVC-CI. The authors conclude that the IVC-CI can provide a useful guide for noninvasive intravascular volume status assessment of critically-ill patients.
-
Femoral nerve block is commonly established for postoperative analgesia in total knee arthroplasty but no evidence of plasma bupivacaine level has been reported. ⋯ Peak plasma concentrations of bupivacaine were demonstrated at 60 minutes after a single shot femoral nerve block, and no signs or symptoms of bupivacaine toxicity were observed Therefore, single shot femoral nerve block with 20 mL of 0.5% bupivacaine is safe.
-
Comparative Study
Comparison of outcomes for staple and conventional closure of the pharynx following total laryngectomy.
Closure of the wall of the pharynx is an important step in the total laryngectomy operation. An inadequate closure results in tissue contamination, wound infection, and the development of pharyngo-cutaneous fistula. ⋯ Pharyngeal stapling might be an alternative technique for total laryngectomy.
-
Recurrence rate of PSVT (paroxysmal supraventricular tachycardia) in Rajavithi emergency department.
PSVT (Paroxysmal Supraventricular Tachycardia) is a common heart disease, especially in young people. Although PSVT is not a life-threatening illness, its symptoms occur in a sudden onset and with increasing frequency. Because of the severity of its symptoms, it can interfere with patients' quality of life and lead to an increase in anxiety levels. The authors found that patients with PSVT tended to have recurrence of symptoms; however, there has been no previous study in Thailand of the rate of recurrent PSVT in adults. Moreover, there has been no study of the factors which precipitate PSVT cause recurrence, and result in hospitalization. ⋯ There was a high rate of recurrence of PSVT in patients in the emergency department at Rajavithi Hospital. Significant factors affecting recurrence were patients presenting with initial heart rate of over 200 beats per minute. Low systolic blood pressure, long duration of symptoms, structural heart disease, low serum Hematocrit, low serum sodium and serum potassium were associated with hospitalization.