Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Clinical Trial
Maternal and neonatal effects of single-dose epidural anesthesia with lidocaine and morphine for cesarean delivery.
Two per cent lidocaine (18-20 ml) with epinephrine 1:200,000 plus 4 mg of morphine was given as a single epidural injection over 3 minutes for elective cesarean section in 60 healthy mothers at term. It provided effective, safe and adequate analgesia in the postoperative period. ⋯ However, this study was done only in healthy mothers not in labor and having a term fetus. We do not recommend using this technique in complicated obstetric patients.
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Case Reports
Fever, skin rash, jaundice and lymphadenopathy after trichloroethylene exposure: a case report.
Trichloroethylene, a chlorinated hydrocarbon has been reported to cause many adverse health effects. This paper describes a female patient presenting with rather unusual manifestation secondary to trichloroethylene (TCE) exposure, i.e. hepatitis and generalized dermatitis. ⋯ After withdrawal from the exposure site, her symptoms improved and liver function test returned to baseline level after a three-months period of follow-up. TCE induced immunologic reaction has been postulated as the pathological process of this illness.
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The epidemiology and exposing causes of snake bites were studied in 274 patients between 1 January 1982 and 30 December 1990. They comprised 142 males (51.82%) and 132 females (48.18%). Their ages ranged from 1 month to 86 years old. ⋯ It was also interesting to learn that 221 cases (80.66%) out of 274 were bitten in Bangkok, 91 cases (33.21%) were bitten from 6.00 p.m. to 9.00 p.m., 129 cases (47.08%) were bitten between June and September, 98 cases (35.77%) were bitten on a foot and 77 cases (28.10%) were bitten on a finger. The high risk factor of being bitten by a snake was walking along a farm or a ranch with masses of grass or undergrowth during the night without self-prevention and good caution. Therefore, health education on preventive measures were elucidated.
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Comparative Study
Effect of intraoperative fluid on blood glucose level in neurosurgery.
There is a considerable controversy regarding glucose administration during intracranial surgery. However, recent animal and human studies suggest that hyperglycemia exacerbates ischemic brain damage and intraoperative hypoglycemia may not be a concern if the surgical procedure is less than 4 hours. We, therefore, studied the blood glucose in neurosurgery with craniotomy in 90 Thai patients, divided into 3 groups. 30 patients in each group received balanced salt solution (0.9% NSS), 5 per cent glucose rate 60-80 ml/h and 5 per cent glucose rate more than 120 ml/h. ⋯ In group III; patients given 5 per cent glucose infusion at the rate of more than 120 ml/h had hyperglycemia (236.75 +/- 63.57 mg%) at 6 hours. In conclusion, we suggest that in Thai patients undergoing neurosurgical procedures; blood glucose levels should be checked intraoperatively if glucose is withheld from the intraoperative fluid regimen. Otherwise 80 ml/h of 5 per cent dextrose intravenous infusion should be given to the patients to prevent hypoglycemia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Propofol vs isoflurane for neurosurgical anesthesia in Thai patients.
Sixty Thai patients, ASA class I-II, Glasgow coma score of 15 undergoing elective intracranial surgery were randomly assigned to 2 groups. In group I, 30 patients were induced with thiopental 3-5 mg/kg, intubation with succinylcholine 1-2 mg/kg and then maintained with 60 per cent N2O in O2, isoflurane and vecuronium as a muscle relaxant. In group II, 30 patients received fentanyl 50 micrograms, propofol 1.0-2.5 mg/kg for induction and vecuronium 0.08 mg/kg for intubation then maintained with 60 per cent N2O in O2, continuous infusion of propofol 2-12 mg/kg/h and vecuronium as a muscle relaxant. ⋯ The cost of anesthesia in group II was 1.3 times that of group I. In conclusion, although neurosurgical anesthesia for Thai patients with fentanyl-propofol technique produces more stable blood pressure during intubation and emergence, rapid recovery from anesthesia and a higher Glasgow coma score, the cost of anesthesia is more expensive. Furthermore, this technique is more difficult and needs more experience.