Ambulatory anesthesia and surgery in Thailand

Current Opinion in Anaesthesiology, 2012

Purpose of review Anesthesia for ambulatory surgery has come a long way since 1842 when James Venable underwent surgery for removal of a neck mass with Crawford W. Long administering ether and also being the surgeon. We examine major advances over the past century and a half. Recent findings The development of anesthesia as a medical specialty is perhaps the single most important improvement that has enabled advances in the surgical specialties. Moreover, improved equipment, monitoring, training, evaluation of patients, discovery of better anesthetic agents, pain control, and the evolution of perioperative care are the main reasons why ambulatory anesthesia remains so safe in modern times. The development of less invasive surgical techniques, economic factors, and patient preferences provided addition impetus to the popularity of ambulatory surgery. Summary Beyond the discovery in the mid-19th century that ether and nitrous oxide could be used to render patients unconscious during surgical procedures, subsequent developments in our specialty have added modestly, in a stepwise manner, to reduce mortality and morbidity associated with its use. These improvements have allowed us to safely meet the steadily increasing demand for ambulatory surgery.

PubMed, 2008

Background: There is a continuing trend to have more elective surgery performed on an outpatient basis. Objective: To determine anesthetic profiles and adverse events in practice of ambulatory anesthesia for elective surgery in different levels of hospitals across Thailand. Material and method: A prospective descriptive study was conducted in 20 hospitals comprising seven university, five regional four general and four district hospitals across Thailand. Consecutive patients undergoing anesthesia for elective surgery were included. The included patients, classified as outpatients, were selected and extracted for summary of the result by using descriptive statistics. Results: The authors reported 7786 outpatients receiving anesthesia for elective surgery. The majority of patients were in ASA class 1 and 2 (96.2%) while the rest were in ASA class 3 (3.8%). Nearly 90% of the ASA class 3 patients were in university hospitals. The majority of patients (83.1%) did not receive premedication. Diazepam was used more frequently (11.5% vs. 0.1%) than other drugs. Noninvasive blood pressure monitoring and pulse oximetry were used in greater than 90%, while electrocardiogram (EKG) was used in 67.2% and end tidal CO2 in only 6.8%. The three most common anesthetic techniques were general anesthesia (including inhalation anesthetics), total intravenous anesthesia (TIVA), and monitored anesthesia care (MAC). Regional anesthesia was performed in 12% of cases. The three most common regional anesthetic techniques were brachial plexus block (7.1%), spinal anesthesia (2.21%), and other peripheral nerve blocks (2.06%). Propofol was the most common drug for induction. Succinylcholine was used for intubation in 8.8%. The three most common nondepolaring neuromuscular blocking agents were atracurium, cisatracurium, and vecuronium. Fentanyl was the most common drug used among opioids. The three most common volatile anesthetics were sevoflurane, halothane, and isolurane. Lidocaine was the most frequently used in 29.76% of cases, while bupivacaine in 7.9% and ropivacaine only in 0.05%. The majority of the events relating to respiratory system were hypoxia or oxygen desaturation (18:10,000), reintubation (2.6:10,000) and difficult intubation (2.6:10,000), pulmonary aspiration (2.6:10,000), and esophageal intubation (1.3:10,000). Other adverse events included awareness (1.3:10,000), suspected myocardial infarction or ischemia (1.3:10,000), and drug error (1.3:10,000). Five patients (0.06%) received unplanned hospital admission. No patients developed cardiac arrest or died. Conclusion: The incidence of major adverse events was low in ambulatory anesthesia for elective surgery when compared to the incidence in general surgical population. The majority of the events occurred in the respiratory system. The authors did not find any complications relating to regional anesthesia. Despite a low incidence of adverse events in ambulatory anesthesia, anesthesia personnel who are responsible for ambulatory anesthesia should have adequate knowledge and skills in selection and preparation of the patients. Therefore, a system of preanesthesia evaluation is very important.

Mending Bodies, Saving Souls: A History of Hospitals, 1999

This chapter depicts the “discovery” of ether anesthesia at the Massachusetts General Hospital within the context of Boston medicine, surgery and dentistry, discussing the local struggles for professional and cultural identity within an environment of sectarianism and professional secrecy. For this purpose, the narrative uses the story of Alice Mohan who actually became the first patient submitting to full ether inhalation for the amputation of her right leg. Mohan’s successful major surgery, performed on November 7, 1846, followed a prior, famous but brief attempt to remove Gilbert Abbott’s congenital neck tumor that forever put Boston and America on the list of pioneering surgical achievements. More than Abbott’s case, Mohan’s long pre-operative hospitalization and botched treatments provide a rare view into the state of contemporary medical therapeutics and the evolution of the Massachusetts General Hospital.

Indian Journal of Clinical Anaesthesia (IJCA) publishes definitive, peer-reviewed articles devoted to the clinical practice of anaesthesia. IJCA publishes a wide range of articles in the discipline of anaesthesiology including basic science, translational medicine, education, and clinical research to create a platform for the authors to make their contribution towards the field without restrictions/barriers of subscription and language. IJCA addresses all aspects of anaesthesia practice, including anaesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anaesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. This Journal is an Open Access journal and aims to publish research articles, reviews, case studies, commentaries, short communications, and letters to the editor on various aspects of anaesthesiology and perioperative medicine and making them freely available worldwide.

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005

BACKGROUND AND RATIONALE Since anesthesia, unlike medical or surgical specialties, does not constitute treatment, The Royal College of Anesthesiologists of Thailand host the Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes to determine factors related to anesthesia related adverse events. MATERIAL AND METHOD A prospective descriptive study of occurrence screening was conducted in 20 hospitals comprised of 7 university, 4 general and 4 district hospitals across Thailand. Anesthesia personnels were required to fill up patient-related, surgical-related, anesthesia-related variables and adverse outcomes on a strutured data entry form. The data included preanesthetic evaluation intraoperative period and 24 hr postoperative period. Adverse events specific form was recorded when adverse events occurred. All data were keyed in data management unit with double entry technique and descriptive statistics was used in the first phase of this study. RESULTS A total of 163403 co...

European Journal of Anaesthesiology, 2006

Background and rationale : The purposes of the Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes were to survey patients, surgical, anesthetic profiles and determine factors related to adverse events. Material and Method : A prospective descriptive study of occurrence screening was conducted in 20 hospitals comprised of 7 university, 4 general and 4 district hospitals across Thailand. Anesthesia personnel were required to fill up patient-related, surgical-related, anesthesia-related variables and adverse outcomes on a structured data entry form. The data were collected during the preanesthetic evaluation, intraoperative period and 24 hr postoperative period. Adverse events specific forms were used to record when they occurred. All data were keyed at data management unit with double entry technique and descriptive statistics was used in the first phase of this study. Results : A total of 163403 consecutive cases were recorded during first 12 months. MD. anesthesiologists involved with 82%, 89%, 45% and 0.2% of cases in university hospitals, regional hospitals, general hospitals and district hospitals respectively. Nurse anesthetists took a major involvement in hospitals run by the Ministry of Public Health. Two-thirds of cases did not receive any premedication (67%) and midazolam was most fre- quent premedication administered (20%). Common monitoring were non invasive blood pressure (NIBP) (97%), pulse oximetry (96%), electrocardiography (80%), urine output (33%), airway pressure (27%) and capnometry (19%) respectively. The choices of anesthesia were general anesthesia (62%), spinal anesthesia (23%), total intravenous anesthesia (6%), monitor anesthesia care (4%), brachial plexus block (3%) and epidural anesthe- sia (1%). The adverse events were oxygen desaturation (31.9:10000), cardiac arrest (30.8:10000), death within 24 hr. (28.3:10000), difficult intubation (22.5:10000),re-intubation (19.4:10000), unplanned ICU admission (7.2:10000), coma/cva/convulsion (4.8:10000), equipment malfunction/failure (3.4:10000), suspected myocar- dial ischemia or infarction (2.7:10000), awareness during anesthesia (3.8:10000), late detected esophageal intubation (4.1:10000), failed intubation (3.1:10000), anaphylaxis or anaphylactoid reaction (2.1:10000), nerve injury (2:10000), pulmonary aspiration (2.7:10000), drug error (1.3:10000), hazard to anesthesia personnel (1.5:10000), unplanned hospital admission (0.1:10000), total spinal block (1.3:10000) and mismatch blood transfusion (0.18:10000) Conclusion : Respiratory adverse events were common anesthesia direct related events. High incidence of cardiac arrest and death within 24 hr. highlighted concerns for prevention strategies. Incidents of adverse events can be used for institutional quality improvement, educational quality assurance and further research for patient safety in anesthesia.

Kaleidoscope history

The history of local anesthesia involves three separate inventions: the pharmacological agent, the local anesthetic, the syringe, and the hollow needle. Each evolved separately and has its history. They were assembled for the first time in 1827 as a syringe with a needle, and in 1884, in combination with cocaine as the first anesthetic injected locally. This is part of the Encyclopedia of the History of Dentistry.

2020

According to the definition of the International Association for the Study of Pain (IASP), pain is defined as: "Unpleasant subjective feeling and emotional experience associated with current or potential tissue damage of a particular localisation", which, as such, poses a challenge for epidemiological research to determine its frequency and prevalence. We have all heard the motto that surgery has experienced its unprecedented development on the wings of anaesthesia. This is most certainly the case, since it is precisely the pain that prevents any invasive procedure on the human body, hence the very elimination of pain has opened up the way for the application and development of surgery. For this reason, the skill and now the science of anaesthesia are epochal civilizational achievements, which is why it is worth remembering the attempts and successes of its application. The very beginning of mankind cannot be imagined without the humans facing some sort of pain. As long ag...

Anesthesia in Nepal is rapidly growing with the availability of modern equipment and newer drugs, subspecialties training programs and formation of professional associations. This article briefly describes how Nepal has travelled all the way from no anesthesia to the current scenario of advanced facilities.

Cyprus Journal of Medical Sciences, 2020

Today, an increasing number of diagnostic and therapeutic procedures are performed in specialized units outside the classical operating room, such as endoscopy units, interventional radiology, neurology and cardiology laboratories. The main reasons of this global trend are recent advances in medical technology, increased knowledge of disease pathogenesis, and some financial factors. Additionally, number and complexity of these procedures are rapidly raising throughout the world. In parallel, the importance of anesthesia management of such patients, also known as non-operating room anesthesia, has become better understood in recent years. In this review, we aimed to discuss the potential difficulties of non-operating room anesthesia, preprosedural patient preparation, intraoperative anesthesia applications, and postprosedural patient care in the light of the current literature.