ABO blood group is not a predictive factor for the amount of early opioid consumption in postanesthesia care unit: a prospective cohort study in 3,316 patients.

BACKGROUND: Immediate postoperative pain in the postanesthesia care unit (PACU) is common. Titration of opioid is the most popular strategy for controlling early postoperative pain. ABO blood group has been found to be associated with pain perception. We aimed to find the factors including ABO blood group for predicting the amount of opioid requirement in PACU. METHODS: This prospective cohort study was performed in 3316 patients who underwent various kinds of anesthetic techniques and received immediate postoperative care in PACU. Preoperative, intraoperative and PACU data were collected. A directed acyclic graph (DAG) representing the hypothesized causal pathways of preoperative, intraoperative and PACU data were compiled prior to conducting multinomial logistic regression analysis. Statistical significance in all models was defined as a P-value < 0.05. RESULTS: Female sex, body mass index, preoperative use of gabapentin, preoperative anxiety score, anesthetic techniques, type of operation, amount of consumed intraoperative opioids, intraoperative use of paracetamol, parecoxib and ondansetron, duration of anesthesia and surgery, amount of blood loss, pain upon PACU arrival, use of paracetamol and parecoxib in PACU were found to be factors influencing amount of opioid consumption in PACU. ABO blood group was not associated with early postoperative opioid requirement. CONCLUSIONS: A significant number of factors are related to amount of opioid requirement in PACU. Some factors can be adjusted to provide better pain relief in early postoperative period. However, ABO blood group is not identified to be a predictive factor for early postoperative opioid consumption in PACU.

Simulation-based medical education in Thailand: a cross-sectional online national survey.

BACKGROUND: Simulation-Based Medical Education (SBME) is a teaching method commonly used in undergraduate medical education. Although Thai medical schools have developed a system that incorporates SBME, various aspects of that system require improvement. We surveyed medical school administrators, instructors, and students about SBME in their institutions and the obstacles involved in its implementation, as well as their experiences, expectations, and attitudes regarding the current system. METHODS: We conducted a cross-sectional online survey between August 2019 and July 2020 among administrators, instructors, and 6th-year medical students. A structured questionnaire was developed and distributed to volunteers as an online survey. We recorded details about the SBME system as well as participant characteristics, obstacles, experiences, expectations, and attitudes. We used descriptive statistics as appropriate. RESULTS: We received responses from 15 (68.2%) administrators, 186 instructors, and 371 (13.7%) sixth-year medical students. SBME was commonly used in teaching and evaluation but less so in research. It was mainly used to improve psychomotor tasks, knowledge, patient care, and communication skills. The expected outcomes were improvements in students' performance, knowledge, and practice. The clinical courses were longer and had fewer participants than the pre-clinical courses. Obstacles encountered included shortages of faculty and simulators, time and space limitations, inadequate faculty training, and insufficient financial support. The administrators surveyed had positive attitudes toward SBME. Medical students reported having experience with SBME and strongly agreed that it was beneficial; however, they expected fewer students per class and more learning time to be devoted to these methods. CONCLUSIONS: SBME in Thailand is focused on teaching and assessment. The system could be improved through better-trained faculty, greater available space, more simulators, and sufficient funding. There were also some aspects that failed to meet students' expectations and need to be addressed. However, participants expressed positive attitudes toward SBME. TRIAL REGISTRATION: TCTR20210524003 (Thai Clinical Trials Registry).

Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children.

BACKGROUND: The variation in the rate of intraoperative respiratory events (IRE) over time under anesthesia and the influence of anesthesia-related factors have not yet been described. The objectives of this study were to describe the risk over time and the risk factors for IRE in children at a tertiary care hospital in southern Thailand. METHODS: The surveillance anesthetic database and chart review of IRE of 14,153 children who received surgery at Songklanagarind Hospital during January 2005 to December 2011 were used to obtain demographic, surgical and anesthesia-related data. Incidence density of IRE per person-time was determined by a Poisson modelling. Risk of IRE over time was displayed using Kaplan Meier survival and Nelson-Aalen curves. Multivariate Cox regression was employed to identify independent predictors for IRE. Adjusted hazard ratios (HR) and their 95% confidence intervals (CI) were obtained from the final Cox model. RESULTS: Overall, IRE occurred in 315 out of 14,153 children. The number (%) of desaturation, wheezing or bronchospasm, laryngospasm, reintubation and upper airway obstruction were 235 (54%), 101 (23%), 75 (17%), 21 (5%) and 4 (1%) out of 315 IRE, respectively. The incidence density per 100,000 person-minutes of IRE at the induction period (61.3) was higher than that in the maintenance (13.7) and emergence periods (16.5) (p < 0.001). The risk of desaturation, wheezing and laryngospasm was highest during the first 15, 20 and 30 minutes of anesthesia, respectively. After adjusting for age, history of respiratory disease and American Society of Anesthesiologist (ASA) classification, anesthesia-related risk factors for laryngospasm were assisted ventilation via facemask (HR: 18.1, 95% CI: 6.4-51.4) or laryngeal mask airway (HR: 12.5, 95% CI: 4.6-33.9) compared to controlled ventilation via endotracheal tube (p < 0.001), and desflurane (HR: 11.0, 95% CI: 5.1-23.9) compared to sevoflurane anesthesia (p < 0.001). CONCLUSIONS: IRE risk was highest in the induction and early maintenance period. Assisted ventilation via facemask or LMA and desflurane anesthesia were anesthesia-related risk factors for laryngospasm. Therefore, anesthesiologists should pay more attention during the induction and early maintenance period especially when certain airway devices incorporated with assisted ventilation or desflurane are used.

Effect of intravenous fentanyl given prior to the end of surgery on emergence agitation in pediatric patients.

OBJECTIVE: Evaluate the effect of intravenous fentanyl on the incidence and severity of EA. MATERIAL AND METHOD: In the clinical trial, 144 patients aged between two and nine years, scheduled for elective surgery were enrolled and randomly assigned to receive either fentanyl 1 microg/kg or normal saline 1 ml/10 kg, 15 minutes before the end of surgery. Watcha's behavioral emergence delirium scale was used to assess EA. RESULTS: The incidence of EA was lower in the fentanyl group (11/72 vs. 23/72 person respectively, p = 0.03). However there was no statistically significant difference in the number of patients with severe EA (1/72 vs. 6/72 person respectively, p = 0.12). Fewer number of patients in the fentanyl group had moderate to severe pain when compared with the control group (16/72 vs. 30/72 person respectively, p = 0.02). The number of patient who required rescue analgesia was significantly lower in the fentanyl group (18/72 vs. 30/72 person respectively, p = 0.04). There were no statistically significant differences in terms of emergence time, postoperative adverse events, and length of stay in the post-anesthetic care unit between the two groups. CONCLUSION: Administration of intravenous fentanyl 1 microg/kg 15 minutes prior the end of surgery decreased the incidence of EA and reduced pain without delaying emergence and without any increase in postoperative complications.

Effectiveness of a preoperative single dose intravenous dexamethasone in reducing the prevalence of postoperative sore throat after endotracheal intubation.

OBJECTIVE: To evaluate the effectiveness of two-different doses of prophylactic dexamethasone intravenous administration in reducing the prevalence of postoperative sore throat following general endotracheal anesthesia. MATERIAL AND METHOD: All patients (105 cases) of different procedures of elective surgery scheduled to have general anesthesia performed with endotracheal intubations were included. The subjects randomized into three pre-operative intravenous substance/drug administrations, group I (35 cases) with normal saline 2 ml, group II (35 cases) with dexamethasone 4 mg, and group III (35 cases) with dexamethasone 8 mg, respectively. The prevalence of sore throat and its severity was assessed, using visual analogue scale (VAS), scores of O to 10; 0 = no pain, and 10 = most severe pain. RESULTS: Among three groups, the duration of surgery, and intubation-induced trauma had no statistical significance. The prevalence of sore throat at 1-hour/24-hour postoperative was 48.6/48.6%, 54.3/28.6%, and 54.3/42.9% in group I, II, and III respectively, and without statistical significance. CONCLUSION: The intravenous dexamethasone had no significant effectiveness against postoperatively sore throat after endotracheal intubation.

Length of postanesthetic care unit stay in elderly patients after general anesthesia: a randomized controlled trial comparing desflurane and sevoflurane.

OBJECTIVE: The purpose of this study was to compare the length of postanesthetic care unit (PACU) stay and recovery profiles of elderly patients after general anesthesia between sevoflurane and desflurane. DESIGN: Randomized, double-blind, controlled clinical trial. SETTING: Tertiary care hospital, university hospital. PATIENTS: Eighty elderly patients undergoing nonemergency surgery under general anesthesia. INTERVENTION: Patients were randomly allocated into 2 groups: sevoflurane group (n = 38) and desflurane group (n = 42) in a double-blind manner. All of the patients underwent general anesthesia with oral endotracheal intubation using the same induction, muscle relaxants, and narcotics medication. When the operation was finished, the volatile agent was discontinued and muscle relaxation was reversed. MEASUREMENT: The length of PACU stay was recorded as the primary outcome. The recovery profiles (time to open eyes, time to follow to commands, and time to extubation) were assessed. MAIN RESULTS: There was no significance between the groups in age, sex, body mass index, American Society of Anesthesiologists physical status, type of surgery, duration of anesthesia, perioperative use of fentanyl, or blood loss. The length of PACU stay was not significantly different in the patients who recovered from sevoflurane (49.4 ± 23.1 minutes) or desflurane (50.1 ± 25.8 minutes) general anesthesia. Desflurane was significantly associated with faster early recovery than sevoflurane measured by time to open eyes (7.5 ± 3.4 vs 9.6 ± 4.6 minutes) and time to follow commands (9.0 ± 3.3 vs 11.2 ± 5.1 minutes), respectively. CONCLUSION: Desflurane was more associated with a faster early recovery (time to open the eyes and follow commands) than sevoflurane in elderly patients after general anesthesia. However, the length of PACU stay was similar in both groups.