Pediatric anesthesia in Mongolia and Thailand.

INTRODUCTION AND HISTORY: In Mongolia, pediatric anesthesia has advanced during the past 25 years through expanded, standardized education programs and international collaboration. Pediatric anesthesia is a recognized specialty, covering all surgical services, including cardiac and transplant, using physicians and nurses. TRAINING: The pediatric anesthesia fellowship is 6 months after 2 years of residency; pediatric nurse anesthesia training is 6 months. CONCLUSION: As a Low- and Middle-Income Country (LMIC) with low population density and extreme weather, the challenges include insufficient equipment, supplies, and clinician numbers, matching few clinicians to many varied patient locations, and covering surgical emergencies over distance and weather. In Thailand, education and training in pediatric anesthesia remain a focus: Pediatric anesthesia is an official subspecialty, the fellowship is accredited, using a competency-based curriculum with milestones of Direct Observation of Procedural Skills and Entrusted Professional Activities. The Bangkok Anesthesia Regional Training Center (BARTC)-Pediatrics, jointly sponsored by the World Federation of Societies of Anesthesiologists (WFSA) and the Society for Pediatric Anesthesia (SPA), have expanded training to anesthesiologists worldwide. Challenges include difficulty balancing service workload and education, as well as attracting pediatric anesthesia fellows due to the strong private sector job market.

Anesthetic management in an infant with tetra-amelia syndrome with congenital maxillomandibular fusion: A case report.

A 10-month-old girl who had tetra-amelia syndrome and congenital maxillomandibular fusion (syngnathia) was scheduled for the surgical fusion separation. Anesthetic management for this case was considerably challenging. Standard monitoring was still applied to the patient's extremities. IV access was suspected to be difficult but firmly needed before intubation to provide resuscitation during an emergency. Connecting anesthetic circuit with nasopharyngeal airway was the preferred technique due to its benefits such as maintaining spontaneous ventilation, providing inhaled anesthetic, as well as monitoring oxygenation and ventilation. Importantly, the cornerstones for handling such complicated cases are multidisciplinary approach and teamwork.

Depth of endotracheal tubes in Thai adult patients.

OBJECTIVE: To predict the proper depth of placement of endotracheal tubes, oral and nasal. MATERIAL AND METHOD: This was a prospective study of 100 patients who underwent general anesthesia with oral endotracheal intubation. The cuff of the endotracheal tube was placed 2 cm below the vocal cords. The positions of the endotracheal tube tip and the airway distances of the patients were measured by fiberoptic bronchoscope; OC = the distance from the right upper canine to the vocal cords, NC = the distance from the right external naris to the vocal cords and T = the distance from the vocal cords to the carina. The correlation between the airway distances and patient's factors were analyzed. The proper depth of placement of the endotracheal tube was calculated with the formula OTT = OC + T-2, nasal endotracheal tube NTT = NC + T-2. RESULTS: The mean distance from the endotracheal tube tip to the carina was 3.0 +/- 1.48 cm (ranged 0.7 - 7.5 cm). The distance from the endotracheal tube tip to the carina of 86 from 100 patients was more than 2 cm. The mean OC was 9.79 +/- 1.27 cm. The mean NC was 15.00 +/- 0.84 cm. The mean T were 13.03 +/- 1.48 cm in males and 11.63 +/- 1.25 cm in females and it also related to the height of the person (Pearson correlation = 0.557, p value < 0.05). These distances did not relate to gender. CONCLUSION: The predicted formula of the depth of the endotracheal tube as "Chula formula"; OTT = 4 + (Ht/10) cm (The distance from the right upper canine to the point which is 2 cm above the carina) NTT = 9 + (Ht/10) cm (The distance from the right external naris to the point which is 2 cm above the carina).