Biomedical subjects

Somboon Thienthong

Publications and source records attributed to Somboon Thienthong.

11 recordsLinked to original sources

PubMed2006

Pain and quality of life of cancer patients: a multi-center study in Thailand.

OBJECTIVE: To identify the association between Quality Of Life (QOL) and pain intensity, and the magnitude of change of pain scores that have a clinically significant impact on patients' QOL. DESIGNS: Multi-center; prospective cohort study. MATERIAL AND METHOD: Patients suffering from cancer pain were recruited from seven university hospitals and three tertiary care centers in Thailand. The FACT-G and the Brief Pain Inventory were used to assess QOL and cancer pain severity, respectively, at study entry and at two-week follow-up. RESULTS: Five-hundred-and-twenty patients were recruited with a mean age of 52. The majority (76%) reported two sites of pain with 80% being treated at either step 2 or 3 (WHO guidelines of pain management). After two weeks, the average level of maximum pain was reduced from 6.6 to 4.8 (mean difference = -1.8, p < 0.001) and the QOL was improved from 58.6 to 61.0 (mean difference = 2.4, p < 0.001). There was a high correlation between the average change of pain intensity and QOL scores (rs = -0.42, p < 0.001). The results show that changes of pain scores of at least three points (3 out of 10) were required for a minimal important difference of FACT-G scores, indicating a significant change on patients' QOL. Pain deterioration had slightly more impact on QOL than pain improvement. A 3-point pain deterioration impaired QOL 10.3 points while 3-point reduction increased QOL only 7.6 points. CONCLUSION: The present findings suggest the importance of pain management. The change of pain scores of at least three points (out of 10 points) had statistical and clinical significance to patients' QOL.

Adolescent↗

PubMed2005

Spinal versus epidural anesthesia for cesarean delivery in severe preeclampsia: a prospective randomized, multicenter study.

In this randomized, multicenter study we compared the hemodynamic effects of spinal and epidural anesthesia for cesarean delivery in severely preeclamptic patients. The epidural group (n = 47) received 2% lidocaine with epinephrine 1:400,000, 18-23 mL, followed by 3 mg of morphine after delivery. The spinal group (n = 53) received 2.2 mL of 0.5% hyperbaric bupivacaine plus 0.2 mg morphine. We hypothesized that the lowest MAP (mean arterial blood pressure, the primary outcome) during the delivery period would have to be at least 10 mm Hg less in the spinal group to be of clinical importance. We found that there was a statistically significant difference in MAP, with more patients in the spinal group exhibiting hypotension (P < 0.001). Although the incidence of hypotension (systolic arterial blood pressure, SAP < or =100 mm Hg) was more frequent in the spinal group than in the epidural group (51% versus 23%), the duration of significant hypotension (SAP < or =100 mm Hg) was short (< or =1 min) in both groups. There was more use of ephedrine in the spinal group than in the epidural group (median, 6 versus 0 mg) but hypotension was easily treated in all patients. Neonatal outcomes assessed by Apgar scores and the umbilical arterial blood gas analysis were similar in both groups. Adverse neonatal outcomes (5-min Apgar score < 7 and umbilical arterial blood pH < 7.20) were found in only 2 premature newborns (weight < 1500 g) who were born without maternal hypotension after regional anesthesia. We conclude that the results of this large prospective study support the use of spinal anesthesia for cesarean delivery in severely preeclamptic patients.

Adult↗

PubMed2005

An analysis of the drug error problem in the Thai Anesthesia Incidents Study (THAI Study).

OBJECTIVES: To analyze the problem of drug error related to anesthesia in Thailand including nature, contributing factors and preventive strategies. MATERIAL AND METHOD: We prospectively recorded anesthesia-related drug error incidents for 18 months in 20 studied hospitals in Thailand. Types of errors and their outcomes were recorded. All data were analyzed to identify contributing factors and preventive strategies. RESULTS: Forty-one drug error incidents were reported in 40 out of 202,699 anesthetized cases or 1: 4,943 in this study. The most common type of error was wrong drug (20 incidents; 48.8%). No relationship between anesthetic techniques and the incidents except for a combined general and epidural technique. The errors were most commonly occurred during induction of anesthesia (26 out of 41; 63.4%) and muscle relaxants were most commonly involved (13 out of 41; 31.7%). The majority of incidents (26 out of 41; 63.4%) caused no adverse effect. However 14 incidents (34.1%) caused transient mild to severe physiological effects, of which 13 had complete recovery but one died. Haste and lack of recheck were two common contributing factors which were minimized by high awareness and double check prior to drug administration. Main strategies suggested to prevent the incidents included specific guideline development whereas the incidents did not effectively decrease by increasing of manpower CONCLUSION: The incidence of drug error in our study was 1 : 4,943. It can cause morbidity and mortality during anesthesia. Practitioners should be aware of these potential incidents and strictly follow the guideline for drug administration.

Anesthesia↗

PubMed2005

The Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes: II. Anesthetic profiles and adverse events.

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 frequent 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 anesthesia (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 myocardial 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.

Adolescent↗

PubMed2005

The Thai Anesthesia Incidents Study (THAI Study) of perioperative allergic reactions.

OBJECTIVES: To determine the incidence, risk factors, signs, symptoms and management of perioperative allergic reactions in the Thai Anesthesia Incidents Study (THAI Study). MATERIAL AND METHOD: Between February 1, 2003, and January 31, 2004, a descriptive, prospective, multicenter study was conducted in 20 hospitals across Thailand. All patients receiving anesthetic and medical agents were monitored for allergic reactions for the first 24 postoperative-hours. Signs and symptoms of suspected allergic reactions included skin reactions, wheezing and unexpected hypotension. The details of allergic reactions were reviewed and recorded. RESULTS: Allergic reactions occurred in 30 of the 163,403 patients included in this study. The reaction-incidence was approximately 1 in 5,500 cases of anesthesia. Forty-eight percent of the affected patients had a history of allergic reactions. The manifestations were skin reactions, hypotension and wheezing in 38, 22 and 19 percent of the overall symptoms, respectively. Reactions were mild, moderate and severe in 40, 23 and 37 percent of the patients, respectively. The three drugs most suspected of causing the reaction(s) were antibiotics (19%), muscle relaxants (17%) and propofol (15%). All of the affected patients recovered after treatment including the one who suffered cardiac arrest because of the allergic reaction. CONCLUSION: The incidence of perioperative allergic reactions was 1 in 5,500 cases of anesthesia. History of allergies was obtained from half of the patients and the most common sign was a skin reaction. The drugs most suspected of causing an allergic reaction were antibiotics. All of the patients responded well to rescue treatment.

Adolescent↗

PubMed2005

The Thai Anesthesia Incidents Study (THAI Study) of anesthesia personnel hazard.

OBJECTIVES: To determine the incidence, causes, management, outcomes and corrective strategies for personnel hazard in Thai Anesthesia Incidents Study (THAI Study). MATERIAL AND METHOD: Personnel hazard incidents were extracted from the Thai Anesthesia Incidents Study (THAI Study) database conducted between February 1, 2003 and January 31, 2004 and analysed using descriptive statistics. RESULTS: Twenty-four incidents of personnel hazard were recorded. Majority of incidents occurred in nurse anesthetist (54.2%). Five incidents exposed to patient blood but no infection reported afterwards. Nineteen incidents (79.2%) were injury without contact to patients blood or body fluid. Most of them were injured by broken ampoules. One case needed to leave from work for a while due to hand dysfunction. CONCLUSION: Personnel hazard incidence were quite low frequency because of under-report. One case of morbidity was reported. Universal precaution and post exposure prophylaxis tended to minimize the risk of infection.

Accidents, Occupational↗

PubMed2005

Transfusion errors in the Thai Anesthesia Incidents Study (THAI Study): three cases.

Of 163,403 recorded cases of anesthesia in the Thai Anesthesia Incidents Study (THAI Study), transfusion errors occurred thrice. Case #1: a 68-year-old male, blood group A, undergoing hepatectomy, received two units of PRC and four units of FFP (all units were group A), but two of the FFP units were given to the wrong patient because the caregiver did not check the patient-identification on all of the blood bags. Case #2: a 42-year-old female, blood group A, undergoing emergency exploratory laparotomy, received 250 mL of group B-blood. Skin rashes, a clue for diagnosis of transfusion error were observed in the postoperative period. The error occurred because the caregiver did not check the patient-identification before starting the transfusion. Case #3: a 42-year-old female, blood group O, undergoing hysterectomy, received 430 mL of group AB-blood. More blood was requested in the ICU and it was discovered that the new bag was group O instead of AB. Mislabeling of the blood sample at the first blood request accounted for the error even though blood group O was recorded on the patient's OPD chart. The first two patients developed minor adverse reactions (grade 1) whereas the third developed a severe reaction (grade 3). All of the patients responded well to treatments. Accordingly, the system for preventing transfusion errors has been improved at both hospitals.

Adult↗

PubMed2004

Two doses of oral sustained-release tramadol do not reduce pain or morphine consumption after modified radical mastectomy: a randomized, double blind, placebo-controlled trial.

BACKGROUND: Tramadol is a weak opioid agonist with antinociceptive effects through its action on the mu-receptor and by inhibiting the neuronal re-uptake of both noradrenaline and serotonin. Tramadol is commonly used for treatment of mild to moderate post-operative pain. An oral form of sustained-release tramadol (SR) was recently formulated for reducing the administration frequency from qid to bid. OBJECTIVE: To evaluate the analgesic efficacy and safety of two doses of oral tramadol SR for the treatment of pain after modified radical mastectomy. STUDY DESIGN: Randomized, double blind, placebo-controlled trial. METHOD: Fifty women were randomly allocated to receive either tramadol SR 100 mg (group T), or placebo tablet (group P) orally approximately 1 hour before surgery with a repeat dose administered 12 hours later by nurses not apprised of the patient groupings. All patients received the standard general anesthesia. Post-operatively, nurses in the research team assessed pain using a visual analog scale 0-100 mm at rest (rVAS) and during arm movements (mVAS) at admission to postanesthesia care unit (PACU) (T0) and 2 (T2), 6 (T6), 12 (T12) and 24 (T24) hours after surgery. Rescue analgesia was provided for 24 hours via a morphine-loaded patient-controlled analgesia (PCA) device at 1 mg bolus with a 5-minute lockout interval. Cumulative morphine consumption and adverse events were recorded. RESULTS: Twenty-five patients with comparable baseline characteristics from each group were studied. The proportions of patients with VAS > 30 (both rVAS and mVAS) at each measurement period were not significantly different between the groups except for the mVAS at T24, where the proportion in group T was higher than group P (48% vs 20%, 95% CI of difference: -53%, -3%, p = 0.04). The median morphine consumption in both groups at T2, T6, T12 and T24 were comparable. No serious adverse effects were observed; however, patients in group T reported nausea and vomiting more than group P (56% vs 24%, p = 0.02). CONCLUSION: Two doses of oral tramadol SR 100 mg had no effect on post-operative pain scores and morphine consumption in patients who underwent modified radical mastectomy. In fact, more patients in the tramadol group reported nausea and vomiting than the placebo group.

Administration, Oral↗

PubMed2004

Treatment of pain after spinal surgery in the recovery room by single dose lornoxicam: a randomized, double blind, placebo-controlled trial.

BACKGROUND: Lornoxicam has been used in microsurgical lumbar discectomy. However, there is no data about controlling pain after open discectomy or laminectomy. OBJECTIVE: To compare the efficacy of a single dose of 16 mg of lornoxicam for the treatment of pain after disectomy or laminectomy with placebo in the PACU. STUDY DESIGN: Randomized, double blind, placebo-controlled trial. MATERIAL AND METHOD: Fifty-six patients who underwent discectomy or laminectomy were randomly allocated to receive 16 mg lornoxicam (Group L), or placebo (Group P) at the beginning of wound closure. Pain scores at rest (using a verbal numeric rating scale: VNRS 0-10), time to first analgesia requirement, morphine consumption during the first 2 hr after surgery and adverse effects were all recorded. The outcomes were assessed on admission to the PACU (T0), then at 1 (T1) and 2 (T2) hr after surgery. RESULTS: Baseline data were comparable between the two groups. The proportion of patients with VNRS > 5 at T0 in both groups were not significantly different (44.4% in group P vs 50.0% in group L, CI of difference: - 32.4%, 21.3%, p = 0.68). The mean VNRS scores, at T0 and T1 were > 5 and at T2 was < 5 in both groups. There was no difference between the two groups. The morphine consumption in both groups was not different (9.0 mg vs 9.3 mg) as well as the time to first analgesia requirement (35 min vs 40 min). Patients in the two groups had no significant difference in the symptoms or degree of nausea/vomiting. The number of patients with excessive sedation and the proportion of patients needing oxygen during transportation to the ward were not different. CONCLUSION: Lornoxicam 16 mg given intravenously before wound closure provides inadequate pain relief immediately after disectomy or laminectomy in the PACU. However, adequate pain relief was demonstrated at 2 hr after surgery, which was similar to the placebo.

Adolescent↗

PubMed2004

An experience with intubating laryngeal mask airway for difficult airway management: report on 38 cases.

A retrospective study was performed on 38 patients (23 males and 15 females) in whom the intubating laryngeal mask airway (ILMA) was used for airway management at Srinagarind and Siriraj Hospital in 2003. The patients 'age and weight ranged between 12 and 75 years and 40 and 94 kg, respectively. Difficult tracheal intubation was suspected before starting general anesthesia in 17 patients, whereas it was found difficult after induction of general anesthesia in 21. The ILMA was successfully placed in all patients with airway patency classified as 'good' and 'acceptable' in 36 patients (94.7%), and 'poor' in two. Oxygen saturation during intubation was maintained above 95 percent in all patients. Tracheal intubation through the ILMA was successful in 34 patients (89.5%), which was described as 'easy' in 27 of 34 patients (79.4%). In the remaining 7, 2-5 attempts were required for successful tracheal intubation. The types of endotracheal tubes used were: 1) the pre-formed silicone tube in 55.9 percent, 2) the pre-formed flexible tube in 41.2 percent; and, 3) the standard polyvinyl tube in 2.9 percent. In the four patients with failed tracheal intubation through the ILMA, three were successfully intubated with conventional laryngoscopy and one with gum elastic bougie. There were no serious complications following the use of the ILMA in these patients. The ILMA proved a safe, very useful and easy to use device with a high success rate for difficult airway management.

Adolescent↗

PubMed2002

A double-blind, randomized study comparing postoperative pain management using epidural ropivacaine with intravenous ketorolac or intravenous ketorolac alone following transabdominal hysterectomy.

OBJECTIVE: The aim of this study is to compare the effect on postoperative pain of epidural ropivacaine in combination with intravenous ketorolac with intravenous ketorolac alone following transabdominal hysterectomy. DESIGN: A multi-center, randomized, double-blind study was conducted in Thailand and the Philippines to assess postoperative pain management in 107 patients given ketorolac alone or in combination with epidural ropivacaine following transabdominal hysterectomy. Pain score was assessed using a 100-mm visual analogue pain scale (VAS). RESULTS: The VAS scores for pain on coughing and at rest were significantly better in the ropivacaine group. The number of patients who asked for morphine in addition was higher in the ketorolac group compared to the ropivacaine + ketorolac group. The time taken to carry out the first three ambulatory steps was similar for both the two treatment groups. A higher degree of motor block was observed in the ropivacaine group over time. The adverse events observed were similar in both groups. CONCLUSION: We demonstrated that epidural infusion of ropivacaine in addition with intravenous ketorolac gave superior pain relief at rest and on coughing in patients undergoing transabdominal hysterectomy when compared to the group receiving intravenous ketorolac alone.

Amides↗