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Background The incidence of postoperative pulmonary complications (PPCs) is increasing in line with the rise in the number of surgical procedures performed on geriatric patients. In this study, we determined the incidence and risk factors of PPCs in elderly Thai patients who underwent upper abdominal procedures, and we investigated whether the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score helps to predict PPCs in Thais. Methods A retrospective study was conducted on upper abdominal surgical patients aged over 65 years who had been admitted to the surgical ward of Siriraj Hospital, Mahidol University, Thailand, between January 2016 and December 2019. Data were collected on significant PPCs using the European Perioperative Clinical Outcome definitions. To identify risk factors, evaluations were made of the relationships between the PPCs and various preoperative, intraoperative, and postoperative factors, including ARISCAT scores. Results In all, 1100 elderly postoperative patients were analyzed. Their mean age was 73.6 years, and 48.5% were male. Nearly half of their operations were laparoscopic cholecystectomies. The incidence of PPCs was 7.7%, with the most common being pleural effusion, atelectasis, and pneumonia. The factors associated with PPCs were preoperative oxygen saturation less than 96% (OR = 2.6, 1.2–5.5), albumin level below 3.5 g/dL (OR = 1.7, 1.0–2.8), duration of surgery exceeding 3 h (OR = 2.0, 1.0–4.2), and emergency surgery (OR = 2.8, 1.4–5.8). There was a relationship between ARISCAT score and PPC incidence, with a correlation coefficient of 0.226 (P < 0.001). The area under the curve was 0.72 (95% CI, 0.665–0.774; P < 0.001). Conclusions PPCs are common in elderly patients. They are associated with increased levels of postoperative morbidities and extended ICU and hospital stays. Using the ARISCAT score as an assessment tool facilitates the classification of Thai patients into PPC risk groups. The ARISCAT scoring system might be able to be similarly applied in other Southeast Asian countries.

Central kisspeptin action is well known in reproductive regulation; however, its peripheral action is not well understood. This study aimed to 1) compare serum or cerebrospinal fluid (CSF) kisspeptin levels between different body mass index (BMI) groups 2) compare the levels of kisspeptin between serum and CSF, and 3) determine correlations between serum or CSF kisspeptin levels with clinical, metabolic, and reproductive parameters. There were 40 male subjects undergoing operations with lumbar puncture anesthesia. Subgroup analysis was performed to compare between the normal (n = 12), overweight (n = 10), and obese groups (n = 17). One lean subject was recruited for correlation analysis. Serum kisspeptin levels were significantly higher in the obese group when compared to the normal weight and overweight groups even after adjusting for age or diastolic blood pressure (DBP) (p0.05 all). Serum leptin levels were significantly higher in the obese group when compared to the normal weight and overweight groups (p0.05 all). CSF kisspeptin levels were below the minimum detectable concentration for the assay (0.06 ng/mL). Serum kisspeptin was positively correlated with body weight, BMI, plasma insulin, the homeostatic model assessment for insulin resistance (HOMA-IR), and serum leptin but was negatively correlated with plasma LH (p0.05 all). In conclusion, serum kisspeptin was related to obesity, leptin, insulin, and insulin resistance, while CSF kisspeptin was below the limits of detection. Thus, peripheral kisspeptin might have a role in metabolic regulation.

Action of kisspeptin in the central nervous system (CNS) is well known on reproductive regulation; however, its peripheral action is not well understood. Recent studies have shown that peripheral kisspeptin might be related to obesity and/or metabolic parameters in humans [1]; however, these associations are still inconclusive. This study aimed to 1) compare serum or cerebrospinal fluid (CSF) kisspeptin levels between different body mass index (BMI) groups 2) compare levels of kisspeptin between serum and CSF, and 3) determine correlations between serum or CSF kisspeptin levels with clinical, metabolic, and reproductive parameters. There were 40 male subjects who underwent an operation with lumbar puncture anesthesia. Subgroup analysis was performed to compare between the lean-normal group (n=13) which included lean and normal weight subjects, the overweight group (n=10), and the obese group (n=17) according to BMI. Blood samples were collected after at least 8-hour fasting before intravenous cannulation prior to the operation while CSF samples were obtained by lumbar puncture before administration of the spinal anesthesia. Serum kisspeptin and leptin levels were significantly higher in the obese group when compared to the lean-normal and overweight groups even after adjusted to age while CSF kisspeptin levels were comparable between different BMI groups (p

Objectives: The Management of Myelomeningocele Study (MOMS Trial) has inspired many fetal therapy centers (FTCs) to offer open fetal surgery for myelomeningocele (MMC). This is an initial effort to create a candidate model that can be applicable to many parts of Asia. Material and Methods: A limited selection of specialists from 4 established FTCs in Thailand, Hong Kong, India, and Singapore met for a round table discussion. Experts from Children's Hospital of Philadelphia (CHOP) involved in the Trial moderated the session. The practice suggestions in this statement were from a targeted literature review and expert opinion. Results: A high prevalence of MMC in Asia supports an effort to adopt the procedure, but only in established FTCs with good maternal and neonatal ancillary supports. The falling incidence of MMCs may affect case volume and maintenance of skill. A regional approach was recommended. Fetal benefits have to be weighed against maternal risks, with a consideration of recent outcome data from the endoscopic approach. Responsible FTCs need standardized diagnosis and management, with their long-term outcome data available for an audit. Conclusions: It is envisaged that the information presented by this multidisciplinary team would be useful for FTCs in Asia or elsewhere that plan to establish more advanced fetal care in the future.

The incidence of maternal oxygen desaturation after cesarean delivery in the postanesthesia care unit (PACU) has not been thoroughly reported. The purpose of this study was to evaluate the incidence of desaturation and to describe the frequency of supplemental oxygen administration in patients being monitored in the PACU. This study was conducted in a tertiary care hospital, and low-risk parturients undergoing cesarean delivery under spinal anesthesia were enrolled. None of the subjects received supplemental oxygen therapy on arrival at the PACU. Their oxygen saturation was continuously monitored using pulse oximetry. Desaturation was defined as an oxygen saturation at or below 94% for more than 30 seconds. The data of 324 healthy, term parturients were included in the analysis. The incidence of desaturation was only 0.3% (95% confidence interval = 0.01%-1.7%). No patient required supplemental oxygen therapy in the PACU. The incidence of postoperative oxygen desaturation in healthy parturients undergoing elective cesarean delivery under spinal anesthesia was uncommon. Routine administration of supplemental oxygen in the PACU is therefore unnecessary.

Nowadays, fetoscopic surgery has been accepted to be a procedure to correct numerous congenital anomalies. This operation can be successfully done under general, regional or local anesthesia with sedation. Incidence of complications from anesthesia in fetoscopic surgery has not been reported in Thailand.To describe anesthetic techniques and incidence of complications in fetoscopic surgery.Data of 152 pregnant women undergoing fetoscopic surgery in a single university hospital was retrospectively chart reviewed from June 2005 to November 2015. Patient characteristics, choices of anesthesia, medication used, intraoperative data and complications were collected.During the study period, spinal anesthesia was the most popular technique used in fetoscopic surgery (71%). Other anesthetic techniques used were general anesthesia with endotracheal tube (GA) (20.5%), epidural anesthesia (1.3%), combined spinal and epidural anesthesia (0.7%), failed spinal anesthesia converting to GA (2.6%) and local anesthesia with sedation (3.9%). Most frequent anesthetic-related complication was maternal hypotension which occurs in 115 out of 152 patients (75.6%). All of 5 cases (3.3%) of postoperative pulmonary edema received SA. Fetal death after operation was 25 in 152 records (16.4%). None of patients received GA experienced desaturation, pulmonary aspiration, failed intubation or pulmonary edema.Spinal anesthesia (SA) is the most frequent technique used for fetoscopy, and hypotension is the most common complication. Since pulmonary edema was also found, judicious perioperative fluid management should be implemented to prevent postoperative pulmonary edema.

To investigate the effect of direct field block with 40 ml of 0.125% bupivacaine on the top of intrathecal morphine on postoperative pain free period.The present prospective randomized controlled trial was undertaken in 56 pregnant patients that underwent elective cesarean delivery at Siriraj Hospital. All patients were randomized into two groups to receive spinal block with intrathecal morphine as a control group, or direct field block on the top of spinal block with intrathecal morphine as a study group. The assessment ofpain score, 24-hour morphine usage, satisfaction score, pruritus, nausea and vomiting, sedation score, and motor power were recorded.Both groups had similar pain score. The number of subjects who had pain free period during the 24 hours in the direct field block group was seven of 28, while in the control group it was four of 28. Median time of pain free period was 2.10 hours in control group and 2.36 hours in direct field block group. There was no significant difference in 24-hour morphine consumption, satisfaction score, pruritus, nausea, vomiting, and sedation score. Motor power was fully recovered within six hours postoperative in both groups.Direct field block with 40 ml of 0.125% bupivacaine in conjunction with intrathecal morphine for cesarean section did not increase pain free period or decrease morphine consumption.

This article was migrated. The article was not marked as recommended. Teaching and learning of difficult airway management are considered to be an essential skill in anesthesiology.ObjectivesTo determine the learning achievement and relative growth scores by two educational techniques: simulation-based (SBL) and problem-based learning (PBL).MethodsThirty-six students were randomly divided into two groups: SBL and PBL in a crossover study design. Comparison the achievement scores and relative growth of knowledge between the two groups were analyzed.Results The baseline scores showed no differences between the two groups (19.8 ± 3.4) and (19.5 ± 2.8) respectively. After the learning courses, the posttest and gain scores of SBL: (24.2 ± 2.3) and (20.2 ± 16.0); significantly showed higher scores than that of PBL: (21.9 ± 2.9) and (10.4 ± 17.6) respectively. After six weeks, the baseline scores showed higher indifferently between the two groups: (25.0 ± 2.8) and (25.4 ± 3.4) respectively. Likewise, the posttest and gain scores of SBL: (27.8 ± 2.9) and (13.7 ± 22.6); appeared to increase as compared to that of PBL: (26.6 ± 2.2) and (8.9 ± 17.9) respectively.ConclusionStudents undergoing SBL showed higher achievement and relative growth scores as compared to PBL.

The use of supplemental oxygen in uncomplicated cesarean deliveries under spinal anesthesia has been thoroughly investigated during recent decades. The aim of this study was to determine the benefits for both mother and infant of administering supplemental, low-dose oxygen via a nasal cannula versus having no supplement (i.e., room air only). Healthy parturients at term undergoing elective cesarean section under spinal anesthesia were randomly allocated into two groups: an oxygen group (n=170), who received 3 LPM oxygen via a nasal cannula; and a room-air group (n=170), who were assigned to breathe room air. Maternal oxygen saturation was measured continuously by using pulse oximeter. The desaturation was determined by oxygen saturation