Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Randomized Controlled Trial Clinical Trial
Analgesic effect of intraperitoneal instillation of bupivacaine for postoperative laparoscopic cholecystectomy.
To study the effectiveness of intraperitoneal instillation of bupivacaine for postoperative laparoscopic cholecystectomy pain relief, especially specific pain (visceral pain, shoulder pain and epigastric pain). ⋯ In this study, intraperitoneal instillation of bupivacaine does not show any advantage for postoperative analgesia after laparoscopic cholecystectomy.
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Randomized Controlled Trial Clinical Trial
Can ketamine potentiate the analgesic effect of epidural morphine, preincisional or postincisional administration?
A randomized controlled trial was conducted to determine the effect of adding epidural ketamine to epidural morphine comparing between giving ketamine at preincisional time and postincisional time on postoperative analgesia in patients undergoing gynecological operations. Eighty patients scheduled for gynecological operation under combined epidural-general anesthesia were randomly divided into 4 groups. Group 1 received epidural morphine 3 mg before skin incision. ⋯ The amount of pethidine and paracetamol required and the time to the first dose of analgesic requirement were not significantly different among the groups. There were no differences in the incidences of pruritus, nausea, vomiting and nightmare. We concluded that adding ketamine to epidural morphine either by preincisional or postincisional administration did not potentiate the analgesic effect of epidural morphine.
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Randomized Controlled Trial Clinical Trial
Starting intravenous morphine in the postanesthesia care unit yielded better postoperative analgesia.
The administration of morphine intravenously in the Postanesthesia Care Unit (PACU) was practiced in many parts of the world, but not routinely done in Thailand. This prospective randomized controlled trial was performed to reassure Thai personnel that this practice was safe, to find the optimum dose of morphine for administration in the PACU, and to find the pain level at which patients needed no more analgesics. Eighty gynecological patients, ASA class I or II, were randomly allocated into two groups. ⋯ We concluded that giving morphine intravenously in the PACU was safe, effective and reduced postoperative analgesic requirement. The dose of morphine in the PACU could be calculated from the pain score at patients' first request for analgesics. Most patients declined additional analgesics when their pain was acceptable and tolerable.
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Cardiac arrest during the perioperative period is a good indicator of the quality of anesthetic management. The incidence of perioperative cardiac arrest in Siriraj Hospital hasn't been reported before. Our objectives were to determine the incidence of perioperative anesthesia-related cardiac arrest and the results of cardiopulmonary resuscitation in these cases in order to find out how to improve our anesthetic care. ⋯ Twenty-one per cent of patients experiencing a cardiac arrest were discharged from hospital. Seventy-three per cent of events occurred in patients with an ASA rating 3-5 and most often the cause of arrest was massive or uncontrolled bleeding. In those patients with an ASA rating 1-2 there were no outstanding cause of arrest.
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This study aimed to assess 1) agreement and correlation of postoperative pain scores rated by nurses and parents 2) the difference between the pain scores (CHEOPS and FLACC) as rated by nurses and parents 3) effects of parental education on pain rating 4) the ease with which parents could score CHEOPS and FLACC. ⋯ Thai parents could be easily trained how to use pain scales. Parental rating was not different from nurse rating. The agreement and correlation between parents and nurses were very high. The ease of using CHEOPS was not different from FLACC.