Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Multicenter Study
Multicentered study of model of anesthesia related adverse events in Thailand by incident report (The Thai Anesthesia Incidents Monitoring Study): results.
The Thai Anesthesia Incidents Monitoring Study (Thai AIMS) was aimed to identify and analyze anesthesia incidents in order to find out the frequency distribution, clinical courses, management of incidents, and investigation of model appropriate for possible corrective strategies. ⋯ Common factors related to incidents were inexperience, lack of vigilance, inadequate preanesthetic evaluation, inappropriate decision, emergency condition, haste, inadequate supervision, and ineffective communication. Suggested corrective strategies were quality assurance activity, clinical practice guideline, improvement of supervision, additional training, improvement of communication, and an increase in personnel.
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Ankle dislocation without fracture is an extremely rare injury. Open dislocations were more common in the previous reports. The authors report a case of closed posteromedial dislocation of the ankle in a 24-year-old basketball player. ⋯ Details of the rehabilitation program were described. Follow up examination at one-year demonstrated good clinical and functional results confirmed with the inversion stress radiographs. The patient can participate in sports activities at the same level as pre-injury.
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To audit the completeness and accuracy in charting of anesthetic recorded by hand. ⋯ The charting of anesthetic record remained incomplete and inaccurate in 43 from 44 items, except the item of vital signs. The average of good anesthetic record was 94.5%. The incomplete anesthetic records were caused by illegibility, incorrect data filling, no data, or incomplete detail of each item such as incorrect ASA classification, or problem list etc. Handwritten records should be carefully filled-in to increase completion so that the data could be used as legal evidence.
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Comparative Study
The comparison of femoral component rotational alignment with transepicondylar axis in mobile bearing TKA, CT-scan study.
The tibial axis referencing method with a balanced tension flexion gap at 90 degrees knee flexion provides adequate femoral component rotation usually in external rotation, the trans-epicondylar line being parallel to the proximal tibial cut. The LCS mobile bearing TKA uses this technique to automatically determine the femoral component rotation with desired tension. The determination of the epicondyles may lead to some confusion. On the lateral side, the prominence of the lateral condyle makes it easy to define. However on the medial side, some surgeons use the prominent part of the medial epicondyle (well recognized on CT scan as the most proximal ridge that gives insertion to the superficial collateral ligament) and use the anatomical transepicondylar axis (aTEA). Other surgeons use the depression below called sulcus that defines the surgical transepicondylar axis (sTEA). ⋯ The balanced flexion gap technique positions the femoral component in external rotation with the LCS TKA. Within 3 degrees to aTEA or sTEA, this technique produced femoral rotational angle closer to sTEA when the sulcus was detected and produced a wide range of different angles when compared to aTEA. However sTEA is not the consistent bony landmark. This technique is a reliable method to determine femoral rotational alignment.
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Despite advances in anesthetic technique, the incidence of perioperative desaturation in general anesthesia has remained high. Knowledge on factors associated with intraoperative desaturation is relatively scanty. The purpose of the present study was to investigate the distribution of time dependent intraoperative desaturation and factors predicting perioperative desaturation. ⋯ Obesity and snorers were the high-risk groups of perioperative desaturation. Elderly patients are at lower risk of desaturation than children intraoperatively, but at a higher risk in the postoperative period Higher FiO2 should be given to high-risk patients during the intraoperative period. Desaturation can still occur at RR, even in patients who received oxygen. Pulse oximeter monitoring should be continued throughout RR care.