Saowapark Chumpathong

Maternal and neonatal outcomes in women with severe pre-eclampsia undergoing cesarean section: a 10-year retrospective study from a single tertiary care center: anesthetic point of view.

Abstract Objective: This study is aiming to determine an actual incidence and characteristics of complications in cesarean section for severe pre-eclampsia (PE) by analysis of a large cohort from a single tertiary care center according to two choices of anesthesia. Methods: Electronic medical records of pregnant women complicated with severe PE delivered by cesarean section from January 2002 to December 2011 were retrospectively reviewed. Medical records of their corresponding neonates were also identified and reviewed. Results: A total of 701 women and 740 neonates (28 twin pairs) were identified. Anesthetic techniques were spinal anesthesia (SA) (88%) and general anesthesia (GA) (12%). Total maternal and neonatal deaths were 0.3% and 1.2%, respectively. Patients in GA group had a higher incidence of coagulopathy, immediate postpartum hemorrhage, intensive care unit admission, renal failure, respiratory complications, and death (p < 0.05). Neonates born from women in GA group had a higher incidence of lower birth weight, birth asphyxia, prematurity, neonatal intensive care admission, respiratory complications, and death (p < 0.05). Conclusion: Spinal anesthesia can be safely administered to severely pre-eclamptic parturients undergoing cesarean section. General anesthesia is associated with more untoward outcomes, as it has been chosen in patients with more severity of the disease.

Effectiveness of endotracheal-tube size by age-based formula for Thai pediatric cardiac patients: a retrospective study

Abstract Background: Pediatric patients with congenital heart diseases may have pathological airway abnormality and delayed development. To predict the appropriate size of endotracheal tube (ETT), a formula between diameter and age has been widely used for Western normal children. However, it is unclear whether this age-based (AB) formula is applicable to Thai pediatric cardiac patients. Objective: Evaluate the effectiveness of uncuffed ETT size by AB formula for pediatric cardiac patients. Methods: A retrospective study was conducted using 320 cases of non-cardiac and cardiac patients aged 2-7 years old who were orally intubated with a regular uncuffed ETT at Siriraj Hospital, Thailand. The exclusion criteria were history of tracheostomy, upper airway obstruction, and expected difficult intubation. Demographic data and final ETT used were recorded. Results: The tube- size predicted by the AB formula could be applied to 54.4% of non-cardiac and 48.1% of cardiac patients (p= 0.314), whereas three sizes of tubes (one above and one below the predicted size) covered 96.9% and 94.4% of non-cardiac and cardiac patients, respectively (p = 0.413). The ETT with 0.5 mm in ID larger than the predicted size were more often used in 35.0% of cardiac patients compared with 22.5% of non-cardiac patients (p= 0.019). There were no significant differences between methods using age (actual, round-up, and truncated) to calculate the AB formula. The Pearson’s correlation between the ID of the ETT with height in non-cardiac and cardiac patients were 0.430 and 0.683, respectively (p <0.001), whereas correlations with weight were 0.622 and 0.561 (p <0.001), respectively. Conclusion: The AB formula was applicable to non-cardiac and cardiac children aged 2-7 years old. For Thai pediatric cardiac patients, we recommend to use a one-size larger ETT than non-cardiac patients.

Incidence and Risk Factors of Hypoxemia During Interventional Rigid Bronchoscopy Under Spontaneous-assisted Ventilation.

Background: Interventional rigid bronchoscopy for tracheobronchial stenosis can be performed under total intravenous anesthesia and spontaneous-assisted ventilation. Intraoperative hypoxemia can occur during this procedure, but the incidence and risk factors have not yet been determined. Methods: Medical records of patients who underwent rigid bronchoscopy for the treatment of tracheobronchial stenosis under total intravenous anesthesia and spontaneous-assisted ventilation during the study period from January 2011 to December 2012 were retrospectively reviewed. Results: There were 126 patients who underwent 263 procedures. The 2 main causes of tracheobronchial stenosis were tuberculosis (41.3%) and malignancy (35.7%). The 2 main locations of stenotic area were the trachea (58.6%) and the left main bronchus (46.4%). Tracheobronchial dilatation and stent insertion were performed in 78.7% and 21.3% of patients, respectively. The incidence of intraoperative hypoxemia was 25.5%. Independent risk factors for intraoperative hypoxemia were a degree of tracheal stenosis ≥75% (odds ratio: 2.48; 95% confidence interval, 1.19-5.17) and tumor removal procedure (odds ratio: 2.9; 95% confidence interval, 1.13-7.41). Conclusions: Incidence of intraoperative hypoxemia during interventional rigid bronchoscopy for tracheobronchial stenosis under spontaneous-assisted ventilation was 25.5%. Risk factors for hypoxemia were a degree of tracheal stenosis ≥75% and tumor removal procedure.