Polpun Boonmak

Background and objective: Operating room nurse was one of the team's personnel who is crucial to the success of resuscitation. Cardiac arrest management requires an effective resuscitation team. Our study aimed to investigate the operating room nurse’s confidence for cardiac arrest management. We also studied the associated factors influencing on their confidence. Materials and methods: This study was a prospective description study in 113 operating room nurses who work at Srinagarind hospital, faculty of Medicine, Khon Kaen university. We assessed their confidence level during cardiac arrest management and associated factors Results: The response rate was 65.5 %.Fair to strongly confidence in willing to perform was 62.8%, basic life support was 62.2%, advanced life support was 60.8%. 50% of operating room nurses did not have confidence in opening airway, ventilation, and automatic defibrillation. Associated factors were life support training, and resuscitation protocol. Conclus...

BackgroundSevoflurane induction for general anaesthesia has been reported to be safe, reliable and well accepted by patients. Sevoflurane induction uses either low or high initial concentrations. The low initial concentration technique involves initially administering a low concentration of sevoflurane and gradually increasing the concentration of the dose until the patient is anaesthetized. The high initial concentration technique involves administering high concentrations from the beginning, then continuing with those high doses until the patient is anaesthetized. This review was originally published in 2013 and has been updated in 2016.ObjectivesWe aimed to compare induction times and complication rates between high and low initial concentration sevoflurane anaesthetic induction techniques in adults and children who received inhalational induction for general anaesthesia. We defined 'high' as greater than or equal to and 'low' as less than a 4% initial concentration.Search methodsFor the updated review, we searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE (1950 to February 2016), EMBASE (1980 to February 2016), Latin American Caribbean Health Sciences Literature (LILACS) (1982 to February 2016) and the Institute for Scientific Information (ISI) Web of Science (1946 to February 2016). We also searched the reference lists of relevant articles and conference proceedings and contacted the authors of included trials. The original search was run in September 2011.Selection criteriaWe sought all published and unpublished, randomized controlled trials comparing high versus low initial sevoflurane concentration inhalational induction. Our primary outcomes included two measures of anaesthesia (time to loss of the eyelash reflex (LOER) and time until a weighted object held in the patient's hand was dropped), time to successful insertion of a laryngeal mask airway (LMA) and time to endotracheal intubation. Other outcomes were complications of the technique.Data collection and analysisWe used standardized methods for conducting a systematic review as described in the Cochrane Handbook for Systematic Reviews of Interventions. Two review authors independently extracted details of trial methods and outcome data from reports of all trials considered eligible for inclusion. We conducted all analyses on an intention‐to‐treat basis, when possible. We estimated overall treatment effects by using a fixed‐effect model when we found no substantial heterogeneity, whereas we applied the random‐effects model in the presence of considerable heterogeneity.Main resultsWe reran the searches and included one new study (100 participants) in this updated review. In total, we included 11 studies with 829 participants, although most analyses were based on data from fewer participants and evidence of low quality. We noted substantial heterogeneity in the included trials. Thus, our results should be read with caution. It was not possible to combine trials for the primary outcome (LOER), but individual trials reported faster induction times (typically 24 to 82 seconds faster, 41 seconds (31.37 to 50.62)) with high initial concentration sevoflurane (six studies, 443 participants, low‐quality evidence). Apnoea appeared to be more common in the high initial concentration sevoflurane group (risk ratio (RR) 3.14, 95% confidence interval (CI) 1.72 to 5.7, two studies, 160 participants, low‐quality evidence). We found no evidence of differences between the two groups in the incidence of cough (odds ratio (OR) 1.23, 95% CI 0.53 to 2.81, eight studies, 589 participants, low‐quality evidence), laryngospasm (OR 1.59, 95% CI 0.16 to 15.9, seven studies, 588 participants, low‐quality evidence), breath holding (OR 1.16, 95% CI 0.47 to 2.83, five studies, 389 participants, low‐quality evidence), patient movement (RR 1.14, 95% CI 0.69 to 1.89, five studies, 445 participants, low‐quality evidence) or bradycardia (OR 0.8, 95% CI 0.22 to 2.88, three studies, 199 participants, low‐quality evidence), and the overall incidence of complications was low.Authors' conclusionsA high initial concentration sevoflurane technique probably offers more rapid induction of anaesthesia and a similar rate of complications, except for apnoea, which may be more common with a high initial concentration. However, this conclusion is not definitive because the included studies provided evidence of low quality.

Background: Adult basic life support (BLS) is an important procedure for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in order to increase patients’ survival rate. So, all healthcare providers (HCP) must pass the BLS course. Although, this is an intensive training course, findings after completion of training showed that some HCP still practiced inappropriately. Objective: To explore common pitfalls in Adult BLS training for HCP. Methods: This study was descriptive design. We studied in HCP who attended adult BLS course at KKU - REACT simulation center, Faculty of medicine, Khon Kaen University. It is a 3 – hour course for knowledge and skills teaching in accordance with the current American Heart Association Guideline. Each instructor taught 8 students (2 BLS manikins); and after teaching, we evaluated a 3 - minute performance at the first examination. The data were recorded and analyzed. Results: We included 194 students into the study. Only 117 students passed ...

Dural puncture is a common procedure, but leakage of CSF from the resulting dural defect may cause postural headache after the procedure, and this can be disabling. Injecting an epidural blood patch around the site of the defect may stop this leakage, and so may have a role in preventing or treating post dural puncture headache. To assess the possible benefits and harms of epidural blood patching in both the prevention and the treatment of post-dural puncture headache. We searched the Cochrane Controlled Trials Register (Cochrane Library, Issue 4, 2000), MEDLINE (January 1994 to December 1998), and EMBASE (January 1980 to December 1998). We also searched the reference lists of relevant articles identified electronically, and asked both the authors of all included trials and colleagues with an interest in this area to let us know of any other potentially relevant studies not already identified. Date of last search: December 2000. We sought all properly randomised, unconfounded trials that compared epidural blood patch versus no epidural blood patch in the prevention or treatment of post-dural puncture headache among all types of patients undergoing dural puncture for any reason. The primary outcome of effectiveness was postural headache. One reviewer extracted details of trial methodology and outcome data from the reports of all trials considered eligible for inclusion. We invited the authors of all such trials both to check the information extracted and to provide any details that were unavailable in the published reports. Intention-to-treat analyses were performed using the Peto O-E method. Information about adverse effects (post-dural puncture backache, epidural infection and lower limb paraesthesia) was also extracted. Three trials (77 patients) were eligible for inclusion. Methodological details were generally incomplete. Although the results of our analyses suggested that both prophylactic and therapeutic epidural blood patching may be of benefit, the very small numbers of patients and outcome events, as well as uncertainties about trial methodology, precluded reliable assessments of the potential benefits and harms of this intervention. Further, adequately powered, randomised trials (including at least a few hundred patients) are required before reliable conclusions can be drawn about the role of epidural blood patching in the prevention and treatment of post-dural puncture headache.

Purpose: Traditional anesthesiology learning was disrupted by the coronavirus disease 2019 pandemic and replaced by online learning. Students and teachers did not prepare well for this change. Determining the differences in perceptions can close the gap and develop more effective curricula. Our study aims to compare students’ and teachers’ perceptions of online anesthesiology learning.Methods: We conducted a prospective descriptive study, a cross-sectional survey between July 2020 and January 2021 in the Anesthesiology Department, Faculty of Medicine, Khon Kaen University, Thailand. Our participants were fifth-year medical students and teachers participating in online anesthesiology. We compared the perception of the teaching process, support system, learning outcomes, satisfaction, and preference. Using an online structured questionnaire survey with a 4-point Likert scale to measure the degree of agreement with each item. We analyzed the difference between students’ and teachers’ p...

To determine the knowledge level and skill base in nurse anesthetists before and after brief ACLS training, and again three months later. Thirty nurse anesthetists were tested for knowledge and skill before ACLS training comprising 1-hr lecture and handout, and 1-hr simulation training. Concepts included ABCD, primary and secondary survey, management, medications, and algorithms for common problems. Skill practice comprised airway management, chest compression and practice with equipment. After the training, the nurse anesthetists were immediately tested and again three months later. Age of participants averaged 39.33 + or - 3.14 years and working experience 10.04 +/- 3.23 years. The knowledge and skill scores pre- vs post-training vs three-months-later was 50.32 +/- 15.24 vs 75.40 +/- 10.29 (p < 0.001) vs 60.48 +/- 11.80 (p < 0.001) and 65.00 + 16.07 vs 79.67 +/- 10.80 (p < 0.001) vs 75.67 +/- 14.53 (p < 0.001), respectively. The pre-training vs three-months-post-traini...

To identify the incidence of common anesthetic complications in 2003 at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand and find the strategies for prevention. The study was part of a multi-center study conducted by the Thai Royal College of Anesthesiologists to survey anesthetic related complications in Thailand in 2003. The authors collected data from all the cases receiving anesthesia service at Srinagarind Hospital between January 1 and December 31, 2003, to report the incidence of common anesthetic complications and to assess the need to improve the quality of service. This was a prospective, descriptive study. When any anesthetic complications occurred, they were reported by anesthesia personnel and anesthesiologists. The reporting forms comprised four categories of complications, viz.: respiratory, cardiovascular, neurological and others. Each category of complications has a guidebook for reference in order to correctly fill out the form. All the for...

Background and Objective : Emergency operating roomsmust be readiness for emergency procedure. Their key performance index is “all patientsreceived procedure within optimized time depend on triage”. So, we would like to studypercentage of patients that received procedure within optimized time during in-office hour and process time of each steps, including obstacles for quality improvement. Methods : This study was prospective descriptive study. We studied in patients who received service in emergency operating room during in-office hour. Data were sought from medical record and study record. Patients were classified depend on their emergency condition group by surgeons (triage). We recorded process time of each steps from request for service until finished procedure. We also recorded obstacles. Result : One hundred and thirty-two patients were included into study.None of true emergency cases were received procedure within 15 minutes.E mergency cases that received procedure within 1 ...

Hemorrhage during pregnancy is common and serious problem. It is a leading cause of maternal death in worldwide particularly in developing countries. Appropriate antenatal, intrapartum and postpartum care can prevent the problem. Despite, we deliver appropriate care in pregnancy, massive hemorrhage still occurs. This situation requires multidisciplinary care including crisis resource management and understanding pathophysiologic change.

Background and objective :  Emergency operating room after-office hours in Srinagarind hospital triaged patients into four types (true emergency, emergency, urgent, and elective cases) by operation urgency. Our aims were to evaluate waiting time for operation and associated factors. Method : This was a prospective descriptive study. We studied in patients who receive service in emergency operating room after-office hours. Data were sought from medical record and study record. Patients were triaged into emergency condition group by surgeons. We recorded process time from request for service until finished procedure. We also recorded the obstacle. Result : One hundred and thirty-three patients were included into study. None of true emergency cases received procedure within 15 minutes. Seventy-six percent of emergency cases received procedure within 1 hours. Eighty-six percent of urgency cases received procedure within 6 hours. And all elective cases received procedure within 24 hours....

Background and objective: Adult basic life support (BLS) for health care provider (HCP) requires manikin aims to train pulse palpation, chest compression, ventilation, and defibrillation. Each manikin is different, in some manikin have skill evaluated device. This study aims to compare between simple manikin and manikin with skill evaluated device for BLS skills for HCP training. Methods: This study was prospective randomized control trial. We studied in students who attended adult BLS course for HCP at KKU-REACT simulation center, Faculty of Medicine, Khon Kaen University. It was a 3-hour course for knowledge and skill teaching. We divided students into two groups. Group I practiced with simple manikin without skill evaluated device (Little Anne ® ). Group II practiced with manikin with skill evaluated device (Resusci Anne SkillReporter ® ). After training, we evaluated performance at the first examination. Then, the data were recorded and analyzed. Results: We included 80 students...

Background: Out-of-hospital cardiac arrest (OHCA) is a significant health problem in many Asian countries. Bystander cardiopulmonary resuscitation (CPR) can reduce mortality from OHCA. The willingness of bystanders to initiate aid is also critical. During the COVID-19 pandemic, CPR eases to spread of COVID-19 with negatively affect the decision. The objectives were to study the influence of the COVID-19 pandemic and bystander-victim relationship on the willingness of Thai healthcare providers (HCPs) and laypersons to perform CPR and associated factors.Methods: The cross-sectional online survey was conducted between August to November 2020 in a Thai population. A structured questionnaire was developed and given to volunteers as an online survey. We recorded participant characteristics and willingness to perform compression-only CPR (W-COC) and conventional CPR (W-CC) on family members, acquaintances, and strangers during the pandemic and in a non-pandemic situation and analyzed assoc...

Objective: To study the reliability of a peer-approved checklist for scoring anesthesia case reports prepared by 5th-year medical students. Methods: A report checklist was created by a tutor in the Department of Anesthesia, Khon Kaen University, comprising: 4 items on pre-anesthetic evaluation; 4 on pre-anesthetic preparation; 8 on intra-operative management; and, 5 on postoperative care. The checklist was pre-approved by all 14 anesthesiology tutors in the Department. Each student prepared case report was evaluated by 4 tutors (in random order) using the checklist. The reports and checklist were collected for inter-rater and intra-class correlation analyses. Results: Thirty anesthesia case reports were included. The kappa (κ) coefficient for each item was between 0.10 and 0.96: 3 items (14.28 % of the total items) had almost perfect reliability (κ = 0.81-1.00); 2 (9.53 %) substantial (κ = 0.61-0.80); 3 (14.28 %) moderate (κ = 0.41-0.60); 4 (23.81 %) fair (κ = 0.21-0.40); and, 12 (3...

Study the satisfaction of parents with ambulatory anesthesia and associated factors, including characteristics of the patients and their parents. This was a prospective, descriptive, observation study. The authors included children who were scheduled for ambulatory anesthetic service between birth and 14 years of age and attended at Srinagarind Hospital, Khon Kaen, Thailand. The authors excluded patients whose parents could not be reached by telephone. Before anesthesia, the authors recorded the patients and parents' characteristics, level of information perception (pre-, peri- and post-anesthesia and complications). After anesthesia, the anesthesia technique and any complications were recorded. The day after anesthesia, the authors made phone calls to the patients to record the parents' satisfaction score (viz, of overall, pre-, peri- and post-anesthesia care, and information about the level of patient care at home), and any anesthesia related complications. Ninety-two pati...

To audit trauma care (including the mortality rate and obstacles faced by the authors) at Srinagarind (University) Hospital using the trauma audit filter. Conduct a prospective, descriptive, study of trauma patients who received trauma medical care at Srinagarind Hospital, Khon Kaen University, Thailand, between January and May 2006. Srinagarind Hospitals trauma audit filter was used to audit trauma care. The audit filter comprised 14 criteria (i.e., 1) emergency medical service; 2) accident and emergency out-patient service; 3) in-patient service). Any filter that generated a "Yes" response was investigated to find the reason(s). The obstacles and mortality were also recorded. The authors enrolled 3209 patients. The mortality rate was 0.5% (95% CI 0.3-0.8). Emergency medical service, accident and emergency out- and in-patient service were rated satisfactorily. The reported obstacles were lack of hospital beds, inappropriate locale for trauma care, financial process, admis...

To evaluate disposable LMA for endotracheal intubation using the FOB guidance and blind techniques. The authors included ASA class I-II patients between 15 and 60 years of age, with mouth opening more than 3 cm, scheduled for elective surgery. The authors excluded patients with any history of gastro-esophageal reflux, full stomach or a body weight < 30 kg. All of the patients received standard general anesthesia. After inducing anesthesia, a disposable LMA No. 3 or No. 4 (Soft Seal, Smiths Medical, Portex Inc, USA) was inserted while the patient was in the sniff position. The authors recorded the insertion time, the ease of insertion, the anatomic placement and position. The authors then inserted a flexible endotracheal tube (No. 6.5 for LMA No. 4 and No. 6 for LMA No. 3) and recorded the success rate and the ease of insertion. After three failures, the authors used FOB guidance. Sixty patients were enrolled (32 males). The mean +/- SD age and BMI was 43.2 +/- 13.4 years and 22.6...

To identify the incidence of common anesthetic complications in 2003 at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand and find the strategies for prevention. The study was part of a multi-center study conducted by the Thai Royal College of Anesthesiologists to survey anesthetic related complications in Thailand in 2003. The authors collected data from all the cases receiving anesthesia service at Srinagarind Hospital between January 1 and December 31, 2003, to report the incidence of common anesthetic complications and to assess the need to improve the quality of service. This was a prospective, descriptive study. When any anesthetic complications occurred, they were reported by anesthesia personnel and anesthesiologists. The reporting forms comprised four categories of complications, viz.: respiratory, cardiovascular, neurological and others. Each category of complications has a guidebook for reference in order to correctly fill out the form. All the for...

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 we...

Sevoflurane induction for general anaesthesia has been reported to be safe, reliable and well accepted by patients. Sevoflurane induction uses either low or high initial concentrations. The low initial concentration technique involves initially administering a low concentration then gradually increasing the dose until the patient is anaesthetized. The high initial concentration technique involves administering high concentrations from the beginning, continuing until the patient is anaesthetized. We aimed to compare the induction times and complications between high and low initial concentration sevoflurane induction in patients who received inhalational induction for general anaesthesia. We defined 'high' as greater and 'low' as less than a 4% initial concentration. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 9); MEDLINE (1950 to September 2011); EMBASE (1980 to September 2011); LILACS (1982 to September 2011) and ISI Web of Science (1946 to September 2011). We also searched the reference lists of relevant articles, conference proceedings; and contacted the authors of included trials. We sought all published and unpublished, randomized controlled trials comparing high versus low initial sevoflurane concentration inhalational induction. Our primary outcomes were two measures of anaesthesia (time to loss of the eyelash reflex (LOER) and time until a weighted object held in the patient's hand was dropped), time to successful insertion of a laryngeal mask airway (LMA), and time to endotracheal intubation. Other outcomes were complications of the technique. We used the standardized methods for conducting a systematic review as described by the Cochrane Handbook for Systematic Reviews of Interventions. Two authors independently extracted details of trial methodology and outcome data from reports of all trials considered eligible for inclusion. All analyses were made on an intention-to-treat basis, where possible. The overall treatment effects were estimated by using a fixed-effect model when there was no substantial heterogeneity, whereas the random-effects model was applied in the presence of considerable heterogeneity. We used data from 10 studies with 729 participants in the review, though most analyses were based on data from fewer participants. There was substantial heterogeneity in the trials. Thus, our results should be read with caution. It was not possible to combine the trials for the primary outcome (LOER) but individual trials found faster induction times (typically 24 to 82 seconds faster) with high initial concentration sevoflurane. Apnoea appeared to be more common in the high initial concentration sevoflurane group (two trials,160 participants). There was no evidence of a difference in the incidence of cough, laryngospasm, breath holding, bradycardia, salivation and hypotension between the two groups, with the overall incidence of complications being low. A high initial concentration sevoflurane technique probably offers more rapid induction of anaesthesia and a similar rate of complications except for apnoea, which may be more common with a high initial concentration. However, this conclusion is not definitive.

This is an update of a Cochrane Review first published in Issue 2, 2002. Dural puncture is a common procedure, but leakage of cerebrospinal fluid (CSF) from the resulting dural defect may cause post-dural puncture headache (PDPH) after the procedure, and this can be disabling. Injecting an epidural blood patch around the site of the defect may stop this leakage. To assess the possible benefits and harms of epidural blood patching in both prevention and treatment of PDPH. We searched the Cochrane PaPaS Group Trials Register; CENTRAL; MEDLINE and EMBASE in April 2009. We sought all randomised controlled trials (RCTs) that compared epidural blood patch versus no epidural blood patch in the prevention or treatment of PDPH among all types of participants undergoing dural puncture for any reason. The primary outcome of effectiveness was postural headache. One review author extracted details of trial methodology and outcome data from studies considered eligible for inclusion. We invited authors of all such studies to provide any details that were unavailable in the published reports. We performed intention-to-treat (ITT) analyses using the Peto O-E method. We also extracted information about adverse effects (post-dural puncture backache and epidural infection). Nine studies (379 participants) were eligible for inclusion. Prophylactic epidural blood patch improved PDPH compared to no treatment (OR 0.11, 95% CI 0.02 to 0.64, one study), conservative treatment (OR 0.06, 95% CI 0.03 to 0.14, two studies) and epidural saline patch (OR 0.16, 95% CI 0.04 to 0.55, one study). However, prophylactic epidural blood patch did not result in less PDPH than a sham procedure (one study). Therapeutic epidural blood patch resulted in less PDPH than conservative treatment (OR 0.18, 95% CI 0.04 to 0.76, one study) and a sham procedure (OR 0.04, 95% CI 0.00 to 0.39, one study). Backache was more common with epidural blood patch. However, these studies had very small numbers of participants and outcome events, as well as uncertainties about trial methodology, which preclude reliable assessments of the potential benefits and harms of the intervention. The review authors do not recommend prophylactic epidural blood patch over other treatments because there are too few trial participants to allow reliable conclusions to be drawn. However, therapeutic epidural blood patch showed a benefit over conservative treatment, based on the limited available evidence.

Objective: To study the reliability of a peer-built checklist for developing an OSCE on the setting-up of a Bird ventilator and performing a spinal block. Methodology: The OSCE checklists were created by all tutors in the Department of Anesthesiology at the Faculty of Medicine, Khon Kaen University. The spinal block OSCE checklist had 22 items; the Bird ventilator setting checklist had 9. The checklists were reviewed for their ability to evaluate thoroughness of understanding then approved by all tutors. Each student was evaluated for each skill by two tutors assigned by simple randomization. Each tutor scored the student according to the checklist, unaware of the score their fellow tutor gave. The inter-rater agreement presented as a weighted kappa coefficient in each item and intra-class correlation in each part. Results: Our subjects were thirty 5th-year medical students who took the anesthesia OSCE in 2003. In the spinal anesthesia checklist, each item had a weighted kappa coeff...

To study the effect of 0.2 mg mL-1 of ondansetron added to morphine patient-controlled analgesia solution after a 4 mg loading dose on the incidence and severity of postoperative nausea and vomiting. One hundred and sixty patients scheduled for elective surgery, between 18 and 65 yr old, were studied. Patients who smoked, received antiemetics and hormonal therapy, had a history of motion sickness or gastrointestinal disease, a body mass index >35 or menstruation at the time of the study were excluded. Patients were assigned to the ondansetron and control groups by block randomization. At the end of anaesthesia, all patients received 4 mg of ondansetron intravenously and the same patient-controlled analgesia regimen of morphine. The ondansetron group (n = 80) received 0.2 mg of ondansetron per 1 mg of morphine. The nausea score, vomiting score and the requested ondansetron dose were evaluated at 1, 2, 6, 12 and 24 h. Patient-satisfaction for nausea/vomiting was recorded at the end of the study. Patient characteristics and cumulative morphine consumption were similar but ondansetron group had higher pain scores (P = 0.006). The ondansetron group had a lower nausea and vomiting scores, and more patients were free from nausea and vomiting than the control group (41 vs. 26, respectively, P = 0.025). The ondansetron group had fewer cumulative ondansetron doses than the control group and better patient satisfaction than the control group (P < 0.05). Ondansetron 4 mg plus 0.2 mg mL-1 given with PCA morphine can reduce nausea and vomiting thus improving patient satisfaction.

ABSTRACT To study the use of intrathecal morphine plus PCA for reducing morphine consumption, pain scores, and improving patient-satisfaction. The authors included patients who had received a flank incision for elective kidney surgery. The patients were random into the intrathecal and control groups by block randomization using the sealed envelop technique. The intrathecal group received 0.3 mg of intrathecal morphine before general anesthesia. Patients and providers were not apprised of the treatment. After the operation, both groups received morphine in a PCA pump. Morphine consumption, numeric rating score (NRS, range 0-10) at rest and while coughing, sedation score, nausea vomiting score, and itching score were evaluated at 1, 2, 6, 12, 24, and 48 hr. Patient satisfaction for pain control was recorded. The authors enrolled 80 patients in the present study. Demographic data was comparable between groups. The intrathecal group had less cumulative morphine consumption (p-value < 0.001), less NRS at rest (p-value < 0.001) and while coughing (p-value < 0.001) than the control group. The intrathecal group had a greater itching score than the control group (p-value < 0.001). The sedation score and patient satisfaction for pain control were not significantly different between groups (p-value = 0.55). Intrathecal morphine plus PCA could reduce morphine consumption and improve the analgesic effect over PCA alone postoperatively. Itching was more common in the intrathecal group. Overall, patient satisfaction for pain control was not improved.

To audit trauma care (including the mortality rate and obstacles faced by the authors) at Srinagarind (University) Hospital using the trauma audit filter. Conduct a prospective, descriptive, study of trauma patients who received trauma medical care at Srinagarind Hospital, Khon Kaen University, Thailand, between January and May 2006. Srinagarind Hospitals trauma audit filter was used to audit trauma care. The audit filter comprised 14 criteria (i.e., 1) emergency medical service; 2) accident and emergency out-patient service; 3) in-patient service). Any filter that generated a "Yes" response was investigated to find the reason(s). The obstacles and mortality were also recorded. The authors enrolled 3209 patients. The mortality rate was 0.5% (95% CI 0.3-0.8). Emergency medical service, accident and emergency out- and in-patient service were rated satisfactorily. The reported obstacles were lack of hospital beds, inappropriate locale for trauma care, financial process, admission process, and lack of equipment. Srinagarind Hospital's audit filter had the capability to audit trauma care. Overall trauma care at Srinagarind Hospital was satisfactory albeit improvements are needed.