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Objectives/Hypothesis The aim of the present study was to compare the surgical condition between deep neuromuscular blockade (NMB) and moderate NMB. Study Design Multicenter, randomized, parallel intervention trial. Methods One hundred two patients underwent microscopic endolaryngeal surgery at four university hospitals. The patients were randomized into moderate NMB (train‐of‐four 1‐2) (M group) or deep NMB (post‐tetanic count 1‐2) (D group) with moderate or high doses of rocuronium, respectively. Surgical rating conditions (SRCs) were evaluated during the surgery. Sugammadex was given to the M group at 2 mg/kg and the D group at 4 mg/kg. Perioperative clinical signs and conditions were recorded until discharge from the postanesthesia care unit. Results Clinically acceptable SRC was observed in 49 patients (100%) in the D group and 43 patients (89.6%) in the M group (P = .027). The frequency of notable vocal fold movement in the M group was significantly higher than the D group (70.8% vs. 32.7%). The patients in the M group required more additional doses of rocuronium (47.9%) than the D group (20.4%) to maintain full relaxation (P = .005). The median time (interquartile range) from administration of sugammadex to train‐of‐four ratio 0.9 in the D group was shorter than the M group (120 [109–180 minutes] vs. 180 minutes [120–240 minutes], P = .034). Conclusions Deep NMB with high doses of rocuronium combined with 4 mg/kg of sugammadex for reversal during endolaryngeal surgery provided better SRC and anesthetic conditions than moderate NMB of rocuronium with 2 mg/kg of sugammadex. Level of Evidence 1b Laryngoscope, 130:437–441, 2020

ANI can be used for early detection of parasympathetic signals before the occurrence of bradycardia or to locate unidentified carotid structures in the head and neck region.

Background: Melatonin became a part of multimodal analgesia in several recent studies because of its analgesic, anxiolytic and anti-inflammatory properties. Incidence of anxiety and pain in patients undergoing hysterectomy is not low. Moreover, preoperative anxiety is related to postoperative pain. The hypothesis of this study was whether melatonin could improve pain and other postoperative conditions after hysterectomy.Methods: A randomized, double-blinded, placebo-controlled trial involved recruitment of 54 patients, aged between 18 and 65 years old, planned to undergo hysterectomy, with or without oophorectomy under spinal anesthesia. The patients were allocated to receive 4 mg prolonged-release melatonin at night before surgery and in the morning before surgery or 2 doses of placebo at the same time point. Morphine consumption within 24 hours with patient-controlled analgesia machine and visual analog scale (VAS) pain score were recorded. In addition, quality of sleep, Thai standard anxiety level score, fatigue, general well-being and satisfaction score were measured by a blinded assessor and analyzed.Results: Mean of cumulative dose of morphine consumption in melatonin and placebo group were 33.04 ±10.42 and 42.63 ±8.21 mg, respectively. (p < 0.001) Mean of postoperative VAS pain scale was lower in the melatonin group at recovery room arrival (T0) (23.41 vs 8.07, p = 0.01). However, there was not a significant difference between postoperative groups at 1(T1), 6 (T6) and 24 h (T24). Fatigue and general well-being score in the melatonin group were better than the placebo group.Conclusion: Prolonged-release formulation of melatonin decreased pain intensity in post anesthetic care room and lowered doses of postoperative morphine within 24 hours after surgery. Postoperative fatigue, general well-being and satisfaction scores were better in the treatment group. However, there was no anxiety and sleep quality improvement. Melatonin may be an additional choice of multimodal analgesia for hysterectomy. Clinical trial registration: TCTR20140516001, Registered 16 May, 2014, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=1076, Efficacy of melatonin on postoperative outcomes after hysterectomy: a randomised, doubl-blinded, placebo-controlled trial

Postoperative delirium (POD) is a common perioperative complication. Although POD is preventable in up to 40% of patients, it is frequently overlooked. The objective of the survey is to determine the level of knowledge and clinical practices related to POD among anesthesiologists in different Asian countries. A questionnaire of 22 questions was designed by members of the Asian focus group for the study of POD, and it was sent to anesthesiologists in Singapore, Thailand, and South Korea from 1 April 2019 through 17 September 2019. In total, 531 anesthesiologists (Singapore: 224, Thailand: 124, Korea: 183) responded to the survey. Half the respondents estimated the incidence of POD to be 11–30% and believed that it typically occurs in the first 48 h after surgery. Among eight important postoperative complications, POD was ranked fifth. While 51.4% did not perform any test for POD, only 13.7% monitored the depth of anesthesia in all their patients. However, 83.8% preferred depth of anesthesia monitoring if they underwent surgery themselves. The results suggest that Asian anesthesiologists underestimate the incidence and relevance of POD. Because it increases perioperative mortality and morbidity, there is an urgent need to educate anesthesiologists regarding the recognition, prevention, detection, and management of POD.

BACKGROUND: Despite the improvement of anesthetic-related modalities, the incidence of unintended intraoperative awareness remains at around 0.005–0.038%. OBJECTIVE: We aimed to describe the intraoperative awareness incidents that occurred across Thailand between January to December, 2015. METHODS: Observational data was collected from 22 hospitals throughout Thailand. The awareness category was selected from incident reports according to the Perioperative Anesthetic Adverse Events in Thailand (PAAd Thai) study database and descriptive statistics were analyzed. The awareness characteristics and the related factors were recorded. RESULTS: A total of nine intraoperative awareness episodes from 2000 incidents were observed. The intraoperative awareness results were as follows: experience of pain (38.1%), perception of sound (33.3%), perception of intubation (9.5%) and feeling of paralysis (14.3%). The observed factors that affect intraoperative awareness were anesthesia-related (100%), patient-related (55.5%), surgery-related (22.2%) and systematic process-related (22.2%). The contributing factors were situational inexperience (77.8%) and inappropriate patient evaluation (44.4%). An awareness of anesthetic performer (100%) and experience (88.9%) were defined as incident-mitigating factors. The suggested corrective strategies were quality assurance activity (88.9%), improved supervision (44.4%) and equipment utilization (33.3%), respectively. CONCLUSION: Nine intraoperative awareness incidents were observed, however the causes were preventable. The anesthetic component seems to be the most influential to prevent these events.