Background and Goal of Study:The use of hypotonic intravenous fluids has been associated with more than 50 international case reports of death or neurological injury in children. In 2003 the Royal College of Anaesthetists warned of the risk of iatrogenic hyponatraemia and water overload developing after the use of sodium chloride 0.18% with glucose 4% in children. A followup survey found less than half of consultant anaesthetists had been aware of this warning. 1 Our audit looked at whether anaesthetists' fluid prescriptions intraoperatively and postoperatively reflected these concerns in our department. Materials and Methods:The audit examined the fluid administration in paediatric operations over a 4 month period. Data collected included the age and weight of the child, the volume, rate and type of fluid prescribed intraoperatively and postoperatively, whether there was any estimate of blood or fluid loss, and whether capillary blood sugar was recorded.We also recorded the current locations of sodium chloride 0.18% with glucose 4%. Results and Discussions: Over the 4 month period, 35 patients received intraoperative fluids: none had a capillary blood sugar recorded and only 1 had an estimate of blood or fluid loss. 31 were given isotonic solutions, at volumes between 3-34 ml/kg. 4 were given hypotonic solutions (2 at 10-20 ml/kg, 2 at greater volumes).Only 17 patients were prescribed postoperative fluids: 13 were given isotonic solutions, of which only 4 were prescribed according to the Holliday and Segar formula. 2 The majority were prescribed at greater rates. 4 were given hypotonic fluids, 1 at the predicted rate, 2 at a greater rate and 1 at almost half the calculated rate. 2 Sodium chloride 0.18% with glucose 4% solution was freely available in all clinical areas. Conclusion(s):There is no restriction in the availability of sodium chloride 0.18% with glucose 4% solution. The majority of paediatric patients are given isotonic fluid intraoperatively. However, despite the concerns about hyponatraemia, post-operatively the majority are being prescribed either hypotonic or excessive rates of fluid.

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.

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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.

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.

The effects of laryngeal mask airway (LMA) insertion and cuff inflation on lower oesophageal sphincter, gastric and barrier pressure, and the relationship of the LMA cuff pressure and volume on the change in the barrier pressure were studied in 20 children. Subjects were aged one to five years, undergoing eye examination under general anaesthesia. There was no significant change in barrier pressure after insertion and inflation of the LMA compared with baseline measures. The cuff pressure and volume were not related to the change in barrier pressure. Two patients had marked decreases (10 to 15 mmHg) in barrier pressure after the LMA insertion. These decreases in barrier pressure would be expected to increase the risk of gastro-oesophageal reflux. We conclude that, although LMA use had little effect on barrier pressure in most children, occasional children will have potentially clinically significant decreases in barrier pressure with use of the LMA.

Background Effective clinical training is essential for healthcare personnel with clinical skill requirements to ensure that the required standard of care is provided. This study aimed to identify an effective learning medium for anesthesia residents by comparing text-based and video-based online training. Methods This randomized, multicenter study was conducted online between October 2020 and March 2021. Three Thai institutions were involved: the Faculty of Medicine Siriraj Hospital, Mahidol University; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University; and the Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University. In all, 126 anesthesia residents responded. They were randomized into a “text group” and a “video group.” Four residents were subsequently excluded from the analyses due to contamination of their learning material from the other group. The 122 eligible students undertook 3 knowledge and skill assessments (“Pretest,” “Posttest 1,” and “Posttest 2”). The primary outcome for both study groups was the gain score after training. This was measured in 2 ways: the difference between the Posttest 1 and Pretest scores and the difference between the Posttest 2 and Pretest scores. Results The mean gain scores for Pretest and Posttest 1 were 6.78 ± 6.59 for the text group and 5.77 ± 3.74 for the video group, with no significant difference (P = 0.347). The mean differences between the Posttest 2 and Pretest scores were 4.69 ± 9.13 for the text group and 3.47 ± 9.07 for the video group, without a significant difference (P = 0.488). The mean satisfaction score of the video group was significantly higher. Conclusions This study demonstrated a significantly higher degree of satisfaction with video-based training but without a significant commensurate improvement in gain score. The results suggest that the online video technique can be helpful in the teaching of clinical skills.