Siriraj Medical Journal

209-217

Authors: Nalinee Panichyawat, M.D., Tripop Lertbunnaphong, M.D.

Background: Medical students are at risk of needlestick injuries (NSIs) while performing obstetrical procedures especially perineorrhaphy, because of their less experience. This study aims to determine the incidence and causes of NSIs during perineorrhaphy and medical students’ attitudes toward occurrence reports. Methods: A cross-sectional study was conducted. After completion of Obstetrics & Gynaecology rotation, the data from final year medical students were collected using a self-administered questionnaire. Results: Of 390 medical students, 290 (74.4%) returned questionnaires with complete data. The annual NSIs incidence during perineorrhaphy was 26.9%. The most common site of injury was the index finger of the non- dominant hand (66.2%). Common causes of NSIs were time pressure (52.1%) and lack of surgical skills (50.7%). Nearly half of students (41%) did not report their occurrence, and 81.3% of injured students believed that NSIs were harmless. Conclusion: The incidence of NSIs during perineorrhaphy and the non-reporting occurrence were quite high among medical students. Structural clinical supervision by medical staffs, HBV vaccination for all medical students, and instruction on standard pre-exposure precaution should be applied. We advocate a strategy plan for increasing students’ awareness and having a simple occurrence reporting system for NSIs, with clear guidelines on post-exposure protocols in all medical schools and teaching hospitals.

224-228

Authors: Sirichai Wilartratsami, M.D., Panya Luksanapruksa, M.D., Monchai Ruangchainikom, M.D., Cholavech Chavasiri, M.D., Areesak Chotivichit, M.D., Witchate Pichaisak, M.D.

Objective: To determine current decision making in methylprednisolone succinate (MPS) administration for acute spinal cord injury (ASCI) treatment in Thailand. Methods: A questionnaire was sent to all orthopedic surgeons who attended the annual meeting of the Spine Society of Thailand 2016. The questionnaire had 3 parts of questions including demographic data, opinions in MPS use in general ASCI patients and patients who meet the exclusion criteria in NASCIS III study. Results: Fifty five respondents completed the survey (overall response rate was 27.1 %) and there was 78.18% prescribe MPS to ASCI patients. Among them, 40 % prescribe according to NASCIS II and 55.6% NASCIS III. The main reasons for MPS administration are practice standard (38.6%), effectiveness (31.8%) and liability issue (22.7%). In patients who met the exclusion criteria of NASCIS III, most respondents do not prescribe any steroids in patients who had age below 14 years old (42.2%), pregnancy (77.8%), severe underlying disease (72.7%), body weight more than 109 kg (40.9%), gunshot injury (59.1%) and previous spinal cord injury (46.5%). Interestingly, there were 93.2% prescribed MPS to patients who sustained ACSI more than 8 hours. Conclusion: Because the institutional standard supported MPS use, most participants prescribed MPS in ASCI despite current clinical data from recent studies. Most participants who did not use MPS in patients had exclusion criteria of NASCIS III.

235-240

Authors: Witchate Pichaisak, M.D., Sirichai Wilartratsami, M.D., Ekkapoj Korwutthikulrangsri, M.D., Visit Vamvanij, M.D., Surin Thanapipatsiri, M.D., Panya Luksanapruksa, M.D.

Objective: To determine current decision making in treatment for incidental durotomy (ID) in Thailand. Methods: A questionnaire was sent to all orthopedic surgeons who attended the annual meeting of the Spine Society of Thailand 2016. The questionnaire had 2 parts including demographic data and 15 questions about details of ID repairing technique and postoperative treatment. Results: Sixty-seven responses were received from 213 participants (31.45% response rate). All respondents were male and performed lumbar spine surgery. Twenty-seven (40.30%) respondents work in a regional hospital. When ID occurred, most of the respondents (87.93%) provided further treatment. Sixty-one percent of respondents preferred prolene. Nylon and silk were used in 20% and 15%, respectively. The preferred size of repairing material was 6-0 (52.23%) and 5-0 (28.36%). The interrupted suture was used in 68.65 percent (46/67). The augmentation included fat graft (29/58, 50%), fibrin glue (12/58, 20.69%) and spongiostan (9/58, 15.5%). Seventy-five percent of respondents (48/64) used vacuum drain and 80% of respondents (54/67) prescribed bed rest after every dural repair. The durations of bed rest were 24 hrs (14/66, 21.2%), 48 hrs (27/66, 40.9%), 72 hrs (16/66, 24.2%) and more than 72 hrs (9/66, 13.6%). Conclusion: The perioperative management of lumbar ID in Thailand has substantial heterogeneity. Most of the participants prefer using interrupted suture, prolene, 6-0 in diameter, fat graft augmentation and placing wound drainage with vacuum. Duration of best rest varied between 24 to more than 72 hours.

247-256

Authors: Krisdee Prabhasavat, M.D., Patcharin Prapaisilp, M.Sc., Pansupang Prabhasavat, M.D., Sasima Tongsai, Ph.D.

Objective: The purpose of this study was to determine normal reference values of intra-thoracic and abdominal aortic diameters of asymptomatic Thai adults obtained by multidetector computed tomography. Secondary end points were evaluation of relationships between aortic diameters and patients’ demographic data or potential risk factors of cardiovascular disease. Methods: Three hundred and ten Thai adults in Siriraj Hospital who had no any signs or symptoms of cardio- vascular disease that examined with computed tomography (CT) of chest and whole abdomen were investigated in this study. Aortic diameters were measured at eight predefined intra-thoracic and abdominal levels on CT images, including ascending aorta, proximal transverse aortic arch, distal transverse aortic arch, aortic isthmus, thoracoabdominal junction, celiac axis, suprarenal aorta and aortic bifurcation. Analysis of data was performed with regard to patients’ demographic data (age, sex, weight, and height) and three potential risk factors of cardio- vascular disease (hypertension, dyslipidemia and diabetes mellitus). Furthermore, we also recorded the co-morbid non-cardiovascular underlying diseases which were classified into seven groups, including tumors (malignant and benign tumors), infectious diseases, inflammatory diseases, autoimmune diseases, degenerative diseases, psychiatric diseases and others. Results: Aortic diameters were 3.14±0.40 cm. at the ascending aorta, 2.88 ± 0.34 cm. at proximal transverse aortic arch, 2.65±0.30 cm. at distal transverse aortic arch, 2.46 ± 0.31cm. at aortic isthmus, 2.10± 0.27 cm. at thoracoab- dominal junction, 1.99 ± 0.26 cm. at celiac axis, 1.81 ±0.25 cm. at suprarenal aorta, and 1.47±0.21 cm. at aortic bifurcation. Overall aortic diameters tend to continuously significantly decrease aortic diameters from proximal to distal direction from ascending aorta to aortic bifurcation. Men had slightly more enlarged aortic diameters in all eight predefined levels than women with statistical significance (p<0.05). Increasing age is an independent and the most influential predictor of increasing size of aortic diameter in all aortic levels. Furthermore, age was classified into three age groups; 18-50 years, 51-70 years and 71-94 years. There were significant differences of aortic diameter in all aortic levels, except two age groups which are 51-70 years and 71-90 years when considered at celiac trunk and aortic bifurcation levels. Aortic diameters increased as weight increased at only one aortic level which was aortic bifurcation, with statistical significance (p<0.001). Weight was an independent influential predictor of aortic diameter in various levels, which were 5-46 percentages of influent degree. All aortic diameters were not increased with underlying hypertension, dyslipidemia and diabetes mellitus. Conclusion: This study delineates normal intra-thoracic and abdominal aortic diameters, including relationships with age and sex in asymptomatic Thai adults.

261-264

Authors: Rakesh Karnawat, M.D., Ghansham Biyani, M.D., Sadiq Mohammed, M.D., Monika Gupta, M.D., Meenal Agarwal, M.D., Shikha Soni, M.D.

Dextrocardia is a congenital cardiac malrotation in which the heart is situated on the right side of the body (dextroversion) with the apex pointing to the right. It may be associated with many cardiac and non-cardiac anomalies. It can also occur as a part of Kartagener’s Syndrome (KS). Presence of congenital and cardiac anomalies make the anesthetic management challenging and knowledge of the same is essential for better patient outcome.