Papers by Surunchana Lerdsirisopon
PubMed, Mar 1, 2009
Background: The Royal College of Anesthesiologists of Thailand organized the first national senti... more Background: The Royal College of Anesthesiologists of Thailand organized the first national sentinel incident reports of anesthesia related adverse events in 2007 on an anonymous and voluntary basis. The aims of the present study were to analyze incidence, risk factors, clinical course and outcome of perioperative arrhythmia and indicate the contributing factors and suggested corrective strategies in the database of the Thai Anesthesia Incidents Monitoring Study (Thai AIMS). Material and method: This study was a prospective descriptive multicentered study conducted between January 2007 and June 2007. Data was collected from 51 hospitals across Thailand. All cases whose arrhythmia was detected intra-operatively and within 24 hr postoperative period were analyzed by 3 independents anesthesiologists. Any disagreements were discussed to achieve a consensus. Results: Four hundred and eighty-nine cases were enrolled as relevant arrhythmia cases. Bradycardia was the most common type (434 cases; 88.8%). Most of all events occurred intra-operatively (94.7%) and electrocardiography was the most common firstly detected monitoring equipment (95.5%). Arrhythmia occurred frequently in patients with hypertension and pre-operative heart rate < 60 beat per min. Intravenous anesthetics, central neural blockage and vagal reflex were considered to be the 3 most common suspected causes of arrhythmia requiring treatment. Most common outcomes were minor physiologic change with complete recovery physiologic change with complete recovery while 7% of incidents developed fatal outcome. The most common contributing factor was human factor (72.4%) especially in experience. An experienced anesthetic team with high awareness could be the minimizing factors. Conclusion: Arrhythmia accounted for 19.2% of 2,537 incidents of the Thai AIMS database. Bradycardia was the most common type of cardiac arrhythmia. Most arrhythmia was benign but might be fatal. Suggested corrective strategies such as guidelines practice, improvement of supervision and quality assurance activity.
Indian Journal of Critical Care Medicine, Feb 28, 2023
Background: Postoperative intensive care unit (ICU) admission is routinely practiced in pediatric... more Background: Postoperative intensive care unit (ICU) admission is routinely practiced in pediatric and adult craniotomy. This study aims to identify the factors associated with an ICU stay of more than one day (prolonged ICU stay, PIS) after pediatric brain tumor surgery. Methods: Medical records of children who underwent craniotomy for brain tumor during a 10-year period were reviewed and analyzed. Perioperative variables were examined and compared between the one-day ICU stay (ODIS) and PIS groups. Results: A total of 314 craniotomies performed on 302 patients was included. Patients requiring postoperative ICU care for more than a day represented 37.9% of the sample. Significant factors found in the multivariate analysis affecting prolonged ICU length of stay included operative time ≥360 minutes (adjusted odds ratio [AOR], 2.438; 95% confidence interval [CI]: 1.223-4.861; p = 0.011), presence of an endotracheal (ET) tube (AOR, 7.469; 95% CI: 3.779-14.762; p < 0.001), and external ventricular drain (EVD) at ICU admission (AOR, 2.512; 95% CI: 1.458-4.330; p = 0.001). Conclusion: While most children undergoing a craniotomy for brain tumor need a postoperative ICU care of ≤1 day, slightly more than a onethird in our study stayed longer. The prediction of a PIS can be beneficial for optimal resource utilization, increasing ICU bed turnover rate, reduction of operation cancellation, and improved preparation for parent expectations.
Clinical Neurology and Neurosurgery, Aug 1, 2016
OBJECTIVES To evaluate the value of physical examination as a monitoring tool during subcortical ... more OBJECTIVES To evaluate the value of physical examination as a monitoring tool during subcortical resection in awake craniotomy patients and surgical outcomes. PATIENTS AND METHODS Authors reviewed medical records of patients underwent awake craniotomy with continuous physical examination for pathology adjacent to the eloquent area. RESULTS Between January 2006 and August 2015, there were 37 patients underwent awake craniotomy with continuous physical examination. Pathology was located in the left cerebral hemisphere in 28 patients (75.7%). Thirty patients (81.1%) had neuroepithelial tumors. Degree of resections were defined as total, subtotal, and partial in 16 (43.2%), 11 (29.7%) and 10 (27.0%) patients, respectively. Median follow up duration was 14 months. The reasons for termination of subcortical resection were divided into 3 groups as follows: 1) by anatomical landmark with the aid of neuronavigation in 20 patients (54%), 2) by reaching subcortical stimulation threshold in 8 patients (21.6%), and 3) by abnormal physical examination in 9 patients (24.3%). Among these 3 groups, there were statistically significant differences in the intraoperative (p=0.002) and early postoperative neurological deficit (p=0.005) with the lowest deficit in neuronavigation group. However, there were no differences in neurological outcome at later follow up (3-months p=0.103; 6-months p=0.285). There were no differences in the degree of resection among the groups. CONCLUSION Continuous physical examination has shown to be of value as an additional layer of monitoring of subcortical white matter during resection and combining several methods may help increase the efficacy of mapping and monitoring of subcortical functions.
Indian Journal of Critical Care Medicine
Background: Postoperative intensive care unit (ICU) admission is routinely practiced in pediatric... more Background: Postoperative intensive care unit (ICU) admission is routinely practiced in pediatric and adult craniotomy. This study aims to identify the factors associated with an ICU stay of more than one day (prolonged ICU stay, PIS) after pediatric brain tumor surgery. Methods: Medical records of children who underwent craniotomy for brain tumor during a 10-year period were reviewed and analyzed. Perioperative variables were examined and compared between the one-day ICU stay (ODIS) and PIS groups. Results: A total of 314 craniotomies performed on 302 patients were included. Patients requiring postoperative ICU care for more than a day represented 37.9% of the sample. Significant factors found in the multivariate analysis affecting prolonged ICU length of stay included operative time ≥360 minutes (adjusted odds ratio [AOR], 2.438; 95% confidence interval [CI]: 1.223-4.861; p = 0.011), presence of an endotracheal (ET) tube (AOR, 7.469; 95% CI: 3.779-14.762; p < 0.001), and external ventricular drain (EVD) at ICU admission (AOR, 2.512; 95% CI: 1.458-4.330; p = 0.001). Conclusion: While most children undergoing a craniotomy for brain tumor need a postoperative ICU care of ≤1 day, slightly more than a onethird in our study stayed longer. The prediction of a PIS can be beneficial for optimal resource utilization, increasing ICU bed turnover rate, reduction of operation cancellation, and improved preparation for parent expectations.
Journal of the Medical Association of Thailand, Jun 1, 2018
Background A number of the anesthesia regimens are used in craniotomy. Rapid emergence is one of ... more Background A number of the anesthesia regimens are used in craniotomy. Rapid emergence is one of the important goals in Neuroanesthesia. In this study, we compared desflurane inhalation and propofol TCI regimen in patients undergoing craniotomy for temporal lobectomy regarding recovery profiles including time of recovery, cognitive function, postoperative pain, post-operative nausea and vomiting (PONV). In addition, we compared the costs between the two regimens. Objective To study effects of desflurane inhalation regimen and propofol TCI in patients undergoing elective craniotomy for temporal lobectomy. Recovery profiles, post-operative complications and treatments and overall costs between two group are compared Design Randomized double-blind prospective study Setting Neurosurgery and Neuroanesthesia unit at King Chulalongkorn Memorial Hospital. นพินธต์น้ฉบบั
Clinical Neurology and Neurosurgery, 2016
OBJECTIVES To evaluate the value of physical examination as a monitoring tool during subcortical ... more OBJECTIVES To evaluate the value of physical examination as a monitoring tool during subcortical resection in awake craniotomy patients and surgical outcomes. PATIENTS AND METHODS Authors reviewed medical records of patients underwent awake craniotomy with continuous physical examination for pathology adjacent to the eloquent area. RESULTS Between January 2006 and August 2015, there were 37 patients underwent awake craniotomy with continuous physical examination. Pathology was located in the left cerebral hemisphere in 28 patients (75.7%). Thirty patients (81.1%) had neuroepithelial tumors. Degree of resections were defined as total, subtotal, and partial in 16 (43.2%), 11 (29.7%) and 10 (27.0%) patients, respectively. Median follow up duration was 14 months. The reasons for termination of subcortical resection were divided into 3 groups as follows: 1) by anatomical landmark with the aid of neuronavigation in 20 patients (54%), 2) by reaching subcortical stimulation threshold in 8 patients (21.6%), and 3) by abnormal physical examination in 9 patients (24.3%). Among these 3 groups, there were statistically significant differences in the intraoperative (p=0.002) and early postoperative neurological deficit (p=0.005) with the lowest deficit in neuronavigation group. However, there were no differences in neurological outcome at later follow up (3-months p=0.103; 6-months p=0.285). There were no differences in the degree of resection among the groups. CONCLUSION Continuous physical examination has shown to be of value as an additional layer of monitoring of subcortical white matter during resection and combining several methods may help increase the efficacy of mapping and monitoring of subcortical functions.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2009
To demonstrate the characteristics, outcomes, and the circumstances associated with intraoperativ... more To demonstrate the characteristics, outcomes, and the circumstances associated with intraoperative recall of awareness. Relevant data of intra-operative recall of awareness were extracted from the Thai Anesthesia Incident Monitoring study (Thai AIMS) database of 1996 incident reports and 2537 incidents which were conducted among 51 hospitals throughout Thailand from January to June, 2007. Details regarding patients, surgical, anesthetic and systematic factors were recorded in a structured data record form. The completed record forms were reviewed independently by three anesthesiologists. The descriptive statistic was analyzed by using SPSS software version 11.5 and demonstrated in number and percent. Twenty-one incidents (21/1996 = 1.05%) of intra-operative recall of awareness were reported. Awareness was predominantly found in females (76.2%) and with ASA physical status I (47.6%). Most of the patients recalled events during the maintenance period and reported sound (71.4%), pain (...
Journal of Neuroanaesthesiology and Critical Care, 2018
Background Complexities of pathological causes in cardiac arrest and death in neurosurgery requir... more Background Complexities of pathological causes in cardiac arrest and death in neurosurgery require individualized management. To decrease the incidents, this study was performed to describe characteristics and factors reducing adverse outcomes together with potential corrective strategies of perioperative cardiac arrest and death in neurosurgical patients. Methods An observational study was performed in 22 hospitals. Peer-reviewed consensus was formed using database from Perioperative Anesthetic Adverse Events in Thailand (PAAd Thai) study. The data contain demography, anesthetic, surgical details, opinions on contributing factors, and factors that minimized incident as well as suggested corrective strategies. Results From 2,000 incidents, 64 (3%) cardiac arrest events were reported with a 50% chance of return of spontaneous circulation. The most common cardiac rhythm documented was asystole. Essentially, electrocardiography was the most frequent early detector. Surgical-related fac...
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Papers by Surunchana Lerdsirisopon