Background: Trauma is the second most common cause of death in Thailand, relatively with massive blood loss. Coagulopathy plays a role in blood loss. Differences in mechanisms and organs injured can affect coagulopathy stage and blood loss. Thromboelastometry is a measuring instrument for accurate and rapid detection of coagulopathy. We hypothesized that thromboelastometry in traumatized patients who require surgery in Songklanagarind Hospital will help with early detection of coagulopathy and assess anticipated blood loss. Methods: After approval from the Institutional Ethics Committee, patients aged above 18 years who had American Society of Anesthesiologists Physical Status (ASA) IE–VE, activated by trauma team and sent for emergency surgery. Anesthesia was induced and maintained, and invasive procedures were done as anesthesiologist's consideration. Thromboelastometry, prothrombin time (PT), partial thromboplastin time (PTT), complete blood count, platelets, arterial blood gas, lactate, and base deficit were assessed and recorded at the emergency room and after Massive Transfusion Protocol (MTP) was activated at 1 and 2 MTP, respectively. Results: Most traumatized patients who were operated on in Songklanagarind Hospital during the study period were male, the most common cause of their injuries was a motorcycle accident, and the most common organ associated with massive blood loss and blood transfusion was the head. After the patients received PRCs of 5 and 11 units, the hematocrit level and platelet count decreased from baseline, while PT and PTT were prolonged. pH, base deficit, and lactate were worse. Clot formation time (CFT), A10, and maximum clot firmness (MCF) of EXTEM were statistically significantly different among the three time periods. Clotting times, CFT, A10, and MCF of INTEM were statistically significantly different among three time periods. A10 and MCF of FIBTEM were statistically significantly different among three time periods. Conclusion: Most baseline laboratory tests in the traumatized patients who received massive blood transfusion and underwent surgery were worse after they received 1 and 2 MTP. These parameters including thromboelastometry could be guided for preparing proper blood components for patients requiring massive transfusion.

BACKGROUND:This study aimed to determine the safety and efficacy of intraoperative intensive glycaemic treatment with modified glucose-insulin-potassium solution by hyperinsulinemic normoglycaemic clamp in cardiopulmonary bypass surgery patients. We hypothesised that the treatment would reduce infection rates in this group of patients. METHODS:A prospective, randomised, double-blind trial was conducted in cardiopulmonary bypass surgery patients. A total of 199 adult patients (out of a planned 400) were randomly allocated to intensive or conventional treatment with target glucose levels of 4.4-8.3 mmol/l and < 13.8 mmol/l, respectively. The primary outcomes were clinical infection and cytokine levels, including interleukin (IL)-6 and IL-10. The secondary outcomes were morbidity and mortality. RESULTS:The study was terminated early because of safety concerns (hypoglycaemia). The clinical post-operative infection rate was 17% in the intensive group and 13% in the conventional group (P = 0.53). The proportion of patients with hypoglycaemia was significantly higher in the intensive group (23%) compared with the conventional group (3%) (P < 0.001). Morbidity and mortality rates were similar for both groups. Anaesthetic duration > 2 h (vs. ≤ 2 h), pre-operative IL-6 level > 15 pg/ml (vs. ≤ 15 pg/ml) and post-operative IL-6 level 56-110 pg/ml (vs. ≤ 55 pg/ml) were independent predictors for post-operative infection. CONCLUSIONS:Intraoperative intensive glycaemic treatment significantly increased the risk of hypoglycaemia, but its effect on post-operative infection by clinical assessment could not be determined. Anaesthetic duration, pre-operative and post-operative IL-6 levels can independently predict post-operative infection.

Rujirojindakul, P.; Liabsuetrakul, T.; McNeil, E.; Chanchayanon, T.; Rergkliang, C. Author Information

Objective: To assess the use of irrigation fluid containers with visible fluid level tubes for TURP (transurethral resection of prostate gland). Design: Prospective, descriptive study Materials and methods: The irrigation fluid container with a visible fluid level tube for TURP was used in TURP procedures. Data were analysed from questionnaires completed by operation nurses regarding the convenience and satisfaction with the use of the irrigation fluid container. Results: All the questionnaire answers showed a good response in convenience and satisfaction with the use of the irrigation fluid container with a visible fluid level tube for TURP. Conclusion: The irrigation fluid container with a visible fluid level tube was found to be convenient and provided satisfaction for operative nurses managing TURP procedure. It is economic, is easy to produce and appropriate for general hospital use.

The aorta is considered as pathologically dilated when the diameter of the aortic root and ascending aorta exceed the normal for a given age and body size. Such aneurysmal dilatation of the aortic root and ascending aorta frequently leads to significant aortic valve regurgitation. Marfan’s syndrome is a genetic disorder of connective tissue that is marked by abnormalities of the skeletal, ocular and cardiovascular system. The main cardiovascular features of Marfan’s syndrome are progressive dilatation of the aortic root and ascending aorta, which may result in aortic rupture and aortic dissection or in aortic valvular regurgitation. The Bentall operation (one-piece composite valve-graft conduit for aortic valve, aortic root and ascending aorta replacement concomitant with coronary button reimplantation) is considered as a standard procedure to correct and prevent potential complications of this disease. This is a report of the first two cases that had received Bentall operation in southern Thailand. The results of the surgical treatment was satisfactory.