Suraseranivongse Suwannee, Attachoo Anchalee, Leelanukrom Ruenreong, Chareonsawan Usa, Horatanaruang Duenpen
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2011 Apr;94(4):450-6.
To assess current pediatric anesthesia practice for further education from Royal College of Anesthesiologists of Thailand.
A questionnaire was sent to 500 anesthetists in public hospitals in January 2010 to investigate preoperative data, intraoperative data, postoperative pain management, ambulatory anesthesia, and pediatric anesthesia training requirement.
Response rate was 30.6%. Preoperative fasting and infective endocarditis (IE) prophylaxis were appropriate except that half the anesthesiologists preferred giving antibiotics in non-cyanotic heart diseases and ordering complete blood count as a routine investigation in healthy patients undergoing minor surgery. Premedication was preferred in children and adolescents. Parental presence during induction was most often selected in children (74.5%). Modified Ayre T-piece was the most popular breathing circuit used during induction while circle circuit was more likely used during maintenance period. Manual ventilation was preferred in neonates. Scavenging system was rarely used Intraoperative fluid was given based on Holliday & Segar Law (> 90%). Isotonic fluid without glucose was preferred for replacement of third space loss and hypotonic fluid with glucose was preferred for maintenance fluid. Transfusion trigger was inversely correlated with age. Postoperative pain scales were more often used in children and adolescents. Fentanyl was more popular in younger age group. Intermittent intravenous administration was the most preferred route. Age group of infants and older were predominantly accepted to be anaesthetized on an ambulatory basis. Pediatric advanced life support was seldom performed. Intermittent training was more popular than certified fellowship training.
Routine investigation in healthy patients, IE prophylaxis in non-cyanotic patients, intraoperative fluid replacement, and pediatric advanced life support and postoperative pain management were the issues recommended for further education.
评估当前泰国皇家麻醉师学院继续教育中儿科麻醉的实践情况。
2010年1月向公立医院的500名麻醉师发送了一份问卷，以调查术前数据、术中数据、术后疼痛管理、门诊麻醉以及儿科麻醉培训需求。
回复率为30.6%。除了一半的麻醉师倾向于在非紫绀型心脏病患者中使用抗生素以及将全血细胞计数作为小手术健康患者的常规检查外，术前禁食和感染性心内膜炎（IE）预防措施是恰当的。儿童和青少年更倾向于使用术前用药。诱导期家长在场在儿童中最常被选择（74.5%）。改良的Ayre T形管是诱导期最常用的呼吸回路，而环路在维持期更可能被使用。新生儿更倾向于手动通气。很少使用清除系统。术中液体输注基于Holliday & Segar法则（>90%）。无葡萄糖的等渗液更适合用于补充第三间隙丢失，含葡萄糖的低渗液更适合用于维持液。输血触发因素与年龄呈负相关。术后疼痛量表在儿童和青少年中更常被使用。芬太尼在较年轻年龄组中更受欢迎。间歇静脉给药是最首选的途径。婴儿和较大年龄组主要被接受进行门诊麻醉。很少进行儿科高级生命支持。间歇培训比认证的专科培训更受欢迎。
健康患者的常规检查、非紫绀型患者的IE预防、术中液体补充、儿科高级生命支持以及术后疼痛管理是建议进行进一步教育的问题。
