JOURNAL OF THE MEDICAL ASSOCTATION OF THAILAND最新文献

{"title":"The First Ever Robotic-Assisted Laparoscopic Radical Nephrectomy with Inferior Vena Cava Thrombectomy Performed in Thailand: A Case Report of Atypical Presentation of Urothelial Carcinoma with Tumor Thrombus","authors":"","doi":"10.35755/jmedassocthai.2023.10.13852","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.10.13852","url":null,"abstract":"Background: Robotic-assisted surgery was proposed as an alternative to open surgery for management of inferior vena cava (IVC) thrombus together with radical nephrectomy in complex renal mass. Here, the authors reported the first case of this type to be managed via this surgical technique in Thailand. Case Report: A 76-year-old Thai female presented with right renal mass with tumor thrombus in the IVC extending 3 cm above the level of the renal vein. The presumed diagnosis was renal cell carcinoma of the right kidney with level 2 tumor thrombus in IVC, clinical staging T3bN0M0. The patient underwent robotic-assisted laparoscopic IVC thrombectomy together with right radical nephrectomy at Siriraj Hospital (Bangkok, Thailand) in May 2020. Results: The operation proceeded uneventfully without immediate complication. The postoperative reduction of IVC diameter was approximately 30%. Total IVC clamp time was 50 minutes, operative time was five hours, with docking time of 20 minutes and console time of 250 minutes, estimated intraoperative blood loss was 2,600 mL, and length of hospital stay was four days. At 30-days and 90-days postoperation, no thromboembolic event or compromising lower extremity venous return was detected. The pathological report revealed high-grade urothelial cell carcinoma with invasion into perinephric fat. Carcinoma involvement was observed in the tumor thrombus and IVC wall (T4N0M0). Conclusion: Robotic-assisted surgery of the IVC is a complex operation that requires robotic surgical proficiency and a highly experienced team. The observed success in the present case demonstrated the feasibly of this procedure in Thailand. Additional benefits include less postoperative pain, reduced blood loss, smaller surgical wound size, and shorter length of hospital stay. Keywords: Robotic-assisted laparoscopic radical nephrectomy; Inferior vena cava thrombectomy; Thailand","PeriodicalId":484667,"journal":{"name":"JOURNAL OF THE MEDICAL ASSOCTATION OF THAILAND","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136143095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Factors of Overweight and Obesity among Medical Personnel in a District Hospital","authors":"","doi":"10.35755/jmedassocthai.2023.10.13896","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.10.13896","url":null,"abstract":"Background: In 2022, the prevalence of overweight and obesity in Thailand reached 47.8%, marking a rise from 34.7% in 2016, the second highest in ASEAN following Malaysia. Furthermore, there is high obesity among healthcare workers. Objective: To investigate the prevalence rate and factors affecting overweight and obesity among medical personnel. Materials and Methods: The cross-sectional study was designed. The sample size of 169 medical personnel working at a district hospital was included in the present study. Age over 20 years old and informed consent was required in the inclusion criteria. Weight, height, and body mass index (BMI) through self-reports for assessing obesity. A 5-level scale of eating behavior and the Global Physical Activity Questionnaire (GPAQ) with a reliability of 0.79 to 0.93 were used to collect the data in September and October 2022. Logistic Regression was used to analyze the data. Results: The prevalence of overweight was 14.79%, (BMI of 23.0 to 24.9 kg/m²) and 40.24% obesity (BMI of 25.0 kg/m² or greater), with more obesity in males than females. The factors associated with obesity were male gender, increasing age, occupation, job position, poor eating behavior, and moving of body while working less than six hours/shift (p<0.05). The findings from the multivariate analysis factors for obesity revealed male gender (AOR 7.99, 95% CI 2.74 to 23.25), age 50 to 58 years (AOR 17.48, 95% CI 2.30 to 133.04), nurse (AOR 0.39, 95% CI 0.17 to 0.91), and poor eating behavior (AOR 3.22, 95% CI 1.46 to 7.08) were associated with obesity. Conclusion: The prevalence of overweight and obesity among health personnel is higher than the prevalence in Thailand and the main factors are shift working, eating behavior, and less moving. The present study finding can be useful in planning the program and practical policies on decreasing obesity in the future. Keywords: Prevalence; Overweight; Obesity; Medical personnel; Eating behavior; Physical activity","PeriodicalId":484667,"journal":{"name":"JOURNAL OF THE MEDICAL ASSOCTATION OF THAILAND","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136142621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Goal-Directed Therapy Using FloTrac/EV1000 Platform for Hemodynamic Optimization to Improve Perioperative Outcomes in Patients Undergoing Major Abdominal Surgery: A Randomized Controlled Trial","authors":"","doi":"10.35755/jmedassocthai.2023.10.13893","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.10.13893","url":null,"abstract":"Objective: To compare the efficacy of early goal-directed therapy (EGDT) based on the FloTrac/EV1000 platform versus standard care to improve perioperative outcomes in patients undergoing major abdominal surgery. Materials and Methods: Forty patients undergoing major abdominal surgery were randomized to the Control or EGDT group. The Control group was managed to achieve a mean arterial pressure (MAP) of 65 to 90 mmHg, a central venous pressure of 8 to 12 mmHg, a urine output of 0.5 mL/kg/h or more, and an SpO₂ of more than 95%. The EGDT group was managed to achieve similar goals using information from the FloTrac/ EV1000 platform by receiving fluid to maintain stroke volume variation (SVV) of less than 13%, inotropic drugs to achieve a cardiac index (CI) of 2.2 to 4.0 L/min/m⁻², and/or vasoactive drugs to achieve a systemic vascular resistance index (SVRI) of 1,600 to 2,500 dynes·s/cm⁻⁵/m². Results: There were 20 patients in each group. The EGDT group received more colloid (p=0.035). The MAP and SVRI of both groups were comparable. The SVV of the Control group was higher (p=0.002), while the CI of the EGDT group was higher (p<0.001). The EGDT group had a shorter intubated time and a shorter stay in the ICU, with a mean difference of –3.95 h (95% CI –7.85 to –0.05, p=0.047) and –14.75 h (95% CI –25.38 to –4.12, p=0.008), respectively. The EGDT group had shorter hospital stays, albeit without significance (p=0.273). No postoperative complication was detected. Conclusion: Implementation of EGDT using FloTrac/EV1000, compared to conventional care, in patients undergoing major abdominal surgery results in shorter intubated time and shorter stay in the ICU. The shorter hospital stay did not achieve statistical significance. Keywords: Early goal-directed therapy; Major abdominal surgery; Perioperative outcome; Intubation time; ICU stay; Hospital stay","PeriodicalId":484667,"journal":{"name":"JOURNAL OF THE MEDICAL ASSOCTATION OF THAILAND","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136142753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-Year Experience of Henoch-Schönlein Nephritis in Thai Children: A Single Center Report","authors":"","doi":"10.35755/jmedassocthai.2023.10.13895","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.10.13895","url":null,"abstract":"Background: The risk of Henoch-Schönlein nephritis (HSN) is well-established, however, the existing data validating this concept remains limited. Materials and Methods: A retrospective 5-year chart review was conducted at Queen Sirikit National Institute of Child Health. Results: Ninety patients were diagnosed with Henoch-Schönlein purpura, with a mean age of 6.9±2.8 years. Among them, 25 cases (27.7%) presented with renal involvement or HSN. Among the HSN cases, 17 were classified as mild and eight as severe. Symptom presentation included hematuria in ten cases (40%), proteinuria with hematuria in six cases (24%), nephrotic range proteinuria with hematuria in four cases (16%), acute nephritis syndrome with proteinuria in three cases (12%), proteinuria in one case (4%), and nephrotic range proteinuria in one case (4%). Significant associations were observed between HSN incidence and patients older than eight years, (p=0.03) and those with purpura lasting more than three weeks, (p=0.02). The onset of renal involvement ranged from 1 to 315 days (mean of 45.4 days and median of 24 days). Three cases (12%) had mild HSN after six months of the onset of disease. There were no reported cases of mortality or chronic kidney disease. Conclusion: The majority of HSN cases manifest as mild and are associated with favorable outcomes. To achieve early diagnosis of HSN in all instances, it is imperative to conduct timely and regular urinary examinations for all affected patients. Keywords: Henoch-Schönlein purpura; Henoch-Schönlein nephritis; Nephrotic syndrome; Hematuria","PeriodicalId":484667,"journal":{"name":"JOURNAL OF THE MEDICAL ASSOCTATION OF THAILAND","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136142751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison and Efficacy of Auricular Point Acupressure with Auricular Patches on Lactation in Nulliparous Postpartum Cesarean Delivery Parturients at Thammasat University Hospital: A Randomized Controlled Trial","authors":"","doi":"10.35755/jmedassocthai.2023.10.13901","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.10.13901","url":null,"abstract":"Objective: To compare the lactation enhancing effect of auricular acupressure with or without a magnetic plate on post-cesarean nulliparous parturients. Materials and Methods: The present study was a randomized controlled trial conducted in the obstetrics ward of Thammasat University Hospital, Pathum Thani, Thailand between February and July 2022. Participants were term nulliparous pregnant women aged between 20 and 40 years old who underwent cesarean delivery. They were allocated into three groups, namely magnetic (M), non-magnetic (NM), and control groups. The standard care plan for post-cesarean cases was applied to all patients. Participants in both M and NM groups were assigned to receive auricular acupressure using auricular patches with and without magnetic plates, respectively. The ear pinna has five specific auricular points, namely chest (AH10), endocrine (CO18), stomach or Wei (CO4), spleen or Pi (CO13), and sympathetic points (AH6a). The treatment began immediately after counseling and continued for seven days. The onset of the first lactation, lactation visual assessment (LVA) level was collected using the survey form. Exclusive breastfeeding was encouraged at a rate of every three hours to meet newborn demands. The onset of lactation was assessed within three hours after auricular acupressure and every time before breastfeeding. Results: Seventy-five pregnant women were recruited and allocated with 25 cases per group. Mean maternal age was 30 years. The demographic characteristics of the three groups were comparable. There were more participants in the M group had onset of lactation within 24 hours, than in the control group significantly, at 20 versus 13, respectively (p=0.039). Onset of LVA level 1, 2, and 4 in the three groups were comparable. The onset of LVA level 3 in the M group was significantly faster than the control group (p=0.023). Satisfactory lactation and auricular acupressure among M and NM groups were comparable. Conclusion: Auricular acupressure with magnetic plates significantly enhanced lactation onset and lactation visual volume (level 3) in postcesarean nulliparous parturients. It merits consideration to be included in routine practice. Keywords: Cesarean delivery; Postpartum lactation; Auricular acupressure","PeriodicalId":484667,"journal":{"name":"JOURNAL OF THE MEDICAL ASSOCTATION OF THAILAND","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136142975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Ventricular Geometric Patterns in Newly Diagnosed Hypertension: An Echocardiographic Study","authors":"","doi":"10.35755/jmedassocthai.2023.10.13905","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.10.13905","url":null,"abstract":"Objective: To investigate patterns of left ventricular (LV) geometric patterns in patients diagnosed with new-onset hypertension using transthoracic echocardiography. The LV diastolic function was also evaluated in these patients. Materials and Methods: The present study was a cross-sectional study that clinically evaluated patients diagnosed with new-onset hypertension at Burapha University Hospital. To classify LV geometric patterns, electrocardiogram, and transthoracic echocardiography to measure LV mass index and relative wall thickness were performed. Other relevant assessments were also conducted, including the diastolic function. Results: Fifty-five patients diagnosed with new-onset hypertension were enrolled, their mean age was 55.3 years, with a standard deviation of 11.8 years. Of all participants, 70.9% (95% CI 57.1 to 82.4) had concentric remodeling, 16.4% (95% CI 7.8 to 28.8) had concentric hypertrophy, 10.9% (95% CI 4.1 to 22.3) had normal geometry and 1.8% (95% CI 0.1 to 9.7) had eccentric hypertrophy. Of all participants, 81.8% were detected to have abnormal LV diastolic dysfunction. Abnormal relaxation pattern was the most common format. Conclusion: In the present study, approximately 10.9% of patients diagnosed with new-onset hypertension had normal LV geometry, whereas 89.1% had abnormal geometry in different patterns. Concentric remodeling was found to be the predominant abnormal geometrical format. Understanding LV geometric patterns helps clinicians stratify risk, predict prognosis, and make informed decisions about treatment strategies for these patients. Keywords: Hypertension; Left ventricular geometric pattern; Diastolic dysfunction","PeriodicalId":484667,"journal":{"name":"JOURNAL OF THE MEDICAL ASSOCTATION OF THAILAND","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136142977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Duration of Prophylactic Antibiotic and Prosthetic Joint Infection in a Developing Country: A Retrospective Cohort Study","authors":"","doi":"10.35755/jmedassocthai.2023.10.13899","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.10.13899","url":null,"abstract":"Background: Perioperative antibiotic prophylaxis is one of the standard measures for preventing periprosthetic joint infection (PJI). In developing countries, poor surgical environment and patient hygiene are often cited as reasons for prolonged antibiotic duration without any evidence to support its effectiveness. Objective: To investigate the infection rate after total knee arthroplasty (TKA) compared between the standard course, which is 24 hours or less and the extended course, which is more than 24 hours of perioperative antibiotic prophylaxis in a developing country. Materials and Methods: The present was a retrospective study that included patients who underwent unicompartmental knee arthroplasty or TKA between January 2013 and December 2018. Three thousand three hundred and sixteen patients were included. Of those, 1,284 and 2,032 patients received standard and extended course of antibiotic prophylaxis, respectively. The incidence of PJI was compared between the groups. The factors significantly associated with PJI were also analyzed. Results: PJI developed in 0.5% (6/1,284 patients) of the standard course group, and in 1.2% (24/2,032 patients) of the extended course group. The difference and 95% confidence interval for the difference between groups were –0.71% (–1.34 to –0.04), which confirmed the non-inferiority status of the standard course group compared to the extended course group. Longer hospital length of stay significantly associated with higher infection rate (p<0.001). Postoperative wound infection was not found to be associated with age, body mass index, American Society of Anesthesiologists classification, blood transfusion, or surgery type. Conclusion: Twenty-four hours of perioperative antibiotic prophylaxis was found to be adequate for PJI prevention in a developing country setting. Keywords: Infection rate; Total knee arthroplasty; Standard course; Extended course; Perioperative antibiotic prophylaxis","PeriodicalId":484667,"journal":{"name":"JOURNAL OF THE MEDICAL ASSOCTATION OF THAILAND","volume":"74 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136143090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Preliminary Study of the Effects of Cochlear Implantation on Developmental Outcome in Thai Children","authors":"","doi":"10.35755/jmedassocthai.2023.10.13900","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.10.13900","url":null,"abstract":"Background: Children born with severe or profound hearing loss usually have delays in receptive and expressive language development that affect academic achievement and social functioning. Cochlear implantation is the treatment of choice for these children. There were very few studies on developmental outcome of the children with severe sensory neural hearing loss who had gone through cochlear implantation. Objective: 1) To assess developmental outcome of cochlear implantation in children aged 9 to 66 months. 2) To study attitude and Parenting Styles and Dimensions Questionnaire (PSDQ) of the parents. Materials and Methods: A cross-sectional descriptive study of 27 children aged 9 to 66 months who received cochlear implantation at Rajavithi Hospital. The data were collected online using the Ages &amp; Stages Questionnaires, Third Edition, Thai-Version (ASQ-3 Thai), Parents’ attitudes and PSDQ, Thai version. Results: The age of cochlear implant was 30.52±12.22 months with 29.6% of the patients getting the cochlear implantation before two years of age. There was 70%, and 37% of children suspected of having delays in language and problem solving. Relationship between language development with age at diagnosis of hearing impairment, age of receive hearing aids, age of auditory-verbal therapy, age of cochlear implantation, and duration of auditory verbal training after cochlear implantation were statistically significant. There was a significant relationship between problem solving and reading with children family type. Most parenting style was authoritative. Parental knowledge and attitudes were very good at 96.3%. Conclusion: Children with severe sensory neural hearing loss who received early diagnosis and cochlear implantation at the age younger than 2 years old, as well as long consecutive auditory and speech skills training, results in better language developmental outcomes. Keywords: Cochlear implantation; Development outcome; Language; Sensory neural hearing loss","PeriodicalId":484667,"journal":{"name":"JOURNAL OF THE MEDICAL ASSOCTATION OF THAILAND","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136142614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Comparative Effectiveness between Branded Generic Atorvastatin (Lipostat®) and Authorized Generic Atorvastatin (Xarator®): A Prospective Cohort Study","authors":"","doi":"10.35755/jmedassocthai.2023.10.13898","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.10.13898","url":null,"abstract":"Background: An authorized generic drug has identical ingredients as the brand-name drug but marketed as a generic version by the innovator company with a lower cost. A branded generic drug is an imitation of the brand-name medication whose patent has expired. The active elements of a branded generic medicine are the same as those of the original drug, however the inactive ingredients may differ. Objective: To assess the effectiveness of the branded generic atorvastatin (Lipostat®), compared to the authorized generic atorvastatin (Xarator®) in decreasing low density lipoprotein cholesterol (LDL-C) levels. Materials and Methods: The present study was a prospective cohort study that included patients who had been taking the authorized generic atorvastatin (Xarator®) 40 mg once daily for at least three months. The authorized generic atorvastatin (Xarator®) was switched to branded generic atorvastatin (Lipostat®) 40 mg once daily for the next three months. Blood chemistry including lipid profile were evaluated before and three months after the transition from Xarator® to Lipostat®. Results: Of the 61 patients, mean age was 67.0±9.9 years, and 45 (73.7%) were male. The two most common comorbidities included coronary artery disease in 80.3% and hypertension in 60.7%. At three months after switching to branded generic atorvastatin, the mean total cholesterol changed from 133.6±28.8 to 130.0±25.8 mg/dL, the triglyceride changed from 123.3±78.3 to 115.6±70.1 mg/dL, and the LDL-C changed from 68.8±24.1 to 65.5±20.3 mg/dL, thus, they were not significantly different compared to the baseline. There were also no significant differences in adverse events between Lipostat® and Xarator®. Conclusion: Branded generic atorvastatin (Lipostat®) is as effective as the authorized generic atorvastatin (Xarator®) in lowering LDL-C levels. Keywords: Atorvastatin; Authorized generic drug; Branded generic atorvastatin; Low-density lipoprotein cholesterol; High-density lipoprotein cholesterol; Statin","PeriodicalId":484667,"journal":{"name":"JOURNAL OF THE MEDICAL ASSOCTATION OF THAILAND","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136142625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain Control and Hemodynamic Changes due to Moderate Sedation during Cardiac Catheterization","authors":"","doi":"10.35755/jmedassocthai.2023.10.13904","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.10.13904","url":null,"abstract":"Background: Moderate sedation is a practice of promoting patient comfort during cardiac catheterization. However, few studies have evaluated the effectiveness of moderate sedation in patients undergoing cardiac catheterization. Objective: To determine the efficacy of moderate sedation in patients undergoing cardiac catheterization. Materials and Methods: The authors retrospectively analyzed patients undergoing cardiac catheterization. They were divided into the moderate sedation group, which received midazolam, fentanyl, or combined midazolam and fentanyl, and the control group, which received no sedative medication. The primary endpoint was self-reported pain score during the procedure. The secondary endpoint was a hemodynamic variation during the procedure. Propensity-score matching was used to reduce confounding biases. Results: One hundred ninety-six patients were included, with 111 patients in the moderate sedation group and 85 patients in the control group. The proportion of patients who experienced any pain was significantly lower in the moderate sedation group than in the control group at 3.6% versus 11.8% (p=0.028). No significant difference was found in the average change in the systolic blood pressure at –9 mmHg versus –4 mmHg (p=0.097) and the heart rate at –1 bpm versus –2 bpm (p=0.289) obtained at baseline and that at the end of the procedure between the moderate sedation group and the control group. However, the change in the diastolic blood pressure (DBP) measured at baseline and at the end of the procedure was significantly lower in the moderate sedation group than in the control group at –4 mmHg versus –1 mmHg (p=0.039). Conclusion: Moderate sedation by using a low-dose fentanyl, midazolam, or combined fentanyl and midazolam is associated with fewer episodes of pain and better DBP stability during cardiac catheterization. Keywords: Conscious sedation; Midazolam; Coronary angiography; Percutaneous coronary intervention; Cardiac catheterization","PeriodicalId":484667,"journal":{"name":"JOURNAL OF THE MEDICAL ASSOCTATION OF THAILAND","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136143092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}