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  • Author: Phornlert Chatrkaw x
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Pornarun Charoenraj, Somrat Charuluxananan, Phornlert Chatrkaw, Chooksak Tunprasit, Parinya Wangdumrongwong and Vorapong Phupong


Background: Anesthesia for cesarean delivery in parturients diagnosed with placenta previa remains controversial.

Objectives: To investigate factors correlated with choice of anesthesia in these parturients and their outcomes.

Methods: Retrospective analysis of patients with placenta previa and cesarean delivery at King Chulalongkorn Memorial Hospital. Peri operative anesthetic and complication data were collected using a structured collection form. Univariate analysis and multivariate logistic regression were used. P < 0.05 was considered significant.

Results: Among 50,237 deliveries from July 1, 2005 to June 30, 2011, there were 562 cesarean sections in diagnosed cases of placenta previa. Cesarean deliveries (479) were performed under spinal anesthesia (81%), epidural anesthesia (1.8%), and if the effects spinal anesthesia dissipated, general anesthesia (2.3%). Among 46 cases of cesarean hysterectomy, 27 patients (58.7%) received regional anesthesia. However, 6 of 10 patients with planned cesarean hysterectomy underwent general anesthesia, while 1 of 4 of a group with regional anesthesia needed conversion to general anesthesia. There was no serious anesthesia-related complication. Factors related to general anesthesia were: a higher American Society of Anesthesiologists (ASA) physical status OR 2.7 (95% CI 1.7-4.3) P < 0.001; presentation with bleeding OR 1.8(95% CI 1.0-3.1) P = 0.033; anterior site of placenta OR 1.8 (95% CI 1.1-3.2) P = 0.025; heart rate >125 bpm OR 5.6 (95% CI 1.5-214) P = 0.01; and pack red cell transfusion OR 3.4 (95% CI 2.0-5.7) P < 0.001.

Conclusions: Most parturients received regional anesthesia. Neuroaxial anesthesia and general anesthesia are safe.

Open access

Supparerk Prichayudh, Tatsana Uthaithammarat, Phornlert Chatrkaw, Sahadol Poonyathawon, Thammasak Thawitsri, Kanya Kumwilaisak, Manasnun Kongwibulwut and Nalin Chokengarmwong



Ultrasonography is being more commonly used by intensivists to assess the hemodynamic status of patients in intensive care units (ICUs) and for other purposes.


To review the indications for and evaluate the impact of cardiac ultrasonography (CUS) on the management of patients in a surgical ICU (SICU).


We conducted a retrospective observational cohort study of patients in the SICU who underwent CUS performed by intensivists at King Chulalongkorn Memorial Hospital from January 2011 to March 2013. CUS was used to determine (1) preload (using inferior vena cava (IVC) diameter and collapsibility index), (2) cardiac contractility (using subjective assessment and fractional shortening), and (3) other miscellaneous findings.


We included data from 157 patients (96 male and 61 female) whose age ranged from 15 to 99 years (mean 63.5 years) in the study. CUS was performed 190 times in these 157 patients. The most common indication for CUS was hemodynamic status assessment (78), followed by shock (69), oliguria (35), and other (8). CUS results led to 71 changes in management (37% of cases) ; namely, fluid challenge (38), inotropic drug management (7), drainage of pleural/abdominal fluid (12), and other changes (14). A weakly-positive correlation between the IVC diameter and CVP (Pearson’s r = 0.45) was demonstrated. The overall mortality rate was 14.6%.


CUS performed by intensivists can be used to assess the hemodynamic status of patients in the SICU, especially those with shock or oliguria, and lead to changes in the management of these patients.