Anesthesia for Indian Ocean tsunami‐affected patients at a southern Thailand provincial hospital

Abstract

On 26 December 2004, a giant earthquake shook South-East Asia, triggering deadly flood waves (tsunami) across the Indian Ocean. The Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand joined the Thai Red Cross Society to provide relief in southern Thailand. The objective of this article is to characterize the emergency surgical patients and anesthesia profiles of tsunami victims at Phang-Nga Provincial Hospital. Available records from the operating room and anesthesia unit of Phang-Nga Provincial Hospital, together with laboratory and administrative data, during the period 26-31 December 2004 were collected and analyzed using descriptive statistics. Thai Red Cross teams provided surgical emergency services for 107 cases during 28-30 December 2004. Ninety-three cases (86%) were Caucasian, one (0.9%) was Japanese and nine (8.4%) were Thai. ASA physical status classifications of 1, 2 and 3 were present in 87.8%, 8.4% and 0.4%, respectively. The majority of injuries comprised multiple soft tissue wounds with severe infection. Eighty-five per cent of cases received debridement and 14.0% tendon or nerve repair or fixation of bone. The anesthesia choices were general endotracheal with rapid sequence induction and intubation (69.2%), general under mask (19.6%), total intravenous anesthesia (4.7%), spinal anesthesia (3.7%) and local anesthesia (2.8%). Anesthesia-related problems included a lack of pre-operative laboratory investigation, hypovolemia, severe wound infection with early sepsis and aspiration pneumonia. Common intra-operative complications included hypotension and oxygen desaturation from pulmonary aspiration or lung contusion. There was one case of post-operative reintubation and no peri-operative mortality. Anesthesia-related problems in tsunami victims included pulmonary aspiration, hypovolemia, sepsis and lack of pre-operative laboratory investigation. General anesthesia was the most common anesthetic technique. Common intra-operative complications included hypotension and oxygen desaturation.