Objective: We aimed to enhance the prediction of difficult intubation by using ultrasonographic parameters (pre-epiglottic space (Pre-E), distance between epiglottis to middle part of vocal cord (E-VC) and Pre-E/E-VC) adjusting for traditional airway assessments. Material and Methods: This prospective cohort study was conducted at a super-tertiary care hospital in Thailand. Participants aged 18-65 years with ASA classification I-III and who required general anesthesia with endotracheal intubation were included. Preoperative traditional and ultrasonographic airway assessments were performed by two investigators. The outcome was difficult intubations as diagnosed by laryngoscopic view grade 3 or 4. Multivariate logistic regression was used to identify predictors for difficult intubation presented by adjusted odds ratio (OR) and 95% confidence interval (CI). Results: A total of 94 patients were recruited. The incidence of difficult intubation was 15%. The median Pre-E/E-VC ratio among this group was 0.8 compared with 1.0 in the control group (p-value 0.124). The cut-off point of <1.0 of Pre- E/E-VC was not associated with difficult intubation after adjusting for sex and other traditional parameters (p-value 0.11). Predictors of difficult intubation were female sex (OR [95% CI]: 13.8 [2.8, 68.3]), sternomental distance ≤175 mm (OR [95% CI]: 11.6 [1.9, 71.4]) and interincisor gap <4 cm (OR [95% CI]: 19.8 [1.1, 373.8]) with the area under the receiver operating characteristic curve at 0.88 and a specificity of 90.0%. Conclusion: There was no association between the Pre-E/E-VC in predicting difficult intubation in low-risk patients. The ultrasonographic measurements of Pre-E/E-VC were not helpful in predicting difficult intubations in our setting. Trial registration: thaiclinicaltrials.org: TCTR20180115002, Registered 9 January 2018 - Prospectively registered, https:// www.thaiclinicaltrials.org/#

Background Because of the high initial cost of intrathecal drug delivery (ITDD) therapy, this study investigated the cost-effectiveness and cost–utility of ITDD therapy in refractory cancer pain management in Thailand over the past 10 years. Methods The retrospective study was conducted in patients with cancer pain who underwent ITDD therapy from January 2011 to 2021 at three university hospitals. Clinical outcomes included the numerical rating scale (NRS), Palliative Performance Scale, and the EQ-5D. The direct medical and nonmedical as well as indirect costs were also recorded. Cost-effectiveness and cost–utility analyses were performed comparing ITDD therapy with conventional therapy (extrapolated from costs of the same patient before ITDD therapy) from a societally oriented economic evaluation. Results Twenty patients (F:M: 10:10) aged 60 ± 15 years who underwent implantation of an intrathecal percutaneous port (IT port; n = 15) or programmable intrathecal pump (IT pump; n = 5) were included. The median survival time was 78 (interquartile range = 121–54) days after ITDD therapy. At 2-month follow-up, the incremental cost-effectiveness ratio (ICER)/pain reduction of an IT port (US$2065.36 (CA$2829.54)/2-point NRS reduction/lifetime) was lower than for patients with an IT pump (US$5479.26 (CA$7506.58)/2-point NRS reduction/lifetime) compared with continued conventional therapy. The ICER/quality-adjusted life years (QALYs) gained for an IT port compared with conventional treatment was US$93,999.31(CA$128,799.06)/QALY gained, which is above the cost-effectiveness threshold for Thailand. Conclusion The cost-effectiveness and cost–utility of IT port therapy for cancer pain was high relative to the cost of living in Thailand, above the cost-effectiveness threshold. Prospective cost analysis studies enrolling more patients with diverse cancers that investigate the benefit of early ITDD therapy with devices over a range of prices are warranted.

Objective: To identify risk factors associated with prolonged postoperative opioids use in non-cancer patients undergoing spinal surgery.Material and Methods: The medical records of patients, who underwent spinal surgery at Songklanagarind Hospital; from January 2014 to January 2019, were retrospectively reviewed, Data analysis was performed using multinomial logistic regression to identify independent factors associated with prolonged postoperative opioids use.Results: There were 65 out of 500 patients (13.0%) who had prolonged postoperative opioids usage. Opioids used before surgery as well as length of hospital stay after surgery were risk factors associated with prolonged postoperative opioids use (relative risk (RR), 47.65; 95% CI, 17.67-128.49 and RR, 1.07; 95% CI, 1.01-1.14, respectively). Whereas, preoperative gabapentinoids use reduced the risk of prolonged postoperative opioids use (RR, 0.33; 95% CI, 0.13-0.83).Conclusion: Avoiding preoperative opioids used, by using gabapentinoids instead could reduce the risk associated with prolonged postoperative opioids use; in addition to related morbidity and mortality in non-cancer spinal pain patients.