The University of Kansas SOM International Education Elective at Siriraj Hospital in Bangkok, Thailand MS-4 Yasser Hassan The University of Kansas SOM January 29 to February 23, 2018

Bangkok, Thailand Capital and largest city in Thailand City population over 8 million Metro population over 14 million Historical roots are a small trading post during the Ayutthaya Kingdom in the 15th century View of downtown from Sky Bar Grand Palace

Siriraj Hospital The largest and oldest hospital in Thailand Founded by King Chulalongkorn in 1888 in response to the cholera epidemic The hospital was named after his son who died of dysentery The former King Bhumibol Adulyadej (Rama IX) was cared for at Siriraj before passing away in October 2016

Department of Anesthesiology 1 week in General 1 week in ENT and Cardio 1 week in Ortho 1 week in OB/GYN First thing I noticed, all the sandals! Intraop TEE during cardiac surgery (Picture taken from their website)

Topic of Interest The similarities and differences of Anesthesiology between The University of Kansas Medical Center and Siriraj Hospital. I selected this topic because I am interested in anesthesiology and am going into anesthesiology residency (at UMKC this year). I wanted to expand my perspective on administering anesthesia because the field is very personal, variable, and dynamic.

Interview With Faculty Member Dr. Pichaya Waitayawinyu, MD, Anesthesiologist Neuro Anesthesia fellowship training at Harborview Medical Center, University of Washington Pediatric Anesthesia fellowship training at Children’s National Health System, Washington D.C. Some key points during the interview: Anesthesiology at Siriraj is actually quite similar to KUMC! Not as much funding so expensive medications such as Sugammadex not used much Reusable drapes, sheets, gowns used in the OR Paper records in the OR 30 Baht program MD requires 6 years of medical school, 1 year internship, 4 years residency CRNA only 1 year training! 1 year ICU experience is not required

Some of the differences in Anesthesiology at KUMC vs Siriraj Pre-Op Intra-Op Post-Op KUMC Patient comes in morning of surgery Either CRNA or Resident present in the room Anesthesiologist responsible for post-op pain Siriraj Patient comes in day before surgery and stays overnight SRNA, CRNA, Resident all could be in the room Surgeon responsible for post-op pain (Anesthesiologist can give guidelines) Only 30 PCAs available

Adductor Canal Nerve Block Dr. Nantthasorn Zinboonyahgoon, MD, Pain fellowship training at Brigham and Women’s Hospital Assisted several of these nerve blocks one of the days of my ortho week – favorite clinical experience Pure sensory nerve block (saphenous nerve) for postoperative analgesia after knee surgery Avoids quadriceps weakness in femoral nerve block

Elephants near Chiang Mai Favorite cultural experience Activities included feeding elephants, making vitamins for them, mud bath, and river bath Facts about elephants: Largest living land mammal Life span similar to humans Weigh 2.25-5.5 tons Eat up to 300 lbs/day Diet consists of roots, grasses, fruit, and bark Only sleep 2 hours per day Faddy (fellow KU MS4) feeding an elephant Making vitamins for the elephants, ingredients included bananas, tamarind, and sugar, wrapped in bamboo leaves Mud bath

Our fellow Thai medical students took us out for dinner, dessert, and out on the town!

References https://en.wikipedia.org/wiki/Bangkok https://en.wikipedia.org/wiki/Siriraj_Hospital http://www.si.mahidol.ac.th/department/Anesthesiology/home/ http://www.pictaram.net/user/259476182/1589986287137590814_259476182 https://www.nysora.com/ultrasound-guided-saphenous-subsartoriusadductor-canal-nerve-block https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466855/ https://www.nationalgeographic.com/animals/mammals/a/asian-elephant/