No abstract available.
Anesthesia, Epidural*

OBJECTIVE: To determine that epidural anesthesia need not increase Cesarean delivery rates and prolong labor. METHODS: From December 1999 to May 2002, 1,585 deliveries were in Ilsan Paik Hospital. We selected 70 (epidural group) and 87 (non-epidural group) singleton, nulliparous, term, cephalic presentation without antenatal complications. We compared duration of labor, rates of Cesarean delivery and perinatal outcomes between these two groups. RESULTS: The duration of active and second stage of labor were not prolonged in the epidural group. Cesarean delivery rates was 8.6% (n=70) in the epidural group and 9.2% (n=87) in the non-epidural group, so there was no significant difference. Perinatal outcomes was no significant difference between the two groups. CONCLUSION: Epidural anesthesia during labor provides the best pain relief and does not increase the Cesarean delivery rates. The duration of the active, second stage of labor and perinatal outcomes was not different between these two groups.
Anesthesia, Epidural*

The need to measure and improve quality in the health care management setting necessitates the development of performance standards. The drive for operating room (OR) efficiency has led administrators to investigate the anesthesia-controlled times (ACTs), which are the specific periods of anesthesia task completion including preparation for anesthetic induction, anesthetic induction itself and the wake up time or time to emergence from anesthesia.
OBJECTIVES: This study aims to conduct an internal benchmarking of ACTs using a secondary analysis of the data collected in a cross sectional survey of randomly selected elective surgical cases from October 2011 to January 2012, looking into the efficiency status of the operating room under the Department of Surgery of the Philippine General Hospital (PGH).
METHODS: Mean observed times for each of the milestone comprising the ACT were calculated taking in consideration the various anesthetic techniques, type of surgical procedures, duration of the operation and the anesthesiologist's experience. Analysis of variance and Fisher's exact test were used to determine the association of these factors with length of the ACT. For those where an association was noted, a multivariate analysis was done to determine its impact on the actual ACT.
RESULTS: Based on data from 539 cases, a set of benchmarks for ACT that better reflects the local setting, is proposed for the different surgical procedures and anesthetic techniques. This includes times for anesthesia preparation of 5 mins, anesthesia induction of 10 minutes and emergence times of 10 mins for total intravenous anesthesia; 20,15 and 15 mins for inhalational anesthesia; 15,10, 10mins for spinal anesthesia; 20, 25, 10 mins for epidural anesthesia and 10, 25, and 15 minutes for combined general-regional anesthesia.
CONCLUSION: It is imperative to standardize ATCs in order to reduce variability and improve efficiency. The first step in achieving this goal is to describe the standards in a particular institution, which in turn may be used as a benchmark by other institutions in a similar setting.

No abstract available.
Anesthesia, Epidural* ; Thoracic Surgery*

No abstract available.
Anesthesia, Epidural* ; Spinal Cord*

No abstract available.
Anesthesia, Epidural* ; Hypotension*

Effect of marcaine plus fentanyl combination for lumbar epidural anesthesia was investigated in random series of 33 patients who were undergoing lumbar discectomy. Patients received 1mg/kg marcaine with 1mcg/kg fentanyl. The volume of local anesthetic solution was calculated basing on the number of segments that needed to block: 1.5 - 1.6ml per segment. It was found that the marcaine plus fentanyl combination provided high effect (100%) on epidural anesthesia, rapid onset (7.51.8 min), long working duration (33070 min), caused milder hemodynamic changes, decreased the incidence of adverse events and produced satisfactory operating condition.
Bupivacaine ; Fentanyl ; Anesthesia, Epidural

No abstract available.
Anesthesia, Epidural* ; Diuresis*

No abstract available.
Anesthesia, Epidural* ; Radiculopathy*

Background: Epidural anesthesia is a widely used anesthesia technique commonly for surgeries involving the lower extremities up to the abdomen.It is beneficial for long duration surgeries because the epidural catheter in place allows additional of local anesthetic as needed. However, this technique has a slower onset of action and requires a larger volume of local anesthetic compared with spinal anesthesia. This study aims to determine if clonidine when used as an adjuvant can hasten the onset of action of levobupivacaine epidural anesthesia thus allowing the early commencement of surgery. Methodology: This is a double blind randomized controlled trial. After approval from the institution‘s research ethics and review committee,a total of 36 patients of American Society of Anesthesiologist ClassificationI or II for elective lower limb orthopedic surgery under levobupivacaine epidural anesthesia were purposively enrolled in this study and randomly assigned by match pairing of characteristics to two groups: GroupA—Clonidine and Group B—plain normal saline solution. Group A were given 0.5% levobupivocaine 15cc with 30 yg (0.2cc) clonidine and groupB were given 0.5% levobupivocaine 15cc with 0.2cc plain normal saline solution. In both groups the onset of levobupivacaine epidural anesthesia (sensory block atT10dermotomal level/Bromage 1) were observed. Side effects such as hypotension, decreased in respiratory rate, oxygen saturation, and any untoward incidence were noted. All data gathered: statistical mean, median, standard deviation, and T test were analyzed using the SPSS software at 5% significance level. Results: The mean onset of action of group A— Clonidine group (5.62 minutes) was foster compared to group B—control (11.33 minutes), which was statistically significant (P«0.05). The highest dermotomal level for the clonidine group was at T6 and T7forthecontrol group. Two segments regression was at 180 minutes forthe Clonidine group while 60 minutes for the control group. The patients given clonidine experienced side effects such as sedation, bradycardio (20% decrease in cardiac rote from baseline), and shivering. Hypotension was not observed in both clonidine and control groups. Conclusion Clonidine ata dose of30 |Jgwhen used as an adjuvant to levobupivacaine epidural anesthesia can hasten its onset of action among patients undergoing elective lower limb orthopedic surgery.
Anesthesia, Epidural ; Clonidine