Awake craniotomy is a neurosurgical technique that involves an awake neurological testing during the resection of an intracranial lesion in eloquent cerebral cortical areas representing motor, language, and speech. This technique is highlighted by an intra-operative cortical mapping that requires active participation by the patient and poses unique challenges to the anesthesiologist. The surgical and anesthetic techniques have evolved significantly over time, as the neurosurgeon and the anesthesiologist learn new steps in making this technique safe to achieve reasonable patient satisfaction. A thorough understanding of this surgical technique's rationale will guide the anesthesiologist in planning the anesthetic management depending on the surgery and neurologic testing. Constant communication between the neurosurgeon, anesthesiologist, and the patient will define this surgical technique's success. It is already a well-established procedure; however, factors that contribute to failures in awake craniotomy procedures have not been well characterized in the literature. Failure is defined as the inability to conduct awake neurologic testing during the awake craniotomy procedure because of various factors which will be described. This paper aims to review the challenges in the performance of three (3) cases of awake craniotomies performed in the Philippine General Hospital. The challenges described in these three (3) cases reveal that this can be experienced by the neurosurgeon, neuroanesthesiologist, and most especially the patient in an acute critical condition. Identification of the procedures' failure and the steps taken to manage such situations with the patient's safety in mind are discussed.
Anesthesia, Intravenous ; Anesthesia, General

BACKGROUND: The induction and maintenance of intravenous anesthesia by propofol-TCI has been popular. When infusing propofol with other drugs at the same intravenous access line, incompatibility may result. We attempted to evaluate the incompatibilities between propofol and rocuronium by subtherapeutic dosing of rocuronium. METHODS: Eighty patients were randomized into two groups. Induction of anesthesia was done by propofol-TCI. The patients in group 1 received rocuronium 0.6 mg/kg at the same intravenous access line with propofol infusion and in group 2 received rocuronium at the different intravenous access line with propofol infusion. One Hz single twitch responses were measured by acceleromyography after rocuronium administration. Intubation was done when the twitch height depressed more than 95% of the baseline. The intubating conditions were assessed and graded as excellent, good, poor and bad. Onset time, recovery index and duration were compared between the two groups. RESULTS: The onset was significantly delayed in group 1 (124.9 +/- 35.5 vs. 101.8 +/- 22.1), but there were no significant differences in the intubating condition, recovery index, duration and the incidence of withdrawal response to rocuronium injection. CONCLUSIONS: Onset time was delayed when administrating rocuronium at the same intravenous access line with propofol-TCI. So giving rocuronium at the different intravenous access line with propofol infusion would be helpful to achieve adequate intubating condition rapidly.
Anesthesia ; Anesthesia, Intravenous ; Humans ; Incidence ; Injections, Intravenous* ; Intubation ; Propofol*

No abstract available.
Anesthesia, Intravenous* ; Humans ; Propofol* ; Respiration*

No abstract available.
Anesthesia, Intravenous* ; Brugada Syndrome* ; Humans

BACKGROUND:Intravenous injection of rocuronium produces intense discomfort at the site of injection in 50?80% of conscious patients.Many trials have sought to lessen the injection pain.The present study evaluated the incidence and severity of pain associated with intravenous injection of rocuronium in conscious patients, and determined the efficacy of different doses of 50 mg rocuronium diluted in 0.9% NaCl at minimizing injection pain. METHODS:Sixty healthy patients scheduled for general anesthesia were randomly divided into three groups (n = 20 each) for injection of 10 ml (NS 10), 20 ml (NS 20), or 40 ml (NS 40) of the NaCl-diluted rocuronium. Before induction, the incidence of pain was ascertained and its severity during subsequent rocuronium injection was classified as none, mild, moderate, severe, very severe. RESULTS:The incidence and the severity of pain were significantly lower in the NS 40 group than in the NS 10 group (P< 0.05). Pain severity was mild or absent for all NS 20 and NS 40 patients. CONCLUSIONS:Rocuronium diluted with NaCl effectively reduces injection pain in a dose dependent manner. s
Androstanols ; Anesthesia, General ; Humans ; Incidence ; Injections, Intravenous

BACKGROUND:Intravenous injection of rocuronium produces intense discomfort at the site of injection in 50?80% of conscious patients.Many trials have sought to lessen the injection pain.The present study evaluated the incidence and severity of pain associated with intravenous injection of rocuronium in conscious patients, and determined the efficacy of different doses of 50 mg rocuronium diluted in 0.9% NaCl at minimizing injection pain. METHODS:Sixty healthy patients scheduled for general anesthesia were randomly divided into three groups (n = 20 each) for injection of 10 ml (NS 10), 20 ml (NS 20), or 40 ml (NS 40) of the NaCl-diluted rocuronium. Before induction, the incidence of pain was ascertained and its severity during subsequent rocuronium injection was classified as none, mild, moderate, severe, very severe. RESULTS:The incidence and the severity of pain were significantly lower in the NS 40 group than in the NS 10 group (P< 0.05). Pain severity was mild or absent for all NS 20 and NS 40 patients. CONCLUSIONS:Rocuronium diluted with NaCl effectively reduces injection pain in a dose dependent manner. s
Androstanols ; Anesthesia, General ; Humans ; Incidence ; Injections, Intravenous

Anesthesia, Intravenous ; Bronchoscopes ; Bronchoscopy ; Humans ; Pneumoconiosis ; diagnosis

BACKGROUND: The rate of obesity has reached epidemic proportions and is on the rise.There have not been adequate studies on the differences in anesthesiology in obese patient. For this reason, we designed this study to determine the effect of obesity on time to awareness, comparing the use of propofol and remifentanil in general anesthesia. METHODS: We enrolled 55 patients into the study, between ages 16 and 45 years, who had an ASA physical status 1, 2 and who were undergoing general anesthesia for an elective obstetric operation. According to the Asia-Pacific obesity criteria, we divided the patients into 2 groups, the obesity group (BMI > or = 25), and the non-obesity group (BMI < 25). Propofol and remifentanil were infused using TCI for general anesthesia. The bispectral index score (BIS) was used for monitoring depth of anesthesia.During each operation, we tried to keep the BIS between 40 and 55 by controling the target concentration of TCI.We compared the time-to- awareness between the obese patient group and the non-obese patient group. RESULTS: The obesity and the non-obesity group did not show significant difference in awareness times between the obesity group, 412.4 +/- 102.5 s and the non-obesity group, 434.1 +/- 49.1 s. CONCLUSIONS: There was no evidence of a significant difference in time-to-awareness between the obese patient group and the non-obese patient group.The use of remifentanil and propofol work equally well in obese and in non-obese patients anesthesized for elective surgery.
Anesthesia, General ; Anesthesia, Intravenous ; Anesthesiology ; Humans ; Obesity ; Piperidines ; Propofol

BACKGROUND: Both propofol and ketamine are useful hypnotics for induction of anesthesia, and the combination of propofol and ketamine has been used for total intravenous anesthesia. The aim of this study was to evaluate the dose response of propofol, ketamine and combination of these drug, and determine possible interaction between two drugs in patients. METHODS: The effect of ketamine on the dose response curve for propofol was studied in unpremedicated 165 ASA physical status I or II patients who were scheduled for elective operation. As an endpoint of hypnosis, ability to open eyes on verbal command was checked. Dose response curves for propofol and ketamine were determined with a probit procedure and their type of pharmacologic interaction was determined by fractional and isobolographic analysis. RESULTS: At the hypnotic endpoint, the ED50s were 1.13 mg/kg propofol, 0.66 mg/kg ketamine, and the ED95s were 1.67 mg/kg propofol, 1.09 mg/kg ketamine. The type of interaction between two drugs for hypnosis was found to be additive and ketamine was 1.7 times potent than propofol as an equieffective dose of hypnosis. CONCLUSIONS: The type of interaction between propofol and ketamine for hypnosis was additive.
Anesthesia* ; Anesthesia, Intravenous ; Humans ; Hypnosis ; Hypnotics and Sedatives ; Ketamine* ; Propofol*

Experiences with propofol in pediatric anesthesia are limited. We undertook a study to evaluate the quantity of induction and recovery from anesthesia with propofol compared to thiopental/halothane. Fifty children received 2mg/kg of propofol as a loading dose followed by a maintenance dose of 9mg/kg/hr for first 30minutes and followed by 6mg/kg/hr there- after. Fifty children received 5mg/kg of thiopental, and maintensnce was provided with halothane (0.5%-1.5%). The interval between the end of the administration of propofol or thiopental/halothane and extubation, as well as discharge to the ward,was significantly shorter with propofol (5.43 versua 10.72 min and 10.30 versus 18.20 min, respectively). Pain on injection site were seen more frequently with propofol, whereas nausea and hiccup were only observed with thiopental. During the first 6 hour after the surgical procedure, an- algesics were needed significantly more often in the thiopental group. In conclusion, propofol used as a single anesthetic for total intravenous anesthesia is a satisfactory agent for oph- thalmic surgery of short duration in children.
Anesthesia ; Anesthesia, Intravenous ; Child* ; Halothane* ; Hiccup ; Humans ; Nausea ; Propofol* ; Thiopental*