The purpose of this paper is to present a utility analysis of the hierarchical framework of pre- anesthetic evaluation as part of antenatal care. A sensitivity analysis will likewise be done to test the robustness of the assumptions.
DELIVERY, OBSTETRIC ; ANESTHETICS ; ANESTHESIA ; ANALGESIA

This paper focuses on the process measures of quality. As shown in later sections, consensus on appropriate processes for a selected anesthesia- related maternal health service, i.e., pre -anesthetic care is obtained and corresponding input requirements for these processes are identified.
ANESTHESIA, OBSTETRICAL ; MATERNAL HEALTH SERVICES ; PATIENT SATISFACTION

The goal of cost-containment in anesthesia requires a global, multif actorial approach. Practice patterns need to be optimized by determined leadership, motivation and commitment of all concerned. It is clear from the current national debate on health care priorities that every health care worker, the anesthesiologist included, needs to examine not only the economic consequences of his daily practice decisions, but also his daily practice patterns of behavior in the operating room. When the patient grants his consent for anesthesia, he puts his complete trust on the anesthesiologist and then goes to sleep. He trusts that the anesthesiologist will give him the best anesthetic, and implicitly, that he [the anesthesiologist) would safeguard his interest and minimize cost. Objectives: 1) To determine the current patterns of volatile anesthetic utilization among the anesthesiologists in our institution; 2) To make a cost-minimization analysis of these practice patterns; and, 3) To collect baseline data prior to the development of pharmaceutical practice guidelines in anesthesiology for our institution. Materials and Methods: A cross-sectional survey was done using the anesthesia records of all patients admitted into the operating room at the Private Division of the University of Santo Tomas Hospital for the month of February 2000. The patients were stratified into those receiving general anesthesia and those receiving regional anesthesia. Only those surgical cases that required general inhalation anesthetic whether as primary or supplemental agent where included in the evaluation. The most commonly used volatile inhalation agents were determined. The cost of delivering inhalation anesthesia either as a single agent or in combination with a regional technique is determined by surveying the charges made for each individual case. Results: Total charges for anesthetic drugs used, including oxygen and local anesthetic agents amounted to Php 1,055,401.60. Charges for drugs alone amounted to Php 1,027,436.60, of which Php 42,738.00 comprise the cost of local anesthetics for regional techniques. All other drugs used amounted to PhP 984,698.60. The total cost for volatile inhalation agents alone comprised 47.9 percent of which sevoflurane accounted for the highest share of Php 378,425.45; isoflurane, Php 26,650.00; enflurane Php 14,908.00 and halothane Php 600.00. The neuromuscular blockers accounted for 16.5 percent; the sedative-hypnotics, diprivan (2.2 percent) and midazolam (2.5 percent); and the opiate agonist, fentanyl (1.9 percent) and partial agonist nalbuphine (3.3 percent) comprise a great part of the rest of the charges. Discussion: Pharmacoeconomics is an increasingly important consideration in the adoption of new drugs into practice. Not only must a new drug confer greater therapeutic benefit, but also that benefit must not be bought at too high a price. For injected drugs, determination of relative cost is straightforward. This is not true for inhaled anesthetics because cost is related to more than the amount of drug taken up; cost is also determined by waste of anesthetic consequent to delivery of anesthetic in excess of the amount taken up. It is not surprising therefore, that the charges for the volatile anesthetics are very much higher than the expected cost of consumption, practically accounting for 60-75 percent of charges for all anesthetic drugs combined. It behooves every anesthesiologist therefore to consider the cost of their pharmaceutical choices at all times and undertake cost minimization strategies for drugs used in anesthesia, especially the volatile anesthetics. (Author)
ANESTHESIA ; ECONOMICS, PHARMACEUTICAL

This article review and discuss the complimentary and alternative medicine (CAM), where it all began, practices and ideas self- defined by their users as preventing and treating illnesses or promoting health and well-being.
HERB-DRUG INTERACTIONS ; HERBALS ; ECHINACEA ; TANACETUM PARTHENIUM ; GARLIC ; GINKGO BILOBA ; PANAX ; KAVA ; VALERIAN ; HYPERICUM ; EPHEDRA

Introduction: Preanesthetic evaluation is a basic element of anesthesia care which aims to reduce the risks associated with anesthesia and increase quality of perioperative care. As part of the preanesthetic evaluation, questionnaires allow the anesthesiologist to quickly review a structured list and focus on pertinent findings thus ensuring a more focused evaluation. The objective of this study is to develop a self-administered preoperative assessment questionnaire in Filipinos that can be used for patients scheduled to undergo anesthesia and to determine if the questionnaire can help in risk stratification of these patients. Methods: Adult patients undergoing anesthesia were asked to fill up a 24-item questionnaire written in Filipino and English that emphasized the cardiovascular, respiratory, neurologic, endocrine, gastrointestinal, hematologic, and homeostatic status of the patient. Questions were answerable by "yes", "no", or "I don't know". A "yes" was counted as two points, "no" one point, "I don't know" as 0. Scores were then added for each patient. An anesthesia resident unaware of the results of the questionnaire validated the patient's responses by doing a routine preoperative evaluation. 'Results from the two were compared. Results: Eighty-four patients were included in the study. No significant difference was noted between the results of the questionnaire and the standard preoperative form. Tweny one patients were included in the high index group because their perioperative course was marked by previously defined adverse events while the remaining 63 were in the low index group because of an unremarkable perioperative course. Mean cumulative score of patients in the high index group was significantly higher than the low index group (30.48 vs. 27.42; p<0.05, Sig). A score of 29 or higher was also found to be associated with adverse events during the perioperative period. Conclusion: This self-administered form in Filipino was comparable to the standard evaluation done by a resident and was helpful in detecting potential problem areas for patients undergoing anesthesia and surgery. (Author)
Human ; ANESTHESIA ; SURGERY ; PREOPERATIVE CARE

HOSPITALS ; HOSPITAL ADMINISTRATION ;

Muscle relaxants are an irreplaceable item within the modern surgical toolkit. Their almost universal use during surgical procedures of medium-to-long duration means that it is essential that all anesthesiologists must have a comprehensive knowledge of their history and the future prospects for their continued evolution. There are a number of naturally- occurring acetylcholinesterase and butrylcholinesterase inhibitors, including the solanaceous glycoalkaloids (SGAs), which are found in the plants of the family Solanaceae. In the Pharmacopiea of the Philippines indigenous plants, one such plants is Cestrum nocturnum (Dama de Noche). Objective: This experimental animal study was therefore undertaken to determine the neuromuscular effect of the intravenous administered Cestrun nocturnum in an anesthesixed cat. Methods: An N-of-1 A-B-A design in in vivo study was undertaken compairing the effect of the Cestrun Nocturnum ansd atracurium on the neuromuscular junction of an anesthesized cat. Results: Intravenously administered cestrum nocturnum produced an incomplete (40% TOF) but sustained depolarization of the neuromuscular junction that took an hour to fully recover. It also prolonged the onset of atracurium- induced paralysis and delayed its recovey in the pesence of neostigmine. Conclusion: In the light of these findings, we infer that cestrum nocturnum interact with atracurium and neostigmne possibly through pharmacokinetic and pharmacodynamic mechanisms. Further studies are recommended to elucidate these mechanisms.
Animal ; ACETYLCHOLINESTERASE ; SOLANACEAE ; NEUROMUSCULAR JUNCTION

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