The Intubating Laryngeal Mask Airway (ILMA) is an advanced type of laryngeal mask airway (LMA), designed to facilitate tracheal intubation with an endotracheal tube. Its use in a 44 year old female with an anticipated difficult airway due to severe burn contractures in the neck and axilla, with lid ectropion, will be discussed. (Author)
Human ; Female ; Adult ; INTUBATION ; INTUBATION ; TRACHEAL ; ANESTHESIOLOGY ; LARYNGOSCOPY

Purpose: Succinylcholine has been the agent of choice when clinical conditions require emergency airway protection during a rapid-sequence induction of anesthesia. However, the administration of succinylcholine is not without its problems. One of its side effects is the occurrence of fasciculations. To prevent fasciculations, a nonparalyzing dose of a nondepolarizing neuromuscular-blocking drug (pretreatment) is given prior to the actual administration of succinylcholine. Atracurium is one of the most popular nondepolarizing muscle relaxants used for pretreatment. Rocuronium is a novel non depolarizing muscle relaxant, that has a promising potential as a pretreatment drug. The objective of this trial was to determine the efficacy of rocuronium as a pretreatment drug and compare it with atracurium and placebo. Methods: Sixty ASA I and II patients about to undergo an emergency operation under rapid sequence induction of general anesthesia patients were enrolled in this double blind study. They were randomly divided into 3 groups of 20 according to the nondepolarizing pretreatment to be used: 0.9 percent NaCl (control), 0.05 mg/kg atracurium and 0.06 mg/kg rocuronium. Two minutes after pretreatment, succinylcholine at 1.5 mg/kg was injected. The presence and magnitude of fasciculations and the ease of tracheal intubation were assessed. Results: There was no difference among the three groups with respect to age, sex distribution and weight. Fasciculations occurred in 42 (70 percent) out of the 60 patients: 9 (45 percent) in the rocuronium group, 13 (65 percent) in the atracurium group and 20 (100 percent) in the saline group, P0.05. The severity of fasciculations was significantly lowest in the rocuronium group, followed by the atracurium group, and was highest with the saline or control group. Intubating conditions were rated as excellent, good, fair or poor in all patients. There was no statistically significant difference among groups. Conclusion: Rocuronium is superior to atracurium in preventing and reducing the intensity of fasciculations induced by succinylcholine, with no difference in the intubating conditions. Its use therefore in rapid-sequence induction of anesthesia as pretreatment is highly recommended, because it facilitates immediate airway intubation devoid of fasciculations and its undesirable effects. (Author)
Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; FASCICULATIONS ; ROCURONIUM ; ATRACURIUM ; SUCCINYLCHOLINE ; ANESTHESIA, GENERAL ; INTUBATION

X-linked dystonia-parkinsonism (XDP) is a rare, adult-onset, progressive, hereditary neurological movement disorder primarily affecting Filipino men with maternal families from Panay province of the Philippines. Medical treatment modalities currently being used have offered temporary symptomatic relief. Surgical management in the form of bilateral globus pallidi internae (Gpi) deep brain stimulation (DBS) has shown promising results and is increasingly being performed in advanced centers, as reported in international literature. Presented herein is the local experience of seven (7) retrospectively reviewed cases from February 2018 to February 2019 in a tertiary center in the Philippines with a particular focus on anesthetic management. All patients were male, from Panay, and presented with progressive dystonia and parkinsonism. All patients underwent planned bilateral, simultaneous DBS electrode, and implantable pulse generator (IPG) placement performed by a multidisciplinary team. Anesthetic management consisted of Bispectral Index (BIS) guided conscious sedation with low dose propofol and remifentanil infusions with a complete scalp nerve block (SB) at the start of the procedure then shifted to awake monitored anesthesia care during electrode placement, microelectrode recording (MER) and macro stimulation testing. All were put under general anesthesia with a supraglottic airway device during the placement of the internal pulse generator (IPG) in the infraclavicular area. All seven patients had successful localization, and insertion of the DBS electrode and discharged improved. The anesthetic management of the DBS used in these cases warrants further investigation and may lead to standardization of future practice.
Deep Brain Stimulation

OBJECTIVES: To  report  a  case  of  congenital  oval  window  aplasia  (COWA)  in  a  Filipino  adult presenting   with      unilateral   maximal   conductive   hearing   loss   and   discuss   the   diagnostic considerations, pathophysiology and management.
METHODS:
Design: Case Report
Setting: Tertiary Public Referral Center
Patient: One
RESULTS: Audiometric evaluation showed a maximal unilateral left conductive hearing loss. High resolution temporal bone CT showed absence of the oval window on the left along with facial and stapes  abnormalities.    Exploratory  tympanotomy  showed  an  aberrant  facial  nerve,  monopodal and  abnormally  located  stapes  and  absent  oval  window. Postoperative  hearing  gain  achieved after a neo-oval window and Schuknecht piston wire prosthesis remained stable over two years.
CONCLUSION: A congenital minor ear anomaly classified as Cremers Class 4a in which a congenital oval  window  aplasia  was  associated  with  an  aberrant  facial  nerve  anomaly  and  a  monopodal stapes is reported. Recent literature supported the view that congenital oval window aplasia can in selected cases be amenable to various surgical approaches and a stable postoperative hearing gain is achievable in the long term.

Human ; Male ; Female ; Adult ; Ear, Middle ; Hearing