To present a case of a patient who will undergo pulmonary embolectomy under deep hypothermic circulatory arrest, to discuss the use of deep hypothermic circulatory arrest, and to elaborate on the various techniques utilized to provide optimum neuroprotection.
Human ; Female ; Middle Aged ; HYPOTHERMIA ; NEUROPROTECTIVE AGENTS ; CIRCULATORY ARREST, DEEP HYPOTHERMIA INDUCED ; HEART ARREST, INDUCED

Nausae and vomiting remains as "the big little problem" in cesarean delivery under spinal anesthesia, attributable to the discomfort from intraoperativeperitoneal manipulations. Recent studies have reported that intrathecal (IT) administration of lipophilic opioids, such as fentanyl, minimizes this discomfort by by improving the qulity ad duration of pain relief when it is combined with 0.5% bupicavaine used for subarachnoid block in cesarean delivery. It ws the objective of this study to determine the efficacy of the addition of intrathecal fentanyl for the prevention of nausea and vomiting during cesarean section under spinal anesthesia. Methods: The comparison of the antiemetic efficacy of 12.5 ug and 25 ug IT and its effects on the onset and duration of hyperbaric bupicavaine induced senory and motor spinal block were observed. Maternal nd fetal adverse effects were, likewise, documented. Forty-five full-term parturients of American Society of Anesthesiologist Physical Status I, scheduled for eective cesarean delivery at the Philippine General Hospital were included in the study. Result: Results revealed that both IT fentanyl 12.5 ug and 25 ug significantly prevented nausea and vomiting during cesarean delivery undr spinal anesthesia i comprison with IT placebo. Furthermore, in comparing the efficacy of the IT fentanyl groups, there was no significant difference between the two groups. There were no notable effects on the co-administration of IT fentanyl on the onset and duration of hyperbaric bupicavaine induced sensory and motor spinal block. Conclusion: Common hemodyamic responses and side effects of spnal anesthesia and addition of low dose IT fentanyl (i.e. hypotension, respiratory depression, shvering pruritus) di not show deleterious effects to the parturients. the low dose IT fentanyl used in the study had no detectable adverse impact on neonatal condition, when assessed by APGAR scoring.
Human ; Female ; CESAREAN SECTION ; ANESTHESIA, SPINAL ; FENTANYL

Objectives: As asthma is a chronic inflammatory disease of the airways, anti‑inflammatory treatment should be positioned at the forefront of guideline-directed asthma care. However, patients tend to rely on short-acting β2- agonists (SABAs) for rapid-onset symptom relief. The impact of SABA overuse and associated clinical outcomes have been investigated extensively in Europe and North America. Limited data are available from countries in Asia, Africa, Latin America, and the Middle East. The SABA use IN Asthma (SABINA) III program, a large multicountry, observational study, was undertaken to describe the global extent of SABA use and its potential contribution to suboptimal disease control. As part of the SABINA III study, we aimed to characterize SABA prescription collection and asthma-related clinical outcomes among patients in the Philippines. Methods: This nationwide, observational, cross-sectional, SABINA III study included patients (aged ≥12 years) with a documented asthma diagnosis recruited between May 2019 and January 2020 from 10 sites in the Philippines. Demographics, disease characteristics and prescribed asthma treatments, including SABA and inhaled corticosteroids (ICS) in the 12 months preceding study start, were recorded during a single visit, and transcribed onto an electronic case report form (eCRF). Patients were classified by investigator‑defined asthma severity, guided by the 2017 Global Initiative for Asthma (GINA) report and practice type, either primary or pulmonary medicine specialist care. Results: Of 245 patients analyzed, 63.3% were classified as having moderate-to-severe asthma (GINA steps 3−5), and most patients (63.3%) were enrolled by pulmonary medicine specialists. Overall, 33.1% (n=81) of patients had experienced ≥1 severe exacerbation in the previous 12 months and 18.4% (n=45) of patients had uncontrolled asthma. With respect to asthma treatments, a total of 6.5% (n=16), 40.4% (n=99), and 2.4% (n=6) of patients were prescribed SABA monotherapy, SABA in addition to maintenance therapy, and ICS, respectively, in the 12 months prior to their study visit. Most patients (n=156 [63.7%]) received prescriptions of fixed‑dose combinations of ICS and long-acting β2-agonists. SABA over-prescription, defined as ≥3 SABA canister prescriptions per year, was observed in 10.6% (n=21) of patients. Additionally, 25.6% (n=23) of patients classified as having mild asthma were prescribed either nebulized SABA (n=17) or oral SABA (n=6). Nearly one-third of patients (n=75 [30.6%]) had purchased over-the-counter (OTC) SABA, and 46.9% (n=115) were prescribed antibiotics. Conclusions In this SABINA III Philippines study cohort, more than 10% of patients were over-prescribed SABA canisters. Additionally, prescriptions for oral or nebulized SABA, the purchase of non-prescription (OTC) SABA, and the high percentage of prescriptions for antibiotics warrant country-wide improvements in asthma care and management.
Asthma ; Bronchodilator Agents ; Prescriptions

Objectives: As asthma is a chronic inflammatory disease of the airways, anti-inflammatory treatment should be positioned at the forefront of guideline-directed asthma care. However, patients tend to rely on short-acting β2-agonists (SABAs) for rapid-onset symptom relief. The impact of SABA overuse and associated clinical outcomes have been investigated extensively in Europe and North America. Limited data are available from countries in Asia, Africa, Latin America, and the Middle East. The SABA use IN Asthma (SABINA) III program, a large multicountry, observational study, was undertaken to describe the global extent of SABA use and its potential contribution to suboptimal disease control. As part of the SABINA III study, we aimed to characterize SABA prescription collection and asthma-related clinical outcomes among patients in the Philippines. Methods: This nationwide, observational, cross-sectional, SABINA III study included patients (aged ≥12 years) with a documented asthma diagnosis recruited between May 2019 and January 2020 from 10 sites in the Philippines. Demographics, disease characteristics and prescribed asthma treatments, including SABA and inhaled corticosteroids (ICS) in the 12 months preceding study start, were recorded during a single visit, and transcribed onto an electronic case report form (eCRF). Patients were classified by investigator-defined asthma severity, guided by the 2017 Global Initiative for Asthma (GINA) report and practice type, either primary or pulmonary medicine specialist care. Results: Of 245 patients analyzed, 63.3% were classified as having moderate-to-severe asthma (GINA steps 3−5), and most patients (63.3%) were enrolled by pulmonary medicine specialists. Overall, 33.1% (n=81) of patients had experienced ≥1 severe exacerbation in the previous 12 months and 18.4% (n=45) of patients had uncontrolled asthma. With respect to asthma treatments, a total of 6.5% (n=16), 40.4% (n=99), and 2.4% (n=6) of patients were prescribed SABA monotherapy, SABA in addition to maintenance therapy, and ICS, respectively, in the 12 months prior to their study visit. Most patients (n=156 [63.7%]) received prescriptions of fixed-dose combina-tions of ICS and long-acting β2-agonists. SABA over-prescription, defined as ≥3 SABA canister prescriptions per year, was observed in 10.6% (n=21) of patients. Additionally, 25.6% (n=23) of patients classified as having mild asthma were prescribed either nebulized SABA (n=17) or oral SABA (n=6). Nearly one-third of patients (n=75 [30.6%]) had purchased over-the-counter (OTC) SABA, and 46.9% (n=115) were prescribed antibiotics. Conclusions In this SABINA III Philippines study cohort, more than 10% of patients were over-prescribed SABA canisters. Additionally, prescriptions for oral or nebulized SABA, the purchase of non-prescription (OTC) SABA, and the high percentage of prescriptions for antibiotics warrant country-wide improvements in asthma care and management.
Asthma ; Bronchodilator Agents ; Philippines ; Prescriptions