Background: The aims of this study were to determine the average length of stay in the Post-anesthesia Care Unit (PACU LOS) in the Philippine General Hospital (PGH) and to create a model that will predict the PACU LOS based on the factors that significantly affect the LOS. Determination and prediction of PACU LOS is essential in resource utilization, and in cost containment and reduction. Addressing the modifiable variables that affect the PACU LOS may lead to an improvement in the LOS of patients in the PACU and, consequently, to better recovery room staffing and a reduced cost for the patients and the hospital. Methods: A prospective chart review of 400 postoperative patients admitted in the PGH PACU was done. Summary statistics were presented. Using the set of variables found to be significant, a regression model was formulated to estimate the PACU LOS. Results: The mean PACU LOS was 4.59 hours. There were significant differences in the mean PACU LOS based on the occurrence of complications. There were also significant differences in the median PACU LOS based on the type and duration of surgery, anesthetic technique, and duration of anesthesia. The multiple linear regression model that best predicted PACU LOS included ASA-PS classification, type of surgery, duration of surgery, anesthetic technique, and occurrence of intraoperative or postoperative complications. Conclusions The mean PACU LOS of the Philippine Genera Hospital is higher than that of published data. The factors included in the model that best predicts PACU LOS may be studied to improve the PACU LOS.
Length of Stay ; Anesthesia ; Anesthesiology ; Regression Analysis

Tetralogy of Fallot (TOF) in pregnancy is a rare occurrence which poses a high risk for detrimental effects on both mother and fetus. This paper reports a 21-year-old primigravid diagnosed with uncorrected TOF who had a successful caesarean section at 32 weeks of gestation. To address the hemodynamic challenges, the anaesthetic management involved the use of a minimally invasive hemodynamic monitor, controlled mechanical ventilation and a combined technique of intravenous anaesthesia using remifentanil and lumbar epidural anaesthesia using levobupivacaine.

Cardiovascular diseases during pregnancy account for significant morbidity and mortality. An abdominal aortic aneurysm posts high mortality for otherwise healthy patients, more so for conditions that alter normal physiology such as in preterm pregnancy. Abdominal aortic dissection during pregnancy is a rare and life-threatening condition for both the mother and the fetus. An understanding of physiologic maternal changes and surgical stress responses is important to attenuate perioperative hemodynamic changes and prevent progression of aortic expansion and aortic rupture. As an anesthesiologist, one is positioned to facilitate communication among the internist, obstetrician and vascular surgeon for surgical success. This case report presents the anesthetic considerations in the perioperative management of a preterm pregnancy for a major abdominal surgery.
Aortic Aneurysm, Abdominal ; Anesthesia, Obstetrical

Anesthesiologists have been at the forefront of initiatives addressing perioperative patient safety. As anesthesia has no direct therapeutic benefit, its risk must be minimized. At times the surgery is simple but the patient’s condition complicates anesthetic management, increasing the risk for complications. This report describes the anesthetic management of an adult patient diagnosed with inclusion body myositis (IBM), a rare inflammatory degenerative myopathy, who initially presented with decreased motor function in both lower and upper extremities causing him to be bedbound for two years. Due to the progression of his disease, he eventually developed dysphagia, hence he was scheduled for esophagoscopy, cricopharyngeal Botox injection, and percutaneous endoscopic gastrostomy. As patients with IBM are at risk for exaggerated sensitivity to neuromuscular blockers and respiratory compromise, anesthesia was at the helm of a multidisciplinary team approach. The perioperative management centered on preoperative optimization, prevention of aspiration, avoidance of anesthetics that may trigger malignant hyperthermia, and prevention of postoperative pulmonary complication. The hospital course was uncomplicated and the patient was discharged well after one day. This report emphasizes how improvements in resources, technology, and healthcare delivery, especially in anesthesia, help prevent perioperative adverse events.
Patient Safety ; Myositis, Inclusion Body ; Malignant Hyperthermia

An anticipated difficult airway requires careful planning and teamwork among the anesthesiologists and the surgical team. This paper reports the airway management of a 7-year-old female scheduled for LASER excision of a huge, obstructing laryngeal neoplasm. Initial attempts to secure the airway with the patient minimally sedated using a C-MAC Video Laryngoscope (C-MAC) and a traditional intubating stylet failed. Successful tracheal intubation was achieved when C-MAC was combined with a pediatric Bonfils Intubating Fiberscope (BIF) with the patient under general anesthesia.