Background: In an effort to prevent and address perioperative hypoxemia, it has become customary to provide supplemental oxygen to all surgical patients. Recently, the value of such a practice has been questioned. This study was designed to determine the incidence as well as the potential risk factors associated with perioperative hypoxemia. Methods: During a 9 - week period, 84 ASA I-II patients who underwent ambulatory surgical procedures under spinal anesthesia were observed. Arterial oxygen saturation (SpO2) was monitored using a pulse oximeter prior to induction of anesthesia, during operation and until the patient was discharged from the recovery room. Patients breathed room air during the entire perioperative course unless dyspnea and/or desaturation occurred. Descriptive statistics was used to examine differences in oxygen saturations before, during, and after surgery. The association between each of the potential risk factors and the number of patients requiring supplemental oxygen was analyzed using Fisher's exact test (for attribute data e.g. level of sensory block) and the Wilcoxon's rank sum test for continuous data (e.g. age, smoking in pack years) to calculate the probability that the proportions did not differ. A/>< 0.05 was considered statistically significant. Results: The incidence of preoperative, intra-operative and postoperative hypoxemia was 0 percent, 0 percent and 1.14 percent respectively while the need for supplemental oxygen was 2.27 percent intra-operatively and 2.27 percent postoperatively. Statistical analysis revealed that the level of block and body mass index were significant factors (P < 0.05) influencing the need for oxygen support. The need for supplemental oxygen was not associated with age, smoking history, surgical position, sedation level and Visual Analog Scale score. Conclusion: Results suggest that seemingly healthy patients who undergo lower abdominal, urologic, gynecologic or lower extremity surgical procedures under spinal anesthesia are at a low risk for hypoxemia. Pulse oximetry as part of routine monitoring may obviate the need for supplemental oxygen in this patient population. (Author)
Human ; ANESTHESIA ; ANOXEMIA ; OXIMETRY ; ANESTHESIA, SPINAL ; AMBULATORY SURGICAL PROCEDURES

Background:The FLACC (Facial expression, Leg movement, Activity, Cry, Consalability) behavioral pain assessment scale was developed and validated by Merkel and colleagues among American children last 1997 for autepain assessment of children 2 months to 7 years of age. Since then, it has been validated among other nationalities. It is now being used in Scotland, Australia, Canada and Thailland. This study aimed to determine the inter-reter reliability and construct validity of the FLACC on Filipino posoperative pediatric patients. Methods: A total of 106 children less than 5 years of age (1,68+1.46 years) who were admitted in the Philippine General Hospital Post Anesthesia Care Unit (PACU) were included. Those who are operated on an emergency basis, had neurologic impairment, had developmental delay and required menchanical ventilation postoperatively were excluded. Prior to the data collection phase, the PACU nurses were trained to use the FLACC scale using videotapes of postoperative children. Whenever possible, children were silmultaneuosly rated by two idependent ratersdurig their stay in the PACU. Those with FLACC scores>4 were given an intervention and the pain measurement was repeated and reported accordingly. Results: Inter-rater reliability was good to very good with kappa values for the pain behavior items ranging from 0.75 to 0.82. Construct validity ws established by showing a statistically significant reduction (p<0.001) beteen the pre-intervention score and post-intervention score using Wilcoxon signed rank test. Conclusion: The FLACC exhibited bith inter-rater reliability and contruct validity in the measurement of acute postoperative pain in Filipino children less than 5 years old.
Human ; Child Preschool ; Infant ; PAIN MEASUREMENT ; PAIN ; PEDIATRICS ; PAIN, POSTOPERATIVE

Objective. Chronic cancer pain and depressive symptoms are interrelated in clinical settings. As local data is lacking, this study aimed to determine the prevalence of depressive symptoms among chronic cancer pain patients seen at the Philippine General Hospital - Pain Clinic (PGH-PC).

Methods. In this retrospective, descriptive, cross-sectional study, data were collected from the charts of chronic
cancer pain patients seen at the PGH-PC. The Pain Clinic Self-Report Questionnaire (SRQ) tool was used to assess depressive symptoms. Clinico-demographic data were obtained and analyzed using descriptive statistics.

Results. Of the 129 patients included in the study, 61 had depressive symptoms corresponding to a prevalence of 47.29% (38.72 - 56.01 95% CI). Overall, a more significant number of patients included in the study were female, belonged to age 41-50, were married, attained secondary education, and were unemployed. Demographically, there were no statistically significant differences between chronic cancer pain patients who exhibited depressive symptoms and those who did not. The cancer type showed a statistically significant difference among those cancer patients with or without depressive symptoms (p = 0.016). Breast and gynecologic malignancies comprised more than half of the patients studied. Neither the cancer stage nor the pain scores had a statistically significant difference among those cancer patients with or without symptoms of depression.

Conclusion. Almost 1 in every two chronic cancer pain patients studied had depressive symptoms. Routine screening of patients for depressive symptoms could identify patients and may initiate interventions in this vulnerable population

Background: Minimally invasive spine surgical techniques (MISST) are associated with less intraoperative blood loss, shorter duration of surgery, and less post-operative pain. In the last two decades, MISST have been performed on an outpatient basis in developed countries but it is still performed primarily on an inpatient basis in the Philippines. This study aims to determine the safety and effectiveness of performing MISST in an ambulatory surgical center in the Philippines.

Methods: A retrospective chart review of patients who underwent MISST in an ambulatory surgical center (ASC) in Manila, Philippines, from January 2014 to December 2018 was done. The different types of MISST were identified and analyzed as to patient demographic characteristics, anesthetic perioperative management, outcomes and complications.

Results: Out of 337 patients included in the review, 8 types of MISST were identified. The average patient age was 55.61 years. Majority (98.2%) of the patients were classified as American Society of Anesthesiologists (ASA) physical status I or II. All patients had a statistically significant (p < 0.05) reduction in pain scores. ASC length of stay varied based on the complexity of the procedure ranging from 2.1 to 12.9 hours. There was a 0.89% incidence of surgery-related complications. Majority (94.4%) of the patients were discharged to home. There was no mortality.

Conclusion: Even in a developing country, transitioning MISST from inpatient to the ambulatory setting can be performed with minimal complications and unplanned hospital admissions while still achieving significant pain reduction. The key elements include careful patient selection, close coordination between the anesthesia and spine surgical teams, and provision of multimodal analgesia.

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.

Parturients with both ankylosing spondylitis (AS) and SARS-CoV-2 Infection (COVID-19) present unique challenges to anesthesiologists. Neuraxial analgesia for labor remains the gold standard in obstetric patients. However, in patients with AS, this approach may be deemed difficult to impossible. Administration of systemic opioids for labor analgesia can be an option, bearing in mind the potential respiratory depressant effect to both the mother and the fetus, especially in the setting of concomitant COVID-19. This paper reports the successful management of such a patient using patient-controlled analgesia (PCA) with intravenous remifentanil.
Spondylitis, Ankylosing ; Remifentanil ; Analgesia, Patient-Controlled ; Analgesia, Obstetrical ; COVID-19