BACKGROUND: Combined spinal-epidural anesthesia is becoming popular especially in obstetrics and orthopedics, however few studies have been done involving abdominal operations METHODOLOGY: A randomized, blind study was conducted to compare the clinical outcome of combined spinal-epidural anesthesia (CSEA) with epidural anesthesia (EA) in abdominal surgery. CSEA was established using tetracaine 0.5 percent for the spinal component and bupivacaine 0.5 percent for the epidural component, whereas EA was established using bupivacaine 0.5 percent and fentanyl. Sixty patients were enrolled (Group CSEA, n=30; Group EA, n=30) RESULTS: The ease of doing the procedures were similar in both groups. Of the two techniques, CSEA was associated with earlier onset times (p0.05), more intense motor block (100 percent in the CSEA group achieved compete motor block compared to 10 percent in the EA group). Ephedrine use was similar in both groups. Pain scores were similar in both groups. Overall patient satisfactions were higher in the CSEA groups. The incidence of shivering was higher in the EA group (33 percent) compared to CSEA group (17 percent). Pruritus was present only in the EA group (10 percent). Nauses, vomiting, and headache were absent in both groups CONCLUSIONS: CSEA is a useful and safe technique that confers advantages over the EA technique for major abdominal surgery. CSEA has low failure rates, rapidly produces a reliable spinal blockade, provides good operating conditions, and offers high level of patient satisfaction.
Human ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; ANESTHESIA ; ANESTHESIA, EPIDURAL ; ANESTHESIA, SPINAL ; OBSTETRICS, ORTHOPEDICS

OBJECTIVE: To determine the incidence and the associated intraoperative factors that contribute to difficult weaning from cardiopulmonary bypass (CPB) among coronary artery bypass graft (CABG) patients with preserved left ventricular ejection fraction (LVEF).

METHODS: This study was a prospective observational cohort study conducted at a specialty center from September 1, 2019, to May 15, 2020. It included adult patients diagnosed with coronary artery disease (CAD) admitted for elective CABG under the CABG Z-Benefit Package, with an LVEF of greater than 50%. After institutional review board approval, data on consecutive patients scheduled for elective, isolated CABG and meeting the inclusion criteria were prospectively collected and analyzed. Descriptive or qualitative statistics was used to summarize the demographic and clinical characteristics of the patients.

RESULTS: Data from 52 patients who met the inclusion criteria were included in the analysis, with 17.3% (n = 9/52) meeting the criteria for difficult weaning from CPB. Of these nine patients, nine (100%) required use of more than one inotrope and/or vasopressor, and two of the nine (22.22%) needed to return to CPB after coming off. Of those patients with nondifficult weaning from CPB, 74.44% (n = 32/43) used a single inotrope, and 42.26% (n = 11/43) successfully separated from CPB without any need for pharmacological support. Among the various parameters assessed, logistic regression analysis showed that every unit increase in base deficit after release of aortic cross-clamp increased the odds of having difficult separation from CPB by 40.21%. Patients who received nicardipine were also 7.8 times more likely to have difficult separation from CPB.

CONCLUSION: In this study of patients with preserved left ventricular function undergoing CABG surgery, we identified two intraoperative variables associated with difficult weaning from CPB: (1) base deficit at release of aortic cross-clamp and (2) the use of nicardipine infusion.

This patient was born at 25th week of gestation with extremely low birth weight (700 grams) and hyaline membrane disease. On his 9th day as neonate, he was diagnosed to have a patent ductus arteriosus (PDA). Due to pulmonary congestion/ hypertension on top of failure of the said PDA to close after a regimen of ibuprofen and subsequently indomethacin, surgical intervention was contemplated which however was delayed because of the onset of pneumonia and bronchopulmonary dysplasia. On the 59th day of life, PDA ligation was done at the Nursery ICU. The patent weighted 800 grams at his supposed to be 33- 34 weeks age of gestation making him the smallest infant to be reported who have underwent PDA ligation in the Philippines.
Human ; DUCTUS ARTERIOSUS, PATENT ; INFANT, LOW BIRTH WEIGHT ; PREMATURE BIRTH ; INFANTS ; NEUROMUSCULAR BLOCKING AGENTS ; HYALINE MEMBRANE DISEASE ; LIGATION

BACKGROUND: This study compared the onset of action of Rocuronium given as single bolus versus divided dosing, using Propofol as an induction agent. The intubating conditions and hemodynamic changes accompanying laryngoscopy and tracheal intubation were assessed following the induction techniques. METHODS: Forty ASA I and II patients who underwent elective surgical procedures under general endotracheal anesthesia, aged 15 to 65 years old and categorized under Mallampati classifications I and II were included. They were randomly assigned to two groups. For Group A intubation sequence was Rocuronium 0.6 mg./kg., Propofol 2 mgs./kg., then 5 m1s. of plain isotonic solution. Group B sequence was: Rocuronium 0.4 mg./kg., Propofol 2 mgs./kg., then Rocuronium 0.2 mg./kg. Single twitch stimulation and train-of-four were used to monitor the onset time and intubation time. Statistical analysis was done by descriptive statistics and paired students T-test with a P-value0.05 considered significant RESULTS: Onset time and intubation time for the group given a divide dose of Rocuronium were shorter. No significant change in mean arterial pressures was seen in both groups, although there was an increase in cardiac rate for the group given a single bolus. CONCLUSION: The combination of Propofol and Rocuronium in divided dose is ideal for rapid sequence intubation.
Human ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; HEMODYNAMICS ; LARYNGOSCOPY ; INTUBATION ; TRACHEAL, ANESTHESIA ; ROCURONIUM ; PROPOFOL

The general objective of this case report was to discuss the use of Ketamine intravenous anesthesia as a physiologic approach in managing surgical correction for neonatal TAPVR who needs an urgent surgical intervention. Specific Objectives are: - To understand the pathophysiology of TAPVR; - To identify the physiologic problems seen in TAPVR prior to surgery, during the surgical procedure, and after correction of the lesions; - To discuss concomitantly how an anesthetic technique and various anesthetic drugs affect these problems; - To discuss the rational use of Ketamine infusion anesthesia in TAPVR.
Human ; Female ; Adult ; HEART DEFECTS, CONGENITAL ; ANESTHESIA ; CASE REPORTS ; INFANT, NEWBORN ; KETAMINE ; ANESTHETICS

BACKGROUND: Intermediate-acting muscle relaxants have gained favor in fast-track cardiac anesthesia since these are associated with early extubation. However, postoperative residual curarization (PORC) still occur in the post anesthesia care unit. This study aims to determine the occurrence of PORC among post coronary artery bypass graft (CABG) patients in the surgical intensive care units (SICU) of the Philippine Heart Center. METHODS: A cross-sectional study was undertaken among 60 patients for elective CABG surgery. Within an hour from SICU arrival, Train of Four (TOF) ratio was obtained and a value of <0.7 signified the presence of PORC. RESULTS: 57 out of 60 (95%) were found to have PORC. Patients without PORC were significantly warmer (36.4o C vs 34.8o C, p-value=0.019) upon SICU arrival compared to those with PORC. The duration of ventilatory support was significantly longer in those with PORC (510 min vs 305 mins, p-value=0.021). The rocuronium induction dose and duration of infusion did not differ between those with and without PORC while the use of reversal drug was seen to significantly prevent its occurrence (p-value=0.003). CONCLUSION This study showed a high incidence of PORC among post-CABG patients in the SICU with the current practice of Rocuronium infusion during surgery. The use of muscle relaxant reversal drug was seen to significantly prevent the development of PORC while higher body temperature upon SICU arrival was observed in patients that did not develop PORC. This study was also able to show that the development of PORC prolonged post-operative mechanical ventilatory support hindering the goals of fast-track cardiac surgery.

This case report is about a four year old boy diagnosed since birth to have TOF. He had a co-existing cerebral infarct secondary to a cerebrovascular accident that occurred at age 3 years. Lately, he was manifesting signs and symptoms of increasing intracranial pressure secondary to brain abscess. The challenge posed is the frequent occurrence of hypercyanotic spells in this patient. How the anesthesiologist circumvented a severe case of intraoperative "tet" spells is hereby presented.
Human ; Male ; Child Preschool ; SURGERY ; ANESTHESIOLOGISTS ; INTRACRANIAL PRESSURE ; TETRALOGY OF FALLOT ; HEMODYNAMIC ; PEDIATRICS ; PHENYLEPHRINE