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

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

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