The purpose of this paper is to present a utility analysis of the hierarchical framework of pre- anesthetic evaluation as part of antenatal care. A sensitivity analysis will likewise be done to test the robustness of the assumptions.
DELIVERY, OBSTETRIC ; ANESTHETICS ; ANESTHESIA ; ANALGESIA

The objective of this case report is to present the pathophysiology of postductal type coarctation of the aorta in a neonate and to present its anesthetic implication during transposition of a rectofourchette fistula and anoplasty.
Human ; Female ; Young Adult ; SURGERY ; CONGENITAL, HEREDITARY, AND NEONATAL DISEASES AND ABNORMALITIES ; THORACIC SURGERY

There is a very large literature on Anesthesiology in the Philippines, two thousand or so of them. Each anesthesiologist today holds in part a measure of the chronicle. The prologue to our story encompasses the past, of anesthesia's beginnings in foreign shores. Our own chapter begins, at a much later date, when a young doctor alighted from a plane 53 years ago. By following his trail we can weave the multiple strands of peoples, places and events that make the tapestry of Philippine anesthesiology today.
ANESTHESIOLOGY ; ANESTHESIA

This paper focuses on the process measures of quality. As shown in later sections, consensus on appropriate processes for a selected anesthesia- related maternal health service, i.e., pre -anesthetic care is obtained and corresponding input requirements for these processes are identified.
ANESTHESIA, OBSTETRICAL ; MATERNAL HEALTH SERVICES ; PATIENT SATISFACTION

This article discusses the current updates in the post-operative pain management with regards to the pathophysiology of pain, adverse physiologic sequelae of pain, pharmacological considerations, and the use of oral, parenteral, peripheral nerve blocks and neuraxial analgesics in conjunction with the mutimodal approach in controlling post- surgical pain for better patient outcome.
PAIN, POST-OPERATIVE ; PAIN MANAGEMENT ; ANALGESIA ; ANALGESIC

This report documents the use of peripheral blocks on a patient with whom conventional anesthetic techniques may prove detrimental. Peripheral nerve blocks, though still infrequently used in clinical practice, indicate a new direction in regional anesthesia. This is sustained by the low incidence of serious complications reported, patients satisfaction, a growing demand for cost- effective anesthesia, good postoperative analgesia and most importantly, a favorable postoperative recovery profile.
Human ; Female ; Aged ; GERIATRICS ; PERIPHERAL NERVES ; AMPUTATION

Background: While the standard lumbar epidural analgesia technique has often been described as the gold standard for pain relief during labor, its disadvantages of delayed onset and the presence of motor blockade to a certain degree pose several constraints to pain burdened mother who also may not want to be confined in the supine position during the entire labor process. An alternative which may address these issues is the combined spinal epidural or walking epidural technique. We embarked on this study to compare both techniques in terms of onset and degree of analgesia and the outcome of labor. Methods: Eighty (80) nulligravid ASA 1-2 term patients were randomly assigned to receive labor pain relief either using the standard continuous lumbar epidural analgesia (CLEA) using .125 percent bupivacaine with fentanyl or the combined spinal epidural analgesia (CSE) technique using intrathecal fentanyl and bupivacaine followed by bupivacaine boluses with fentanyl as needed. Outcome measures studied were Visual Analogue Pain Scores, onset degree and duration of pain relief and the progress and outcome of labor including neonatal outcome. Side effects were also noted. Results: Very significant was the rapid onset of action, denser, and longer duration of pain relief in the CSE group. Likewise a faster rate of cervical dilation resulting in a shorter first stage of labor was noted. Second stage duration and mode of delivery in both groups however did not differ significantly. Maternal satisfaction during the first stage was greater in the CSE group, although overall maternal satisfaction was comparable in both groups. Pruritus, although a significant occurrence in the CSE group did not need any intervention for treatment. No adverse effects on both the neonate and mother were noted. Conclusion: Based on the results of our study, the CSE or walking epidural is a encouraging alternative to laboring mothers, especially those in severe pain requiring rapid and profound relief. Our results show that compared the standard epidural technique, it hastens the rate of first stage labor - but whether ambulation plays a significant role in this aspect needs to be further investigations
Human ; LABOR PAIN ; OBSTETRIC LABOR ; ANALGESIA, EPIDURAL ; PAIN

Breast surgery is frequently associated with post-operative nausea, vomiting, pain and painful restricted movement. Paravertebral block may be an alternative to general anesthesia for this type of surgery. We studied the efficacy and safety of paravertebral block technique for the operative treatment of breast cancer and compared post-operative pain relief, length of hospital stay, patient satisfaction, incidence of nausea and vomiting in paravertebral block to general anesthesia. Methods: After written informed consent was obtained from 37 female patients due for modified radical mastectomy, 19 women were randomly allocated to receive paravertebral block, while 18 women received general anesthesia. During monitored sedation, paravertebral blocks opposite spinous processes C6-T7 were performed using bupivacaine 0.5 percent (maximum dose = 3 mgs/kg) with epinephrine, 3-4 ml per segment. Results: Post-operative pain score (VAS) at rest, with deep breathing and coughing; requirement for analgesics; and incidence of nausea were lower in the paravertebral group. There was no difference between groups in the mean length of hospital stay post operation to discharge and incidence of vomiting and other side effects. There was greater patient satisfaction in the paravertebral group. Conclusion: Paravertebral block is an effective and safe alternative to general anesthesia with less pain, less nausea and greater patient satisfaction.
Human ; Female ; ANESTHESIA ; ANALGESIA ; ANESTHESIA, GENERAL ; BREAST NEOPLASMS ; PAIN, POSTOPERATIVE

Background: Ropivacaine is a new amino-amide local anesthetic structurally related to bupivacaine. It is a potent, long acting local anesthetic with lower toxicity and a wider safety of margin than bupivacaine. This drug however is still under clinical investigation. Studies of ropivacaine for spinal anesthesia in humans are still in their early stage. Therefore, the authors embarked on this randomized, double-blind study to examine the clinical efficacy and safety of ropivacaine 0.75 percent versus bupivacaine 0.5 percent as used in spinal anesthesia Methodology: Fifty adult patients were randomized to receive either ropivacaine 0.75 percent or bupivacaine 0.5 percent given intrathecally. Baseline vital signs (heart rate and blood pressure) were measured before, during, and after surgery. Onset as well as duration of action of the study drugs were measured and side effects noted. Bromage Scale was also measured for all patients. The subjects as well as the investigators were unaware of the drug being given. Results: Using independent t-test, there was no difference seen between treatment groups for onset of action (p value =0.912) and duration of action (p value=0.349). Using repeated measures analysis of variance test for significance, also showed no difference between treatment groups with the vital signs, systolic blood pressure (p value=0.183), diastolic blood pressure (p value= 0.489) and heart rate (p value=0.374). However, using multiple contrasts of the different time readings showed significant findings in systolic and diastolic blood pressure readings as well as the heart rate readings. For the side effects, only four were noted for the population, and these are hypotension, hypertension, tachycardia and bradycardia. Fishers exact test showed insignificant finding, however, most of the cases with side effects occurred in bupivacaine. Conclusion: Ropivacaine 0.75 percent given intrathecally is a safe and efficacious alternative to bupivacaine 0.5 percent showing less cardiovascular side effects.
Human ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; ANESTHESIA, SPINAL ; ROPIVACAINE ; BUPIVACAINE ; ANESTHETICS, LOCAL

Backgound: The effect of dextromethorphan, an N-methyl d-aspartate (NMDA) antagonist, on the analgesic consumption and pain scoring after abdominal gynecologic surgery was studied. Methods: In this double-blind study, 60 patients were randomized into 2 groups. The study group was given oral dextromethorphan 25 mg 8 hours before the scheduled operation and one hour before the operation. Patients in the control group were given placebo capsules at the same intervals. Both groups of patients were given diclofenac sodium 75 mg i.m. prior to transfer to the post anesthesia care unit, and every twelve hours thereafter for a total of three doses. The study group was given dextromethorphan eight hours after the last dose prior to operation and every eight hours thereafter for the next 24 hours. The control group received placebo capsules at the same intervals. Visual analog pain scores were recorded preoperatively and at 4,8,12 and 24 hours postoperatively with the patient supine and coughing. Results: The mean VAS scores for the two groups, during rest and coughing, at 4 hours of observation, showed no significant difference. However, at 8 hours until 24 hours of observation, a significant difference was noted. Results of this study show that administration of dextromethorphan 25 mg orally preoperatively and postoperatively provides an adjuvant analgesic effect, as evidenced by lesser opioid requirements and lower resting and coughing VAS pain scores postoperatively. Conclusion: These results imply that the development of central hyperalgesia in the spinal cord induced by nociceptive stimulation of surgery was either blocked or modulated by dextromethorphan acting on NMDA receptors. The nonsedating property and lack of adverse side effects of dextromethorphan make it a promising alternative analgesic to other commonly used drugs.
Human ; Female ; Aged ; Middle Aged ; Adult ; HYPERALGESIA ; DEXTROMETHORPHAN ; GYNECOLOGIC SURGICAL PROCEDURES ; PAIN, POSTOPERATIVE