Single enantiomer compounds like levobupivacaine appear to be safe alternative to racemic agents, like bupivacaine for postoperative analgesia. This double-blind randomized dose ranging trial amed to compafe the efficacy sna safety of three concentration of continuous epidural infusion of levobupivacaine for postoperative analgesia after lower extremity orthopedic surgery. After informed consent, 63 eligible patients were randomized to receive levobupivacaine 0.0625%, 0.125%, or 0.25% as a continuous postoperative epidural infusion. Intraoperatively,vital signs, oxygenation, sensory block level, motor block, and abnormal signs and symptoms were monitored. on and a half (1 1/2) hours after the last intraoperative bolus of levobupivacaine, the epidural infusion was started at a rate of 6/ mL/h for 24 24 hours. Pain intensity and pain reliefscores, using the 10-cm visul analog scale, were assessed postoperatively. The time to first request for analgesia (with morphine or tramadol) and the total rescue doses gicen were recorded. Twenty patients were randomized to Goup A (0.0625%), 22 to Group B (0.125%), and 21 to Group C (0.25%). All three group were similar as to age, gender distribution and baseline physical findings. Pain scores, pain relief, and ie to the first rescue does were not significant different among the three groups. The most common adverse events were fever (8%), hypotensy (3%), and vomiting (2%). one patient developed severe hypotensio probably secondary to inadequately replaced intraoperative blood loss. Levobupivacaine is effective and safe for postoperative analgesia as an epidural infusion at 0.0625%, 0.125%, and 0.25%.
Human ; Aged ; Middle Aged ; Adult ; Young Adult ; LEVOBUPIVACAINE ; ANALGESIA ; ORTHOPEDICS ; ANESTHETICS, LOCAL ;

Nausae and vomiting remains as "the big little problem" in cesarean delivery under spinal anesthesia, attributable to the discomfort from intraoperativeperitoneal manipulations. Recent studies have reported that intrathecal (IT) administration of lipophilic opioids, such as fentanyl, minimizes this discomfort by by improving the qulity ad duration of pain relief when it is combined with 0.5% bupicavaine used for subarachnoid block in cesarean delivery. It ws the objective of this study to determine the efficacy of the addition of intrathecal fentanyl for the prevention of nausea and vomiting during cesarean section under spinal anesthesia. Methods: The comparison of the antiemetic efficacy of 12.5 ug and 25 ug IT and its effects on the onset and duration of hyperbaric bupicavaine induced senory and motor spinal block were observed. Maternal nd fetal adverse effects were, likewise, documented. Forty-five full-term parturients of American Society of Anesthesiologist Physical Status I, scheduled for eective cesarean delivery at the Philippine General Hospital were included in the study. Result: Results revealed that both IT fentanyl 12.5 ug and 25 ug significantly prevented nausea and vomiting during cesarean delivery undr spinal anesthesia i comprison with IT placebo. Furthermore, in comparing the efficacy of the IT fentanyl groups, there was no significant difference between the two groups. There were no notable effects on the co-administration of IT fentanyl on the onset and duration of hyperbaric bupicavaine induced sensory and motor spinal block. Conclusion: Common hemodyamic responses and side effects of spnal anesthesia and addition of low dose IT fentanyl (i.e. hypotension, respiratory depression, shvering pruritus) di not show deleterious effects to the parturients. the low dose IT fentanyl used in the study had no detectable adverse impact on neonatal condition, when assessed by APGAR scoring.
Human ; Female ; CESAREAN SECTION ; ANESTHESIA, SPINAL ; FENTANYL

This 22 years-old male under went spinal fusion for correction of a servere Thoraco-Lumbar Scoliosis (Cobb's angle at 65o (degree) under general anesthesia with O2-Sevoflurane (1-2 vol%),Atracurium (0.3 mg.kg-1.hr-1,) Dexmedetomidine (0.4 ug,kg-1.hr-1,). With discontinuation of Atracurium infusion 30 minutes and Sevoflurane 15 minutes before ake-up test, the patient was able to mov both feet on command with only Dexmedetomidineinfusion running. Upon establshing intact neurological function, the level of anesthesia as deepened using Propofol 50mg/IV, Atracurium 20mg/IV and Fentanyl 50 ug,/IV. Coorective spine surgery with pedicle rod and screw instrumentation, spinal fusion with iliac bone grafting was then continued and completed under Dexmedetomidine 0.2-2.4 ug.kg-1.hr-1, and O2-Sevoflurane at 1 vol%. Dexmedetomidine insusion was continued at 0.2 ug.kg-1.hr-1, at the Post-Anesthesia Care Unit. Postoperative course was likewise unremarkable with no recall of intra-operative events.
Human ; Male ; Young Adult ; DEXMEDETOMIDINE ; SCOLIOSIS ; SPINAL FUSION ; SPINAL CORD

Conjoint twins are rare anomalies unique to multiple prgnancies. this rare conditions occurs in 1:200 monozygotic twin pregnancies, 1:900 twin pregnancies and 1:25,0000 to 100,000 births. Data regarding rare obstetric anomaly is sparse and intrapartal management is all the more lacking. This is a case report of a 39-years-old, multigavid woman was diagnosed to have conjoint twins based on early ultrasound findings. On her 37th week of gestation she was admitted for elective cesarean section. Abdominal delivery was done under spinal anesthesia with bupivacaine hyperbaric 0.5% 15 mg with morphine sulfate 0.032%. The male conjoint twins were delivered via primary classical incision. The monochorionic, mono-amniotic placenta was manually extracted one minute after delivery with no gross abnormalities. Both babies has apgar scores of 9 remaining 9 at 1 and 5 minutes. they had an agregate weight of 4000 grams and were assessed to be 37 weeks by pediatric aging.
Human ; Female ; Adult ; TWINS, CONJOINED ; PREGNANCY, TWIN ; ANESTHESIA, SPINAL ; TWINS ; CESAREAN SECTION ; ANESTHESIA, LOCAL

The patient is a 38-years-old female primigravid at 40-41 weeks age of gestation who was referred for labor analgesia. Physical examination was unremarkable. She however had optic neuritis two years prior to admission which which gave her residual blurring of vision on her left eye. she was given lumbar epidural analgesia using bupivacaine 0.1%and 50 mg fentanyl. The fetus however had non-reassuring fetal heart tones thus the decision to do cesarean section. Epidural anesthesianwas given via the indwelling epidural catheter using Bupivcaine 0.5%. The operation and recovery were unremrkable up to postoprative daw 4 when the patient experienced low back pain followed by motor and sensory deficit from the umbilicus down. The complication of lumbar epidural anesthesia was first entertained was first entertained further investigaion revealed that the patient has multiple sclerosis.
Human ; Female ; Adult ; ANESTHESIA, EPIDURAL ; MYELITIS, TRANSVERSE ; OPTIC NEURITIS ; MULTIPLE SCLEROSIS ; ANESTHESIA, LOCAL ; ANALGESIA, EPIDURAL ; MULTIPLE SCLERO ; GRAVIDITY

Primary brain tumor and pregnancy rarely occur together .Meningioma and pregnancy mre rarely do. This is a case of 29-years-old woman, diagnosed with cerebello-pontinenge meningioma who underwent cesarean section on the 35th weeks of pregnancy. The perioperative period was uneventful. this case demonstrate balanced anesthesia with low MAC Sevoflurane plus propofol infusion with adition of analgesics, Tramadol and Diclofenac that offers a reasonably adequate anesthetic level that can prevent increases in maternal intracranial pressure prioperatively without deleterious effect to the fetus and the uterus. It is emphasized that continuous and vigilant monitoring of the mother and fetus is essential.
Human ; Female ; Adult ; CEREBELLOPONTINE ANGLE ; MENINGIOMA ; BRAIN NEOPLASMS ; PREGNANCY ; PREGNANCY, HIGH-RISK ; ANETHESIA

Muscle relaxants are an irreplaceable item within the modern surgical toolkit. Their almost universal use during surgical procedures of medium-to-long duration means that it is essential that all anesthesiologists must have a comprehensive knowledge of their history and the future prospects for their continued evolution. There are a number of naturally- occurring acetylcholinesterase and butrylcholinesterase inhibitors, including the solanaceous glycoalkaloids (SGAs), which are found in the plants of the family Solanaceae. In the Pharmacopiea of the Philippines indigenous plants, one such plants is Cestrum nocturnum (Dama de Noche). Objective: This experimental animal study was therefore undertaken to determine the neuromuscular effect of the intravenous administered Cestrun nocturnum in an anesthesixed cat. Methods: An N-of-1 A-B-A design in in vivo study was undertaken compairing the effect of the Cestrun Nocturnum ansd atracurium on the neuromuscular junction of an anesthesized cat. Results: Intravenously administered cestrum nocturnum produced an incomplete (40% TOF) but sustained depolarization of the neuromuscular junction that took an hour to fully recover. It also prolonged the onset of atracurium- induced paralysis and delayed its recovey in the pesence of neostigmine. Conclusion: In the light of these findings, we infer that cestrum nocturnum interact with atracurium and neostigmne possibly through pharmacokinetic and pharmacodynamic mechanisms. Further studies are recommended to elucidate these mechanisms.
Animal ; ACETYLCHOLINESTERASE ; SOLANACEAE ; NEUROMUSCULAR JUNCTION

We present a case of a 20 year old patient with twin pregnancy 25-26 weeks AOG on top of a reexisting mitral stenosis in congestive heart failure accompanied by comunity acquired pneumonia; questionable asthma and gestational diabetes mellitus. The physiologic changes associated with twin pregnancy such as increaased blood volume, cardiac output, heart rate and a decrease in systemic vascular resistance are conflicting with the requirements of mitral stenosis, thus down grading the mitral stenosis to NYHA class IVD. Anesthesia was provided with continuous lumber epidural anesthesia using isobaric bupivacaine 0.5% under vigilant and invasive monitoring. Central venous pressure was monitored and maintained to normal with judicious fluid administration and diuresis. Epidural morphine was given for postoperative pain control.
Human ; Female ; Young Adult ; PREGNANCY, TWIN ; ANESTHESIA ; MITRAL VALVE STENOSIS ; HEART FAILURE ; PREGNANCY ; PREGNANCY, HIGH-RISK

A case of a 40 year old, term multigravid parturient with active pulmonary tuberculosis and with severe congenital kyphoscoliosis on the thoraocolumbar area. patient came in due to decreased fetal movement and was found to have severe oligohydramnios by biophysical scoring. She underwent emergency cesarean section with bilateral tubal ligation under general anesthesia. Patient delivered a live, healthy, term male baby. Bilateral tubal ligation was then performed. How she was positioned, induced and maintained for the procedure would be the topic of this paper. Technical issues of supine positionig, intubation and respiratory support need to be considered during anesthetic planing. Although regional anesthesia is commonly administered for cesarean section, maternalcompromise and technical factors may preclude this approach.
Human ; Female ; Adult ; STERILIZATION, TUBAL ; MCDONOUGH SYNDROME ; PREGNANCY, HIGH-RISK

This is the case of a 22-year-old male student actively involved in mixed martial arts (MMA) with a history od recurrent dislocation of both shoulder joints since he was 16 years old; most recent of which is twisting of his right shoulder one month prior to admission. Personal history revealed two years regular use of illicit substances such as marijuana and methamphetamine as well as the non-medical use of oral diazepam and intramuscular meperidine. He subsequently underwent arthroscopic right shoulder reconstruction in the beach chair position under continuous interscalene brachail plexus block with dexmedetomidine infusion for sedation.
Human ; Male ; Young Adult ; ARTHROSCOPY ; ANESTHESIA ; SHOULDER DISLOCATION ; DEXMEDETOMIDINE ; DIAZEPAM ; MEPERIDINE