The perioperative management of conjoined twins poses unique anatomic, physiologic, logistic, and even ethical challenges, necessitating a multidisciplinary team approach. We present a case of omphalopagus conjoined twins separated at the second month of life (39 2/7 weeks post-conceptual age). This paper highlights significant components in the anesthetic management of conjoined twins for separation surgery, in light of modern medicine and technological advancements.

INTRODUCTION: A previous prospective, randomised controlled trial showed that animated videos shown to children before magnetic resonance imaging (MRI) scan reduced the proportion of children needing repeated MRI sequences and improved confidence of the children staying still for at least 30 min. Children preferred the interactive video. We hypothesised that the interactive video is non-inferior to showing two videos (regular and interactive) in improving children's cooperativeness during MRI scans. METHODS: In this Institutional Review Board-approved prospective, randomised, non-inferiority trial, 558 children aged 3-20 years scheduled for elective MRI scan from June 2017 to March 2019 were randomised into the interactive video only group and combined (regular and interactive) videos group. Children were shown the videos before their scan. Repeated MRI sequences, general anaesthesia (GA) requirement and improvement in confidence of staying still for at least 30 min were assessed. RESULTS: In the interactive video group ( n = 277), 86 (31.0%) children needed repeated MRI sequences, two (0.7%) needed GA and the proportion of children who had confidence in staying still for more than 30 min increased by 22.1% after the video. In the combined videos group ( n = 281), 102 (36.3%) children needed repeated MRI sequences, six (2.1%) needed GA and the proportion of children who had confidence in staying still for more than 30 min increased by 23.2% after the videos; the results were not significantly different between the two groups. CONCLUSION The interactive video group demonstrated non-inferiority to the combined videos group.
Child ; Humans ; Anesthesia, General ; Magnetic Resonance Imaging ; Prospective Studies ; Simulation Training ; Child, Preschool ; Adolescent ; Young Adult ; Video Recording

OBJECTIVE: To evaluate the early effectiveness of local infiltration anesthesia (LIA) with compound betamethasone in total knee arthroplasty (TKA). METHODS: The clinical data of 102 patients with knee osteoarthritis who were treated by TKA and met the selection criteria between May 2022 and March 2023 were retrospectively analyzed. They were divided into control group and study group according to whether LIA preparation was added with compound betamethasone, with 51 cases in each group. There was no significant difference of baseline data, such as age, gender, body mass index, operative side, preoperative range of motion (ROM), Knee Society Score (KSS), white blood cell (WBC), and hematocrit between the two groups ( P>0.05). The intraoperative total blood loss and hidden blood loss were recorded, and WBC was recorded on the 1st, 2nd, and 3rd days after operation. Pain was assessed by visual analogue scale (VAS) score on the 1st, 2nd, and 3rd days after operation and morphine intake milligrames equivalent within 48 hours after operation. Passive ROM, maximum extension and flexion angles of knee joint were measured on the 3rd day after operation; the early postoperative complications were recorded. RESULTS: There was no significant difference in total blood loss and hidden blood loss between the two groups ( P>0.05). The postoperative pain levels in both groups were relatively mild, and there was no significant difference in VAS scores in the first 3 days after operation and in morphine intake milligrams equivalent within 48 hours after operation between the two groups ( P>0.05). The WBC in the first 3 days after operation was significantly improved in both groups ( P<0.05). The WBC in the study group was significantly higher than that in the control group on the 1st and 2nd days after operation ( P<0.05), but there was no significant difference between the two groups on the 3rd day after operation ( P>0.05). On the 3rd day after operation, the maximum extension angle of knee joint in the study group was smaller than that in the control group, while the maximum flexion angle and passive ROM of knee joint in the study group were larger than those in the control group, and the differences were significant ( P<0.05). There were 6 cases of fever and 17 cases of deep venous thrombosis in the control group, and 1 case and 14 cases in the study group, respectively. There was no poor wound healing and periprosthetic joint infection in the two groups, and there was no significant difference in the incidence of complications between the two groups ( P>0.05). CONCLUSION The application of compound betamethasone in LIA during TKA is a safe and optimal strategy to promote the early postoperative rehabilitation of patients.
Humans ; Arthroplasty, Replacement, Knee ; Anesthesia, Local ; Retrospective Studies ; Treatment Outcome ; Knee Joint/surgery* ; Osteoarthritis, Knee/surgery* ; Blood Loss, Surgical ; Morphine

Background and Objective: Hip fractures among the elderly continue to be a serious public health concern. Hip fractures result in extremely painful injuries and given the higher risk of the elderly for complications, managing pain in this population can be challenging. This study aimed to describe the outcomes of peripheral nerve blocks on elderly patients with fragility hip fractures who will undergo elective or emergency hip surgery. Methods: A single-center prospective cohort study was conducted at the Philippine General Hospital from May 2022 to November 2022. Patients included were aged 60 years old and above with fragility hip fracture, for elective or emergency hip surgery, and with American Society of Anesthesiologists (ASA) Physical Status Score 1–3. Patients’ baseline profile, intraoperative characteristics, and postoperative outcomes were collected using a standard data collection form. The data collector was blinded to the type of block performed. Results: A total of 29 patients who underwent hip surgery were included in the study. Most (65.5%) had Subarachnoid block + Peripheral Nerve Block (SAB+PNB) while 24.1% had General Anesthesia + Peripheral Nerve Block (GA+PNB) and 10.3% had no Peripheral Nerve Block (PNB). The median Numerical Rating Scale (NRS) 30 minutes post block was similar (p=0.977) in those who had PNB blocks (GA+PNB = 0, SAB+PNB = 0). The median NRS at rest during Postoperative day 1 (POD1) was significantly highest (p=0.023) in the No PNB group (3) than in both GA+PNB (0) and SAB+PNB (0). In contrast, the median NRS at rest during POD2 was similar (p=0.713) in the three groups (GA+PNB = 0, SAB+PNB = 0, No PNB = 0). The median NRS at motion during POD1 was significantly highest (p=0.008) in the No PNB group (6) than in both GA+PNB (0) and SAB+PNB (1). Also, the median NRS at motion during POD2 was significantly highest (p=0.009) in No PNB group (4) than in both GA+PNB (0) and SAB+PNB (1). Median Morphine Milligram Equivalent (MME) of postoperative opioid was significantly higher in the No PNB group among the three groups (p=0.047). The median satisfaction score (p=0.210), median delirium score at POD2 (p=0.993), and median length of hospitalization (p=0.173) were all similar in the three groups. Conclusion Peripheral nerve block is effective in elderly patients undergoing surgery for fragility hip fractures. It results in lower pain scores and can be administered with equal effectiveness either with general anesthesia or with subarachnoid block. Mortality rate, incidence of delirium, and hospital length of stay did not vary between those with and without peripheral nerve block.
regional anesthesia ; anesthesia, conduction

The perioperative management of conjoined twins poses unique anatomic, physiologic, logistic, and even ethical challenges, necessitating a multidisciplinary team approach. We present a case of omphalopagus conjoined twins separated at the second month of life (39 2/7 weeks post-conceptual age). This paper highlights significant components in the anesthetic management of conjoined twins for separation surgery, in light of modern medicine and technological advancements.
Human ; twins ; conjoined ; anesthesia

Background and Objective: Hip fractures among the elderly continue to be a serious public health concern. Hip fractures result in extremely painful injuries and given the higher risk of the elderly for complications, managing pain in this population can be challenging. This study aimed to describe the outcomes of peripheral nerve blocks on elderly patients with fragility hip fractures who will undergo elective or emergency hip surgery. Methods: A single-center prospective cohort study was conducted at the Philippine General Hospital from May 2022 to November 2022. Patients included were aged 60 years old and above with fragility hip fracture, for elective or emergency hip surgery, and with American Society of Anesthesiologists (ASA) Physical Status Score 1–3. Patients’ baseline profile, intraoperative characteristics, and postoperative outcomes were collected using a standard data collection form. The data collector was blinded to the type of block performed. Results: A total of 29 patients who underwent hip surgery were included in the study. Most (65.5%) had Subarachnoid block + Peripheral Nerve Block (SAB+PNB) while 24.1% had General Anesthesia + Peripheral Nerve Block (GA+PNB) and 10.3% had no Peripheral Nerve Block (PNB). The median Numerical Rating Scale (NRS) 30 minutes post block was similar (p=0.977) in those who had PNB blocks (GA+PNB = 0, SAB+PNB = 0). The median NRS at rest during Postoperative day 1 (POD1) was significantly highest (p=0.023) in the No PNB group (3) than in both GA+PNB (0) and SAB+PNB (0). In contrast, the median NRS at rest during POD2 was similar (p=0.713) in the three groups (GA+PNB = 0, SAB+PNB = 0, No PNB = 0). The median NRS at motion during POD1 was significantly highest (p=0.008) in the No PNB group (6) than in both GA+PNB (0) and SAB+PNB (1). Also, the median NRS at motion during POD2 was significantly highest (p=0.009) in No PNB group (4) than in both GA+PNB (0) and SAB+PNB (1). Median Morphine Milligram Equivalent (MME) of postoperative opioid was significantly higher in the No PNB group among the three groups (p=0.047). The median satisfaction score (p=0.210), median delirium score at POD2 (p=0.993), and median length of hospitalization (p=0.173) were all similar in the three groups. Conclusion Peripheral nerve block is effective in elderly patients undergoing surgery for fragility hip fractures. It results in lower pain scores and can be administered with equal effectiveness either with general anesthesia or with subarachnoid block. Mortality rate, incidence of delirium, and hospital length of stay did not vary between those with and without peripheral nerve block.
regional anesthesia ; anesthesia, conduction

Background and Objective: Brachytherapy is the only demonstrated technique of delivering the high radiation dose required to control cervical cancer (>80 Gray [Gy]) without causing unwanted side effects. There is still limited data available in the Philippines regarding the anesthetic management of patients receiving intracavitary brachytherapy for cervical cancer. It is the aim of this study to present the anesthetic management of these procedures performed in a non-operating site remote from the main hospital during the first 1 ½ years of the COVID-19 pandemic. Methods: A retrospective review of 446 eligible charts was made. Data collected included demographic variables, ASA physical status classification, anesthetic technique, anesthetic agents used, oxygen supplementation device, duration of procedure, intra-procedure complication, intra-procedure pain medications, post-procedure pain medications, recovery room (RR) rescue medications, time to fulfill discharge criteria, and patient disposition. Results: Four hundred forty-six (446) anesthetic encounters involving 117 patients is presented. Charts from 46 patients were excluded as it cannot be located. Mean age of the patients was 49 years with majority having normal BMI. Spinal anesthesia (SA) was more frequently (75%) used compared to total intravenous anesthesia (TIVA). Less than 5% immediate anesthesia-related complications were recorded and all patients were discharged on the same day. Conclusion Spinal anesthesia and TIVA are safe and effective anesthetic techniques in patients with cervical cancer undergoing high dose intracavitary brachytherapy. Prospective studies to assess other aspects of their care as well as anesthesia-related long-term effects from repetitive anesthetic exposure is recommended.
brachytherapy ; uterine cervical neoplasm ; anesthesia, spinal ; anesthesia, intravenous

Background: Epidural anesthesia is a widely used anesthesia technique commonly for surgeries involving the lower extremities up to the abdomen.It is beneficial for long duration surgeries because the epidural catheter in place allows additional of local anesthetic as needed. However, this technique has a slower onset of action and requires a larger volume of local anesthetic compared with spinal anesthesia. This study aims to determine if clonidine when used as an adjuvant can hasten the onset of action of levobupivacaine epidural anesthesia thus allowing the early commencement of surgery. Methodology: This is a double blind randomized controlled trial. After approval from the institution‘s research ethics and review committee,a total of 36 patients of American Society of Anesthesiologist ClassificationI or II for elective lower limb orthopedic surgery under levobupivacaine epidural anesthesia were purposively enrolled in this study and randomly assigned by match pairing of characteristics to two groups: GroupA—Clonidine and Group B—plain normal saline solution. Group A were given 0.5% levobupivocaine 15cc with 30 yg (0.2cc) clonidine and groupB were given 0.5% levobupivocaine 15cc with 0.2cc plain normal saline solution. In both groups the onset of levobupivacaine epidural anesthesia (sensory block atT10dermotomal level/Bromage 1) were observed. Side effects such as hypotension, decreased in respiratory rate, oxygen saturation, and any untoward incidence were noted. All data gathered: statistical mean, median, standard deviation, and T test were analyzed using the SPSS software at 5% significance level. Results: The mean onset of action of group A— Clonidine group (5.62 minutes) was foster compared to group B—control (11.33 minutes), which was statistically significant (P«0.05). The highest dermotomal level for the clonidine group was at T6 and T7forthecontrol group. Two segments regression was at 180 minutes forthe Clonidine group while 60 minutes for the control group. The patients given clonidine experienced side effects such as sedation, bradycardio (20% decrease in cardiac rote from baseline), and shivering. Hypotension was not observed in both clonidine and control groups. Conclusion Clonidine ata dose of30 |Jgwhen used as an adjuvant to levobupivacaine epidural anesthesia can hasten its onset of action among patients undergoing elective lower limb orthopedic surgery.
Anesthesia, Epidural ; Clonidine

Morquio syndrome is a subtype of mucopolysaccharidoses, wherein the accumulation of glycosaminoglycans (GAGs) in various organ systems lead to alteration of anatomy and physiology. Most prominent features are extensive bony abnormalities, which normally require surgical correction. This paper reports the case of a 7-year-old child with Morquio syndrome who successfully underwent correction of genu valgum under general endotracheal anesthesia via asleep induction and videolaryngoscopy, with supplemental peripheral nerve block. The precautions and anesthetic care done to ensure a safe procedure are discussed, especially with anticipation of a possible difficult airway.
Mucopolysaccharidosis IV ; Mucopolysaccharidoses ; Anesthesia

Hutchinson-Gilford Progeria Syndrome (HGPS) is a rare genetic disorder causing accelerated aging and agerelated pathologies. Weighing benefits and risks on doing surgical versus conservative pain management require multidisciplinary planning and consideration in HGPS patients. This presents a case of a 15-year-old patient with HGPS with severe pain from bilateral hip dislocation managed with peripheral nerve block and steroid injection. This afforded her immediate pain relief allowing her to undergo physical rehabilitation comfortably.
Progeria ; Anesthesia