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.

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

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: Propofol, a sedative agent with quick onset and short duration of action, has long been used for many adult procedures requiring anesthesia and sedation. There is hesitance, however, to its use for children because of several reports of adverse events. This hesitance reflects more of a scarcity of pediatric clinical trials rather than a proven clinical problem. This study is therefore undertaken to determine the safety of propofol infusion in normal healthy children less than three years old who will undergo elective surgeries. Methods: This was a prospective study of 24 ASA I patients under 3 years of age who underwent either lower abdominal or lower extremity surgery under combined general and regional anesthesia, and cheiloplasty/palatoplasty under general anesthesia with infraorbital block. Patients were put to sleep by sevoflurane gas induction. Endotracheal intubation was facilitated by atracurium. Blood samples for arterial blood gases (ABGs), creatinine, alanine aminotransferase (ALT) and triglycerides were extracted. After the regional block was established, sevoflurane was discontinued and the propofol infusion was started. The range of vital signs, total dose of propofol and the total time it was administered were noted. After 24 hours, ABGs, creatinine, triglycerides and ALT levels were determined. Results: Pearsons Correlation test showed that no linear relationship exist between the dose of propofol and the postoperative levels of triglycerides, creatinine and ALT. Preoperative ABG analysis showed that 29 percent had metabolic acidosis, 33 percent had respiratory acidosis and 21 percent had normal values. Postoperatively, 75 percent had normal ABG results while 25 percent had metabolic acidosis. Conclusion: Propofol is safe for use in children less than 3 years of age. No significant elevations in the postoperative levels of creatinine, ALT and triglycerides were noted in the study. Majority of patients had normal ABG results postoperatively. (Author)
Human ; Child Preschool ; PROPOFOL ; CHILD ; PROSPECTIVE STUDIES ; TRIGLYCERIDES ; CREATININE ; ANESTHESIA, CONDUCTION

Objectives: This study aims to answer the question:How well do the In- Service Examinations predict performance int he Written Diplomate Certification Examination? Methodology: Descriptive statistics and measures of central tendencies were used to described the distribution of the data. Linear regression using the Pearson Product Moment Correlation was used to evaluate data. Results: Of the 50 residents who were in the program from 1999 to 2000, only were included in the study. One did not take the In- Service Examination during his 2nd year of residency while the other has yet to take her WDCE. Conclusion: This study found a high positive correlation of scores in the Philippine Board of Anesthesiology ISEs and the WDCE. The In- Service Examination is a useful tool for gauging the readiness of a resident to perform well in the Written Diplomate Certification Examination. It is also a useful method for assessing the rate of improvement of the anesthesiology resident during his training. The results of this study help to established the ISEs as a mean of determining the strengths and weaknesses of anesthesia trainees and their training programs.
Human ; ANESTHESIOLOGY ; CERTIFICATION ; SCORES, CORRELATION