Traumatic diaphragmatic hernia (TDH) occurs in about 5 percent of blunt and penetrating abdominal injury and 10 percent of victims of penetrating chest injury. Ten percent of such injuries become apparent only months or years later after the initial trauma. The TDH patient is at risk for surgical complications, including pulmonary aspiration, tension pneumothorax, hypoxemia, strangulation and necrosis of entrapped bowel and hemodynamic instability. Diagnosis and proper management of TDH is essential in order to minimize such complications. The anesthetic management of a patient with previously unsuspected, chronic traumatic diaphragmatic hernia is discussed.
Human ; Male ; HERNIA, DIAPHRAGMATIC ; HERNIA, DIAPHRAGMATIC, TRAUMATIC ; PNEUMOTHORAX

Mitochondrial encephalomyopathies are genetic defects affecting the mitochondrial respiratory chain. This case report describes the anesthetic considerations for a patient with mitochondrial disease undergoing renal transplantation. Special risk such as malignant hyperthermia as well as plausible anesthetic technique are addressed. This is the case of a 36 year old female previously diagnosed to have end stage renal disease secondary to chronic glomerulonephritis and mitochondrial disease who presented for renal transplantation. Anesthetic technique was general endotracheal anesthesia under total intravenous anesthesia. To avoid a life threatening sequelae associated with mitochondrial diseases, vigilance towards possible complications was undertaken.
Human ; Female ; Adult ; MITOCHONDRIAL ENCEPHALOMYOPATHIES ; KIDNEY TRANSPLANTATION ; KIDNEY FAILURE, CHRONIC ; MITOCHONDRIAL MYOPATHIES ; MITOCHONDRIAL DISEASES

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

Introduction: Propofol is a nonopioid intravenous anesthetic with a fast onset and short duration of action. It is commonly used as an induction agent, the sole agent in total intravenous anesthesia, or in short ambulatory procedures. One side effect of this drug is pain on injection. The pain on propofol injection can reach as much as 70%. Different pharmacologic interventions have been used to decrease propofol injection pain. The objective of this study is to determine the efficacy of different pharmacologic agents in reducing propofol injection pain. Materials and methods: A search for randomized controlled trials was done using electronic databases and manual searching. Letters were sent to anesthesiology departments nationwide for unpublished studies that may be included. Studies that met the inclusion criteria were appraised for methodological quality by two independent reviewers using the Physiotherapy Evidence database (PEDro) assessment tool. Meta-analysis was done using Review Manager (RevMan) Version 5.0 for Windows. Results: Sixteen studies were included in the review. Meta-analysis was done for lidocaine versus normal saline in decreasing propofol injection pain. Nineteen percent of patients complained of moderate pain and 7 percent complained of severe pain among those treated with lidocaine compared with 81% and 93%, respectively, among those given normal saline solution. the interventions not included in the meta-analysis were assessed based on the levels of evidence by Furlan. Conclusion: Lidocaine 40mg/IV given prior to propofol was efficacious in decreasing pain compared with normal saline solution. There is strong evidence for the use of remifentanil 0.01-0.02 mg or 2ug/kg as pretreatment in decreasing pain on propofol injection.
Human ; Adult ; PROPOFOL ; PAIN MANAGEMENT ; ANESTHETICS, INTRAVENOUS ; LIDOCAINE

This is a case of 27-year-old male who sustained multiple metallic embolism from non-accidental self-injection of elemental mercury through the intravenous route. The patient allegedly self-injected at least twenty thermometers' worth of elemental mercury in a span of one year. The patient presented with generalized body fatigue, difficulty in position sense, distal hand weakness, tremors, labile mood, insomnia, and emotional instability. Physical examination showed multiple subcutaneous granulomas in the extremities at the sites of elemental mercury injection. Radiographic studies in the lungs, abdomen and extremities showed multiple dense spherules and pinpoint opacities indicative of metallic mercury embolism. Serum mercury levels were elevated. The patient underwent multiple hemodialysis sessions due to acute renal failure and tubular nephropathy secondary to mercury poisoning. The patient was eventually referred to the anesthesia department for excision of foreign body granulomas. Fentanyl, Propofol, Atracurium and Sevoflurane were used to induce and maintain anesthesia. Intra-operative course was unremarkable. Chelation therapy with DMSA (2,3-dimercaptosuccinic acid) was done postoperatively. Serum mercury was undetectable 20 days after surgery and chelation therapy. There were no postoperative complications. The patient was discharged well after 43 days of admission.
Human ; Male ; Adult ; EMBOLISM ; CHELATION THERAPY ; MERCURY POISONING, NERVOUS SYSTEM ; CUSHING SYNDROME

We describe a case of an 11 month- old boy suspected to have King- Denborough syndrome. He had multiple congenital anomalies and one of which is an inguinal hernia. Since such patients are predisposed to developing malignant hyperthermia, we did the repair of the inguinal hernia under spinal anesthesia.
Human ; Infant ; MALIGNANT HYPERTHERMIA ; HERNIA ; HERNIA, INGUINAL ; KING DENBOROUGH SYNDROME ; ANESTHESIA, SPINAL ; ANESTHESIA, CONDUCTION

Background. There has been an increasing awareness of the importance of acute pain management particularly multiple studies revealing the frequent undertreatment of acute pain and establishment of JCAHO pain management standard. Methodology. Current acute pain practices and patient satisfaction were assessed at St. Luke's Medical Center from May to September 2008 involving patients who underwent elective abdominal surgical procedures using a modified questionnaire based on the 2005 American Pain Society Quality Improvement Guidelines and Recommendations. Results: The study revealed predominant use of a multimodal approach to pain treatment which resulted in mean and median worst VAS scores of 4-5 and 5-6 respectively. Patient satisfaction was high and reasons for dissatisfaction include lack of empathy and indifference of healthcare providers, patients, and their families and a regular ongoing process of quality improvement. Conclusion. Recommendations are made on the institutionalization of efforts of the Acute Pain Service with emphasis on structural setup, multidisciplinary approach, education of health care providers, patients, and their families, and a regular ongoing process of quality improvement.
Human ; Aged ; Middle Aged ; Adult ; Young Adult ; PAIN MANAGEMENT ; PAIN CLINICS

HOSPITALS ; HOSPITAL ADMINISTRATION ;

Osteogenesis imperfecta is a rare inherited connective tissue disorder that presents with skeletal deformities and extraskeletal abnormalities. Pregnancy superimposed on existing osteogenesis imperfecta has a significantly increased maternal and fetal morbidity, hence presents multiple unique anesthetic challenges. A 25- year old term primigravid previously diagnosed with osteogenesis imperfecta and muscular dysthrophy presents for cesarean section. Important considerations in the management of this patient included anesthetic choice with their corresponding advantages and possible complications, patient positioning, intraoperative monitoring and possibility of difficult airway. Knowledge of the physiologic and anatomic abnormalities of the individual patients as well as understanding the advantages and complications associated with both regional and general anesthesia are thus crucial in formulating the appropriate anesthetic management plan that would ensure safety of both mother and child.
Human ; Female ; Adult ; OSTEOGENESIS IMPERFECTA ; ANESTHESIA ; CESAREAN SECTION ; PREGNANCY ; ANESTHESIA, CONDUCTION

Osteogenesis imperfecta is an inherited disorder of collagen with skeletal and extraskeletal manifestations that affect airway and anesthetic management of patients with the disease. This paper aimed to report a case of a patient with osteogenesis imperfecta for abdominal hysterectomy, discuss the anesthetic considerations of patients with the disease, describe balanced anesthesia using high dose dexmedetomidine as a primary agent and, use of ProSeal LMA for airway management. A 44- year old female with osteogenesis imperfecta is scheduled for abdominal hysterectomy for molar pregnancy. Airway management was achieved with a ProSeal LMA, and surgery was conducted using balanced anesthesia with high dose dexmedetomidine, midazolam, fentanyl, atracurium and O2- nitrous oxide. Dexmedetomidine was given at concentrations ranging from 0.7 mcg/kg/hr to 3mcg/kg/hr without untoward adverse effects. No complications were observed intraoperatively and in the immediate postoperative period. Dexmedetomidine is demonstrated to be safe and effective when used as part of a balanced anesthesia for patients with osteogenesis imperfecta. Likewise, the airway can be reliably managed with the use of a ProSeal LMA.
Human ; Female ; Adult ; OSTEOGENESIS IMPERFECTA ; DEXMEDETOMIDINE ; ANESTHESIA ; AIRWAY MANAGEMENT