Background: For several decades now, the use of uncuffed endotracheal tube (ETT) is the gold standard in providing airway and ventilatory support to children under anesthesia. However, there has been a change in focus from the application of uncuffed ETT to cuffed ETT among children, and this matter has been debated for years. In fact, several studies have shown that even across and within countries, the attitudes and practices of anesthesiologists on the use of types of endotracheal tubes differed. Objective: To describe the current attitudes and practices of anesthesiologists regarding the use of uncuffed or cuffed ETT for children. Methods: A systematic review of observational studies on the current attitudes and practices of pediatric anesthesiologists regarding the use of cuffed and uncuffed ETT was conducted from May to November 2020. Cochrane reviews, Medline, Pubmed, and EMBASE were searched and yielded five relevant studies. Results: The use of cuffed ETT ranged between 11%-61% in the included studies and all reported that there were no consensus or standard on whether cuffed or uncuffed ETT was better. Reported factors for cuffed ETT use included: 1) Personal choice, 2) Department protocol, 3) Availability of resources, and 4) Specific conditions such as obesity, planned or emergency procedure, and reduced lung compliance. In terms of ETT size, reported criteria were: 1) Use of a formula, 2) Use of abacus/calculator, and 3) In relation to the fifth finger's width. Conclusions The current systematic review demonstrated that there is wide variation in current attitudes and practices of anesthesiologists regarding the use of uncuffed or cuffed endotracheal tubes in children. Likewise, factors affecting choice of ETT and criteria for selection varied in the published literature. The results of this systematic review highlight the need for a standard guideline to help clinicians choose if cuffed or uncuffed ETT is better in certain scenarios and to help them decide in selecting the most appropriate ETT size.
Anesthesiology

Rationale: The provision of surgical services in the Philippines is an essential component of our healthcare system. Despite an increasing number of accredited training programs, geographic maldistribution remains a key factor in access to surgical care in the country. This study aimed to describe the geographic distribution of surgeons and anesthesiologists in the Philippines and factors that affect their practice to provide insights into the country's surgical capabilities. Additionally, demographic factors such as workforce density, professional mobility, and economic indicators were explored. The ultimate goal was to establish an updated database for continuous monitoring of surgical manpower, facilitated through the collaboration of the Philippine College of Surgeons (PCS) and the Philippine Society of Anesthesiologists (PSA). Methods: This cross-sectional study, sponsored by the World Surgical Foundation (WSF) and the Philippine College of Surgeons Foundation (PCSF), received exemption from review by the Single Joint Research Ethics Board (SJREB) of the Department of Health. An online survey was distributed to surgeons and anesthesiologists across the Philippines from July 1 to December 31, 2020. Active practitioners in relevant specialties were eligible, excluding retirees. Procedures adhered to ICH-GCP principles, National Ethical Guidelines, and the Data Privacy Act. Additional data, sourced from various outlets, was consolidated, verified and subsequently entered into an electronic data sheet (Google Sheets, Google LLC, Palo Alto CA) to extract descriptive statistics of the surgical and anesthesia workforce at the national and regional levels. Results: Analysis of the data indicates male dominance with a noticeable trend of increasing female participation in surgical training programs, while anesthesiologist gender distribution showed a female preponderance. Maldistribution in manpower persists, influenced by factors such as training programs, medical education, and the availability of secondary and tertiary hospitals, and other socio-economic conditions in the country. The study reveals regional variations in the distribution of surgeons and anesthesiologists in the Philippines, with a notable concentration in urban centers, the highest being in Luzon, particularly in the National Capital Region (NCR). Conclusion The study highlights gender disparities and regional variations in the distribution of surgeons and anesthesiologists in the Philippines, with a significant concentration in Luzon, particularly in the National Capital Region (NCR). Disparities in subspecialty distribution are exacerbated by healthcare education discrepancies and inadequate healthcare infrastructure especially in rural areas. Addressing these challenges requires focused efforts on expanding training programs, recruiting specialists, and ensuring equitable access to surgical care nationwide. Establishing a comprehensive surgical workforce database is essential for informed policymaking, monitoring workforce distribution, and assess service quality to enhance access to surgical services.
Workforce ; Health Resources ; General Surgery ; Anesthesiology

Endoscopy, Gastrointestinal ; Anesthesia ; Surveys and Questionnaires ; Anesthesiology ; Hospitals, Public ; China ; Endoscopy

Anesthesia/adverse effects* ; Anesthesiology ; Humans ; Neuromuscular Monitoring

Fuwai Hospital was established in 1956 and the Anesthesia Department of Fuwai Hospital was one of the earliest anesthesia departments then in China. Under the leadership of several department directors and with the concerted efforts of all generations of colleagues, the Anesthesia Department of Fuwai Hospital has dramatically transformed, upgraded and modernized. For more than six decades, the Anesthesia Department has been providing high-quality peri-operative anesthesia care for cardiovascular surgeries, conducting innovative experimental and clinical researches, and offering comprehensive training on cardiovascular anesthesiology for professionals across China. Currently, Fuwai Hospital is the National Center for Cardiovascular Diseases of China and one of the largest cardiovascular centers in the world. The present review introduces the Anesthesia Department of Fuwai Hospital, summarizes its current practice of anesthesia management, the outcomes of cardiovascular surgeries at Fuwai Hospital, accumulates relevant evidence, and provides prospects for future development of cardiovascular anesthesiology.
Anesthesia ; Anesthesia Department, Hospital ; Anesthesiology ; Cardiovascular Diseases ; Hospitals ; Humans

Background: The aims of this study were to determine the average length of stay in the Post-anesthesia Care Unit (PACU LOS) in the Philippine General Hospital (PGH) and to create a model that will predict the PACU LOS based on the factors that significantly affect the LOS. Determination and prediction of PACU LOS is essential in resource utilization, and in cost containment and reduction. Addressing the modifiable variables that affect the PACU LOS may lead to an improvement in the LOS of patients in the PACU and, consequently, to better recovery room staffing and a reduced cost for the patients and the hospital. Methods: A prospective chart review of 400 postoperative patients admitted in the PGH PACU was done. Summary statistics were presented. Using the set of variables found to be significant, a regression model was formulated to estimate the PACU LOS. Results: The mean PACU LOS was 4.59 hours. There were significant differences in the mean PACU LOS based on the occurrence of complications. There were also significant differences in the median PACU LOS based on the type and duration of surgery, anesthetic technique, and duration of anesthesia. The multiple linear regression model that best predicted PACU LOS included ASA-PS classification, type of surgery, duration of surgery, anesthetic technique, and occurrence of intraoperative or postoperative complications. Conclusions The mean PACU LOS of the Philippine Genera Hospital is higher than that of published data. The factors included in the model that best predicts PACU LOS may be studied to improve the PACU LOS.
Length of Stay ; Anesthesia ; Anesthesiology ; Regression Analysis

INTRODUCTION: Intrathecal morphine, commonly administered at doses of 100 to 200 mcg, is a popular choice for post-cesarean analgesia; however, a trade-off between opioid analgesia and side effects exists. This study was conducted to determine the lowest dose of intrathecal morphine that will provide adequate analgesia with the least side effects among post-cesarean patients. METHODS: Sixty term parturients for cesarean delivery under spinal anesthesia were randomized into three treatment groups to receive 50, 100 or 150 mcg of intrathecal morphine with a standard multimodal pain regimen and intravenous tramadol as needed. Pain scores, demand for rescue analgesic, and incidence of adverse effects (nausea, vomiting, and pruritus) during the first 24 hours’ post-spinal anesthesia were recorded and compared between groups. RESULTS: Pain scores and demand for rescue doses of tramadol were higher for the 50-mcg group as compared to the other groups. There was no significant difference in pain scores between the 100 and 150-mcg groups. No rescue dose of tramadol was necessary in the 100 and 150-mcg groups. No significant difference was seen in the incidence and severity of nausea and vomiting across treatment groups. The incidence and severity of pruritus were significantly higher in the 150-mcg group. No significant difference was noted in the incidence and severity of pruritus between the 50 and 100-mcg groups. CONCLUSION A dose of 100 mcg of intrathecal morphine, in combination with a multimodal regimen, provides adequate analgesia with the least side effects.
pain management ; Pregnancy ; Female ; Cesarean Section ; Anesthesiology ; Analgesics, Opioid ; morphine

Muscle relaxant monitor is a research hotspot in the field of clinical anesthesiology. According to the research status at home and abroad, combing the developing history of muscle relaxant monitor, detecting principle, a variety of electrical stimulation mode, and a variety of detection ways, this study reviews and analyzes the advantages and disadvantages of various testing methods and application status, provides technical research foundation for the degree of nerve block for quantitative assessment of muscle relaxant monitor instrument design. Meanwhile, we advocate that clinicians should use quantitative muscle relaxant monitor as much as possible in the perioperative period to reasonably guide the use of muscle relaxants so as to reduce the risk of complications caused by residual effects of muscle relaxants and provide more scientific and accurate digital guidance for assessing the degree of muscle relaxants of patients.
Anesthesiology ; Electric Stimulation ; Humans ; Monitoring, Physiologic ; Muscle, Skeletal

With the life span of the general population increased, rectal prolapse in elderly patients became a major concern in terms of the decision of the treatment modalities and quality of life of patients. Most elderly patients with rectal prolapse in the past received a perineal approach with the fear of general anesthetic complications rather than the abdominal approach. However, improvement in perioperative care in anesthesiology and minimally invasive surgery, the trend of surgical management of rectal prolapse is rapidly changing. Minimally invasive surgery including the laparoscopic and robotic surgeries showed comparable short-term outcomes even in elderly patients. Recently published guidelines also recommended a laparoscopic abdominal approach for the management of rectal prolapse.
Aged ; Anesthesiology ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Perioperative Care ; Quality of Life ; Rectal Prolapse

PURPOSE: As the Korean population ages, an increasing number of elderly patients with gastric cancer are undergoing surgical resection. The aim of this study was to analyze the surgical outcomes and prognostic factors after gastric cancer surgery for patients 80 years of age or older.METHODS: We analyzed the medical records of 720 patients with gastric cancer who underwent gastrectomy from March 2010 to December 2014 retrospectively. Patients were divided into two groups: octogenarians (age ≥80 years, n=46) and non-octogenarians (age <80 years, n=674). We evaluated clinicopathologic data including postoperative morbidity, mortality, and 5-year survival rate.RESULTS: The rate of curative resection was not different between the two groups. The American Society of Anesthesiology score was significantly higher in the octogenarians (P<0.05). Octogenarians exhibited poorer performance scale scores, higher comorbidities, and more advanced TNM stages than non-octogenarians. There was no difference in surgical resection margins between the two groups. In addition, octogenarians suffered from more postoperative morbidity and mortality than non-octogenarians. In the analysis of risk factors of survival after gastrectomy for octogenarians, advanced TNM stage and dose of transfusion were independent risk factors. Overall survival was significantly lower in octogenarians than non-octogenarians. There was no difference in the disease-specific survival for each stage of cancer after adjustment for tumor stage.CONCLUSION: Octogenarians had more preoperative risk factors and postoperative morbidity and mortality, but cancer-specific survival was comparable with non-octogenarians. Careful preoperative evaluation, thorough resection, and attentive postoperative care can improve the overall survival of octogenarians with gastric cancer.
Aged ; Aged, 80 and over ; Anesthesiology ; Comorbidity ; Gastrectomy ; Humans ; Medical Records ; Mortality ; Postoperative Care ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; Survival Rate ; Treatment Outcome