Neurophysiology and anesthetic implications

Changes in cerebral blood flow influence not only the metabolism of the brain but alo brain bulk and hence intracranial pressure. Changes in intracranial dynamics are fundamental to neuroanesthetic practice, and therefore intracranial pressure.

A double-blind, randomized study comparing postoperative pain management using epidural ropivacaine with intravenous ketorolac or intravenous ketorolac alone following transabdominal hysterectomy.

OBJECTIVE: The aim of this study is to compare the effect on postoperative pain of epidural ropivacaine in combination with intravenous ketorolac with intravenous ketorolac alone following transabdominal hysterectomy. DESIGN: A multi-center, randomized, double-blind study was conducted in Thailand and the Philippines to assess postoperative pain management in 107 patients given ketorolac alone or in combination with epidural ropivacaine following transabdominal hysterectomy. Pain score was assessed using a 100-mm visual analogue pain scale (VAS). RESULTS: The VAS scores for pain on coughing and at rest were significantly better in the ropivacaine group. The number of patients who asked for morphine in addition was higher in the ketorolac group compared to the ropivacaine + ketorolac group. The time taken to carry out the first three ambulatory steps was similar for both the two treatment groups. A higher degree of motor block was observed in the ropivacaine group over time. The adverse events observed were similar in both groups. CONCLUSION: We demonstrated that epidural infusion of ropivacaine in addition with intravenous ketorolac gave superior pain relief at rest and on coughing in patients undergoing transabdominal hysterectomy when compared to the group receiving intravenous ketorolac alone.

Sedation for pediatric patients outside the operating room: A review

Sedation is defined as "a technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation to render unintended loss of consciousness unlikely. In this sedated state, it is believed that protective reflexes are intact, the airway is maintained independently and continuously, and the child can respond to physical stimulation or verbal command. In reality and in pediatric practice, it is difficult to realize the anxiolysis, analgesia, sleep and lack of movement necessary for the safe conduct of many diagnostic and therapeutic procedures. Many children are in fact anesthetized to achieve these aims. Loss of consciousness is a state of anesthesia with all its attendant risks. In the published guidelines for pediatric sedation, definitions of light sedation, deep sedation and anesthesia overlap. It follows, therefore, that in the interests of safety, the standards for care for sedation should be the same as those for the child undergoing anesthesia. In dental practice, "conscious sedation" in tandem with behavioural management techniques is the ideal. If, despite the use of these techniques, the child remains uncooperative, alternative approaches such as deep sedation or general anesthesia are to be considered. This elusive state of "conscious sedation" is attempted in other areas outside the operating theatres in the belief that respiratory distress is less likely to occur. In many instances, the anesthesiologist is called when the procedure cannot be carried out because, either sedation is inadequate / unsuccessful or a complication of deep sedation has taken place. Barbiturates, benzodiazepines, narcotics, antihistaminics, chloral hydrate, ketamine, and propofol are among the drugs that have been used to induce sedation. Unfortunately, serious cardiac and respiratory side effects, as well as excessive sedation have been associated with these drugs, even when normal doses are used. This review shall endeavor to present the risk factors, agents and techniques, areas of application, and recommendations for the safe use of sedation.

Ketamine analgesia for dilatation and currettage

This study evaluated ketamine as an analgesic used on Filipino patients for Dilatation and Currettage. Due to bed space limitations and the increasing trend to raise patient turnover by providing ambulatory care, ketamine promised to provide the appropriate analgesia with an early return of function.

The effects of anesthesia on the memory of surgical patients

The aim of this study was to determine if anesthesia has any influence on human memory.

Balanced anesthesia with nalbuphine hydrochloride in pediatric patients : preliminary study

This study of the clinical use of nalbuphine as a component of a balanced anesthesia technique was undertaken with the purpose of exploring the feasibility and safety of this drug as well as to establish possible guidelines for its use.

Anesthetic management of the airway in patients with burn contractures of the neck

This study presents a review of thirteen cases of severe neck contractures done at the University of the Philippines - Philippine General Hospital Medical Center from 1977 to 1980. From a comparison of the different anesthetic techniques and their results, we hope to recommend a safe and effective technique for use in such cases.