A 9-year-old female with Trisomy 21 with complex craniovertebral instability causing severe cervicomedullary compression underwent occipitocervical fusion. This paper will discuss the anaesthetic management and highlight the use of the Narcotrend monitor not only as a depth of consciousness monitor but more importantly as a tool to detect surgery-induced cerebral hypoperfusion by monitoring the right and left cerebral hemispheres independently and simultaneously.

Background. Minimally invasive spine surgical techniques (MISST) are associated with less intraoperative blood loss, shorter duration of surgery, and less post-operative pain. In the last two decades, MISST have been performed on an outpatient basis in developed countries but it is still performed primarily on an inpatient basis in the Philippines. This study aims to determine the safety and effectiveness of performing MISST in an ambulatory surgical center in the Philippines. Methods. A retrospective chart review of patients who underwent MISST in an ambulatory surgical center (ASC) in Manila, Philippines, from January 2014 to December 2018 was done. The different types of MISST were identified and analyzed as to patient demographic characteristics, anesthetic perioperative management, outcomes and complications. Results. Out of 337 patients included in the review, 8 types of MISST were identified. The average patient age was 55.61 years. Majority (98.2%) of the patients were classified as American Society of Anesthesiologists (ASA) physical status I or II. All patients had a statistically significant (p < 0.05) reduction in pain scores. ASC length of stay varied based on the complexity of the procedure ranging from 2.1 to 12.9 hours. There was a 0.89% incidence of surgery-related complications. Majority (94.4%) of the patients were discharged to home. There was no mortality. Conclusion. Even in a developing country, transitioning MISST from inpatient to the ambulatory setting can be performed with minimal complications and unplanned hospital admissions while still achieving significant pain reduction. The key elements include careful patient selection, close coordination between the anesthesia and spine surgical teams, and provision of multimodal analgesia.

Objective. Chronic cancer pain and depressive symptoms are interrelated in clinical settings. As local data is lacking, this study aimed to determine the prevalence of depressive symptoms among chronic cancer pain patients seen at the Philippine General Hospital - Pain Clinic (PGH-PC).Methods. In this retrospective, descriptive, cross-sectional study, data were collected from the charts of chroniccancer pain patients seen at the PGH-PC. The Pain Clinic Self-Report Questionnaire (SRQ) tool was used to assess depressive symptoms. Clinico-demographic data were obtained and analyzed using descriptive statistics.Results. Of the 129 patients included in the study, 61 had depressive symptoms corresponding to a prevalence of 47.29% (38.72 - 56.01 95% CI). Overall, a more significant number of patients included in the study were female, belonged to age 41-50, were married, attained secondary education, and were unemployed. Demographically, there were no statistically significant differences between chronic cancer pain patients who exhibited depressive symptoms and those who did not. The cancer type showed a statistically significant difference among those cancer patients with or without depressive symptoms (p = 0.016). Breast and gynecologic malignancies comprised more than half of the patients studied. Neither the cancer stage nor the pain scores had a statistically significant difference among those cancer patients with or without symptoms of depression.Conclusion. Almost 1 in every two chronic cancer pain patients studied had depressive symptoms. Routine screening of patients for depressive symptoms could identify patients and may initiate interventions in this vulnerable population