Masui. The Japanese journal of anesthesiology
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Paralysis after long-term administration of neuromuscular blocking agents especially pancuronium and vecuronium has been reported since 1970's. In this article, these papers were reviewed, and the etiology and the clinical features were analyzed. Most of the cases of muscle paralysis after prolonged use of pancuronium bromide were associated with concomitant use of large doses of steroids. ⋯ In patients with impaired hepatic and/or renal functions, metabolites of neuromuscular blocking agents might accumulate. In some patients with paralysis after neuromuscular blocking agents, underlying neuromuscular complications such as critical illness polyneuropathy have been implicated with the cause of the muscle paralysis. In order to avoid paralysis after long-term administration of neuromuscular blocking agents, following recommendations are made. 1) Monitor neuromuscular blockade. 2) Examine patient's neuromuscular status before starting to give relaxants. 3) Be careful in giving relaxants in patients with poor renal and/or hepatic functions. 4) Use smallest possible amount of relaxant. 5) Be careful about the drugs administered simultaneously especially steroids and antibiotics. 6) During the use of a neuromuscular blocking agent, perform physical therapy of extremities to avoid disuse atrophy especially when its administration is temporally terminated.
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Of 2,667 patients with herpes zoster who visited our hospital between January 1972 and March 1989, 136 patients whose treatments were started after more than 6 months following the onset were subjects of the present study. Thus we performed a retrospective study of the therapeutic effects of sympathetic ganglion block (using alcohol) on postherpetic neuralgia left untreated for more than 6 months after the onset. ⋯ Thus the patients who underwent sympathetic ganglion block with alcohol tended to show better results. The above findings suggest that, in patients with postherpetic neuralgia in whom the initiation of treatment was delayed, treatment mainly consisting of thoracic or lumbar sympathetic ganglion block using alcohol in combination with antidepressants and antianxiety drugs can greatly improve patients' activities of daily life and that, at present, this method is most effective in relieving postherpetic neuralgia.
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Four patients with severe and intractable cancer pain were treated with continuous subarachnoid analgesia (CSA). All patients underwent placement of a 32-gauge subarachnoid catheter attached to an infusion pump allowing continuous administration of local anesthetic agent and morphine. ⋯ At present, CSA is not a routine treatment, because it may lead to severe complications. CSA produces excellent pain relief without disturbing consciousness and is recommended for the treatment of severe and intractable cancer pain.
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Optimal dose of epidural midazolam with saline for postoperative pain relief was investigated. Forty three patients for upper abdominal surgery were divided into 5 groups. Each group had either 10 ml saline only (saline group), 10 ml saline + midazolam 0.025 mg.kg-1 (0.025 group), 10 ml saline + midazolam 0.05 mg.kg-1 (0.05 group), 10 ml saline + midazolam 0.075 mg.kg-1 (0.075 group), or 10 ml saline + midazolam 0.1 mg.kg-1 (0.1 group) administered epidurally for complaint of postoperative pain. ⋯ TNA was about 2 hours in 0.025 and 0.05 groups, over 6 hours in 0.075 and 0.1 groups. Complete sleep was the cause of long TNA in 0.075 and 0.1 groups. It was concluded that optimal dose of epidural midazolam with saline 10 ml was 0.05 mg.kg-1 for postoperative pain relief after upper abdominal surgery.
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The changes in EMG evoked by train-of-four (TOF) stimulation of ulnar nerve were recorded to determine proper single bolus dose of vecuronium for endotracheal intubation in surgical patients. Onset and duration of neuromuscular block were judged by percent depression of EMG. Mean time intervals for 90% depression in TOF seen in 0.10 mg.kg-1 vecuronium group (n = 10), 0.15 mg.kg-1 vecuronium group (n = 10) and 0.20 mg.kg-1 vecuronium group (n = 10), were 181.1 sec, 135.0 sec and 120.0 sec, respectively. ⋯ No statistically significant difference was observed in recovery time between 0.10 mg.kg-1 and 0.15 mg.kg-1 group. These results indicate that the appropriate dose of vecuronium for rapid intubation is considered to be 0.15 mg.kg-1. This dose is allowable for surgical procedures of short duration.