Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Effect of pre-mixed lidocaine with propofol on propofol injection pain in elderly patients].
The purpose of this study was to compare the younger and older patients in the incidence and the severity of the pain during injection of propofol. Thirty-four, elderly patients (60-80-yr-old) and 52 patients (20-40-yr-old) scheduled to undergo elective surgery were studied. We conducted a prospective, randomized and double-blinded trial. ⋯ There were no significant differences between older and younger patients in the severity of propofol injection pain in both S group and L group. In conclusion, elderly patients suffered the pain on injection of propofol with the same incidence as the younger patients did. Lidocaine premixed with propofol significantly reduces the incidence and the severity of pain associated with propofol in elderly patients.
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Clinical Trial
[Relief of subacute herpetic pain and postherpetic neuralgia with repeated application of 10% lidocaine cream].
Analgesic efficacy of repeated application of a lidocaine cream formula was investigated in herpes zoster patients with subacute pain with no further improvement after continued treatment since their acute stage (S-HZ group, n = 23), and in patients to whom past treatments had not provided adequate pain relief (PHN group, n = 28). In both groups, visual analog scale (VAS) values decreased significantly from their corresponding values before the present treatment with few cases of side effects and complete disappearances of the pain in 21.6% of all the patients. The results indicate that the repeated application of the lidocaine cream is a safe and effective treatment method. Significantly higher effectiveness was achieved in the S-HZ group in terms of the difference in the VAS values between before and after the treatment, effectiveness in improving the activities of daily life, and overall efficacy evaluation.
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Monitoring of motor-evoked potentials (MEPs) is employed to examine functional integrity of descending motor pathway during thoracic aortic surgery. We experienced two cases of intraoperative changes in MEPs during thoracic aortic replacement. ⋯ No postoperative paraplegia was found in both cases. We conclude that monitoring of MEPs is useful not only because we can detect symptoms of the spinal cord injury from ischemia immediately but also because they give us a clue to decide operative procedures.
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We report a case of unexpected difficult intubation in an adult caused by a laryngeal web. A 43-year-old woman with uterine myoma was scheduled for abdominal hysterectomy. After induction of anesthesia, the vocal cords were seen clearly under laryngoscopy. ⋯ Bronchoscopy revealed a very narrow airway below the level of vocal cords caused by a laryngeal web. Tracheostomy was performed. Two weeks later, tracheostomy was closed without any sequela.
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Comparative Study Clinical Trial
[Intravenous patient controlled analgesia combined with continuous thoracic epidural analgesia for post-thoracotomy pain].
We compared the efficacy of intravenous patient controlled analgesia of buprenorphine plus continuous thoracic epidural infusion of bupivacaine (IV-PCA group) with the efficacy of continuous thoracic epidural infusion of bupivacaine and buprenorphine (the TEA group). No patient in IV-PCA group required supplemental analgesics, while 90% of TEA group required supplemental intramuscular buprenorphine to relieve post-thoracotomy pain. In TEA group, 94% of the supplemental drugs were administered during night shifts. These results indicate that IV-PCA of buprenorphine combined with continuous thoracic epidural infusion of bupivacaine is more effective analgesic management than continuous TEA with buprenorphine and bupivacaine.