Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Advantage of ropivacaine for postoperative epidural analgesia following leg orthopedic surgery].
Epidural administration of local anesthetics may lead to effective pain relief. However, tachyphylaxis or other problems following prolonged epidural anesthesia may develop and in many cases difficulties exist in the maintenance of the similar degree of sensory blockade. The present study was therefore performed to investigate the analgesic effect of continuous postoperative epidural infusion of ropivacaine with fentanyl in comparison with that of bupivacaine or ropivacaine alone. ⋯ Epidural injection of ropivacaine with fentanyl decreased postoperative pain with stable vital signs in patients undergoing leg orthopedic surgery, as compared to bupivacaine or ropivacaine alone, possibly because of the maintenance of sensory blockade by ropivacaine and enhancement of this sensory blockade by fentanyl.
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Clinical Trial Controlled Clinical Trial
[Intra-operative ketamine administration reduced the level of post-thoracotomy pain].
Two different types of post-operative pain (such as acute pain and chronic pain) occur in patients undergoing thoracotomy. It has been suggested that the acute post-thoracotomy pain consists of inflammatory pain and chronic post-thoracotomy pain caused by intercostal neuralgia. In the present study, we examined the effect of intra-operative administration of ketamine, an NMDA receptor antagonist, on the acute and chronic post-thoracotomy pain. ⋯ These data suggest that post-thoracotomy pain might be mediated by NMDA receptor dependent central sensitization and that the intra-operative administration of ketamine might block the development of the NMDA receptor dependent central sensitization.
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We previously showed that pre-operative hemorrhagic shock and surgical hemorrhage were the major causes of life-threatening events in the operating room and subsequent fatality. We investigated the background of these events. ⋯ To reduce life-threatening hemorrhagic events in the operating theater, reorganization of emergency medical service and blood supply, improvement of surgical techniques, improved triage of patients with hemorrhagic shock, flexible application of compatible blood products in emergency situations, and improvement of the quality and number of anesthesiologists should be considered.
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Clinical Trial
[Effectiveness of ropivacaine and fentanyl for postoperative epidural analgesia following thoracic surgery].
Epidural ropivacaine is now a common drug used for postoperative analgesia. However, little information is available concerning regression of sensory blockade and analgesia following prolonged epidural infusion of ropivacaine. We investigated the efficacy of ropivacaine and fentanyl for postoperative analgesia after thoracic surgery. ⋯ A bolus of 3 ml with continuous 4-6 ml x h(-1) epidural injection of ropivacaine plus a small dose of fentanyl would decrease postoperative pain with stable vital signs in patients after thoracic surgery.
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We experienced acute myocardial infarction due to coronary artery spasm after caesarean section. A 41-year-old multigravida woman with no previous cardiac history or coronary risk factor developed acute myocardial infarction after caesarean section, and was successfully resuscitated with emergency percutaneous transluminal coronary angioplasty. Acute myocardial infarction during pregnancy and postpartum period is a rare event, but could be associated with high mortality if it occurs. It is necessary to consider the possibility of acute myocardial infarction and provide early diagnosis and treatment by multidisciplinary team when a pregnant woman complains of retrosternal chest pain.