Masui. The Japanese journal of anesthesiology
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The aim of the study was to evaluate the efficacy and the incidence of complication in pediatric patients for laparotomy receiving continuous fentanyl infusion for postoperative pain. ⋯ Intravenous fentanyl infusion for postoperative pain in pediatric patients after laparotomy is an effective and safe procedure with a few complications.
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Chronic intractable pain is well known to be very difficult in management. The mechanisms of intractable chronic pain are complicated. Therefore, such a patient is often involved with multiple pain mechanisms and needs multiple drugs which have different types of analgesic actions. ⋯ Therefore, the evaluation of many factors which modulate the pain behavior is important. Opioids such as morphine and other analgesics are sometimes useful for the treatment of chronic intractable pain. Nerve blocks and interventional treatments are also helpful.
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Patient controlled epidural analgesia (PCEA) is a useful method in alleviation of postoperative pain; however, PCEA sometimes provided inadequate pain relief in the elderly. Therefore, we investigated optimal doses of fentanyl by PCEA in management of postoperative pain after gynecological surgery in the elderly. ⋯ We found that fentanyl 0.172 microg x kg(-1) x 1 hr(-1) by PCEA was the most appropriate dose for alleviation of postoperative pain after gynecological surgery in the elderly.
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Case Reports
[Pulmonary aspiration during anesthetic induction in a patient with a history of distal gastrectomy].
We experienced a case of pulmonary aspiration during anesthetic induction. Posterior laminoplasty was scheduled for a 59-year-old man with ossification of posterior longitudinal ligament, who had undergone distal gastrectomy 30 years ago. Anesthesia was induced with intravenous administration of midazolam and fentanyl, and inhalation of sevoflurane was gradually increased to 7% in oxygen under spontaneous breathing, since difficult intubation had been predicted due to poor neck mobility However, the patient vomited during laryngoscopy. ⋯ After administration of fentanyl, continuous administration of intravenous dexmedetomidine was started, and 2% lidocaine viscous solution was gargled. Endotracheal intubation was successfully performed using AirWay Scope without pulmonary aspiration, and midazolam was administered intravenously. Surgery was completed without any troubles, and the patient was extubated fully awake.
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Anesthetic management of cesarean section for placenta accreta is very challenging. The aim of our retrospective study was to review past placenta accreta cases in our hospital to suggest a strategy for anesthetic management for placenta accreta. ⋯ We suggest the minimum requirements for anesthetic management in patients with placenta accreta as follows: (1) discussion with obstetricians to formulate a cesarean section plan, (2) early evaluation to formulate an anesthetic plan and to obtain informed consent, (3) two experienced anesthesiologists, (4) general anesthesia, (5) 2 large-bore intravenous lines, (6) an arterial line and (7) 10 units of both fresh frozen plasma and crossmatched packed red blood cells.