Masui. The Japanese journal of anesthesiology
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The salivary enzyme alpha-amylase is an established non-invasive marker of psychological and physiological stress. Since there are positive correlations between salivary alpha-amylase secretion and sympathetic parameter increment during stress, salivary alpha-amylase might be an indicator of sympathetic-adrenal-medullary (SAM) system and central sympathetic activity In contrast, it is well known that sympathetic neural activity is significantly involved in development and deterioration of pain symptoms as a part of pain disorders. ⋯ Furthermore, a hand-held device, which is able to measure the activity of salivary alpha-amylase easily and quickly, was developed recently, and we can try to evaluate the condition of pain at the outpatient clinic and the bedside. Though the actual utility of this measuring device for clinical use is unclear, it is hoped that the measuring device of salivary alpha-amylase is one of helpful methods for pain assessment in the future.
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Propofol target-controlled infusion (TCI) is now commonly used for the induction and maintenance of anesthesia. In this study, we measured the propofol plasma concentrations of elderly patients to evaluate our hypothesis that propofol TCI is reliable for use in elderly patients. ⋯ We concluded that propofol TCI is a reliable method for maintaining anesthesia even in elderly patients, whereas the individual differences of the elderly patients was greater than those obtained from normal patients.
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Spinal cord stimulation (SCS) is an established treatment for intractable neuropathic pain. SCS is performed using an implantable pulse generator connected to leads with electrodes positioned in the dorsal epidural space, which are then used to stimulate the ascending and descending dorsal column fibres to achieve paresthesia covering the area of pain. ⋯ The clinical indications for SCS are mainly peripheral vascular diseases (PVD), refractory angina, failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS) type 1 and type 2, spinal cord stenosis and neuropathic pain. The new puncture trial method is less invasive and can reduce psychological resistance of the patient for SCS manipulation.
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Continuous infusion of fentanyl for postoperative pain management is performed commonly. But the usage of traditional syringe pump or infusion pump sometimes makes medical staff confusing for its difficulties of handling. We have simplified the postoperative pain management system using the single-use continuous infusion device and the protocol for administration of fentanyl. ⋯ It is concluded that good postoperative pain management is possible with single use infusion device safely.
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Pain of the leg ulcer significantly decreases patients' QOL, and pain control is an important treatment as the ulcer treatment. Continuous epidural block is often selected, but we can not provide enough continuous epidural block because of oral anticoagulant treatment and infection because of long-term indwelling catheter. ⋯ We obtained approvals not only from patients but also from plastic surgeons and dermatologists. We suggest that continuous popliteal block can be a usual method of the general pain control procedure.