Masui. The Japanese journal of anesthesiology
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We describe a case of negative pressure pulmonary edema (NPPE) followed by laryngospasm occurred immediately after extubation. A 56-year-old man with a tumor at the site of ureteroneocystostomy underwent left ureterectomy and partial resection of the neobladder under general anesthesia. The tracheal intubation was difficult with glade 3 of Cormack classification. ⋯ Furosemide was administered in ICU and mechanical ventilation with 5cmH2O PEEP was started. Seventeen hours later, the pulmonary edema disappeared and he was successfully extubated without any complications. It was warned that laryngospasm would occur even after the full emergence, leading to NPPE.
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The authors describe an experience of spinal cord stimulation (SCS) in a 30-year-old woman who developed complex regional pain syndrome type-I (CRPS-I) with spread phenomenon. She had received lumbar SCS under a diagnosis of CRPS-I in her left leg for 8 years. She had refractory pain in her right arm for the recent two years. ⋯ Test stimulation with cervical epidural spinal electrode showed good results and the pulse generator was implanted. It is suggested that the symptom of CRPS-I involving spread phenomenon was possibly due to a cortical reorganization. But a certain effect of SCS may be contributing to the favorable results of test stimulation for the treatment of CRPS-I with spread phenomenon in this case.
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It has been known widely that sensitivity to pain and opioid analgesics varies widely among individual subjects. Because of this variability, a dose of an opioid analgesic that can produce satisfactory pain relief without adverse effects in some patients might cause underdosing or overdosing in other patients, which is often problematic in the clinic. ⋯ Further, many technologies of genotyping polymorphisms, most often single nucleotide polymorphisms (SNPs), have been developed and advanced, leading to accelerated understanding of many associations between various genetic polymorphisms and sensitivity to pain and opioids. In this article, we review the evidence of these associations accumulated thus far.
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Randomized Controlled Trial Comparative Study
[Comparison of intravenous fentanyl analgesia and epidural analgesia for postoperative pain relief].
Epidural analgesia is available for postoperative pain relief except for the patients with bleeding tendency or under anticoagulation. Intravenous fentanyl analgesia can be applied for such patients but its effect has not been evaluated enough. We compared these two methods after abdominal surgery. ⋯ Intravenous fentanyl analgesia is safe and possibly more effective than epidural analgesia.
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There are gene polymorphisms changing the expression or activation of the serotonin (5-HT) receptors, which are associated with pain. This review showed an availability of 5-HT2A receptor gene polymorphism in analgesic sensitivity. To search gene polymorphisms related to analgesic sensitivity is important to further effective pain management. In future 5-HT2A receptor gene polymorphisms, together with polymorphisms of other genes, may greatly contribute to effective postoperative pain management and personalized medicine.