Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial
[Efficacy and safety of remifentanil-based regimen for postoperative pain management in abdominal surgery patients: a double-blind study with low-dose remifentanil infusion of 0.02 microg x kg(-1) x min(-1)].
Remifentanil is a powerful analgesic with fast onset and ultra-short duration of action. Its context-sensitive half-time is consistently short even after a prolonged infusion. Remifentanil is effective for providing better postoperative analgesia, but this method is not generally accepted in Japan. The present study was conducted to document efficacy and safety of low-dose remifentanil infusion in postoperative patients. ⋯ Remifentanil infusion at 0.02 microg x kg(-1) x min(-1) can safely be used without any serious adverse events, while it may not be enough for postoperative analgesia. The best dosage of this drug for postoperative analgesia remains to be elucidated.
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Randomized Controlled Trial
[Effect of concentration on counting numbers on pain induced by injection of propofol].
One of the concerns in the use of propofol is the pain on injection of the drug. Many attempts were made to prevent such pain, none of which has been reasonably successful. We hypothesized that the pain is attenuated when the patient is directed to concentrate on counting numbers while propofol is injected. ⋯ Intensive counting did not reduce the incidence of pain on injection of propofol. Age and the degree of pain on inserting intravenous cannula can be a useful predictor for an intolerable pain on injection of propofol.
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We report our experience of successful nasotracheal intubation with a spiral tube, by using the Pentax-AWS Airwayscope (AWS) with a gum-elastic bougie (GEB) in a patient with invasive recurrent tongue cancer. The patient was a 55-year-old man who had undergone partial resection of the tongue and cervical lymphadenectomy, and was scheduled for extended resection of the tongue and larynx under general anesthesia. Sufficient mask ventilation with the head-tilt and chin-lift maneuver was achieved. ⋯ This allowed us to place the spiral tube uneventfully through the GEB. No evidence of bleeding or damage of the tumor was found. Nasotracheal intubation with the GEB under the guidance of the AWS monitor may be useful in cases such as those involving tongue cancer in which oral space is either narrowed or restricted.
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The i-gel is a relatively new supraglottic airway, which has been shown to be useful during general anesthesia, and it may have a potential role during cardiopulmonary resuscitation. In a manikin study, we have found that, compared with laryngeal mask airways, the i-gel was significantly easier and faster to insert, due mainly to no-necessity of cuff inflation. ⋯ The pack includes the i-gel O2 (which has a side port for oxygen delivery), a suction catheter, a sachet containing lubrication jelly, and a fixation strap. We describe the role of the i-gel during emergency airway management.
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We report our experience with the Pentax-AWS Airwayscope with an infant-size Intlock (AWS-I) in a patient with increased intracranial pressure due to acute hydrocephalus. A 12-month-old female infant with increased intracranial pressure due to acute hydrocephalus was scheduled to undergo emergent ventriculoperitoneal shunting under general anesthesia. She had a clonic convulsion and was sedated with midazolam. ⋯ Tracheal intubation while preventing an intracranial pressure increase was needed. After induction of general anesthesia with thiamylal and fentanyl the AWS-I was inserted to obtain a laryngoscopic view without excessive force. Under AWS observation, tracheal intubation was uneventful, and no vital sign change was observed.