Masui. The Japanese journal of anesthesiology
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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.
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Randomized Controlled Trial
[Incidence and onset time of fentanyl-induced cough depends on the dose of IV fentanyl].
IV fentanyl en bolus can provoke cough reflex. We evaluated the effects of the IV fentanyl dose on the incidence and onset time of fentanyl-induced cough. ⋯ The results indicated that the incidence of fentanyl-induced cough increased, and the onset time decreased, with the increasing dose of fentanyl.
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A 73-year-old man with severe orthostatic hypotension was scheduled for open cholecystectomy. His blood pressure was 126/80 mmHg in the supine position and 50/30 mmHg in the upright posture. ⋯ Epidural anesthesia was used in the latter half of the operation. Meticulous use of vasoactive drugs such as dopamine and phenylephrine as well as adequate maintenance of systemic blood volume by infusion of a crystalloid solution enabled his hemodynamic condition to become stable during anesthesia.
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Visual disturbance including visual loss is a rare but devastating complication after non-ophthalmic surgery. Reported incidence of visual disturbances ranged from 0.028 to 0.2% after spine surgery and from 0.0009 to 25.6% after cardiac surgery. ⋯ After cardiac surgery, anterior ischemic optic neuropathy is most prevalent and risk factors included age, diabetes, long cardiopulmonary bypass time and anemia. Anesthesiologists and surgeons should be aware of this complication and further investigations regarding etiology, prevention and managements on postoperative visual disturbances would be required.