Masui. The Japanese journal of anesthesiology
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We report a case of successful one-lung ventilation with a spiral-tipped double lumen tube for resection and reconstruction of the tracheal bifurcation. A 71-year-old woman with lung cancer developed its invasion to the right bronchus near the tracheal bifurcation. Right lung total pneumonectomy or reconstruction with resection of the tracheal bifurcation was planned. ⋯ The tracheal tube was exchanged with a spiral-tipped double lumen tube under bronchofiberscopy and one-lung ventilation was achieved. Total pneumonectomy and reconstruction of the tracheal bifurcation proceeded uneventfully. One-lung ventilation with a spiral-tipped double lumen tube may be useful in tumor resection that involves distorted anatomy, such as at tracheal bifurcation.
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In recent years, failed back neck surgery syndrome (FBNSS) has been increasing as the number of spinal surgeries rises. In particular, the frequencies of surgeries for intervertebral disk herniation and spinal stenosis are high, and FBNSS is commonly attributable to these procedures. FBNSS is a challenging disease for us pain clinicians, and its causes and treatment methods are diverse. ⋯ In contrast, Racz Spring Guide Catheters epidural neuroplasty can be carried out in outpatient settings, is less invasive and achieves excellent pain relief. Because of the superior performance and handiness of the Racz Spring Guide Catheter instruments, it is a technique that can be carried out in many institutions. This report describes the instruments and operative techniques applied for Racz Spring Guide Catheter epidural neuroplasty.
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We present a case of anticipated difficult airway with severe rheumatoid arthritis in which intubation with fiberoptic bronchoscope (FOB) assisted by Pentax-AWS Airwayscope with the thin Intlock (AWS T) was effective. A 69-year-old woman was scheduled to undergo laparoscopic cholecystectomy for acute cholecystitis in a previous hospital. Tracheal intubation with Glidescope or nasal intubation was unsuccessful and abandoned due to mucosal injury and bleeding. ⋯ We planned to perform tracheal intubation preserving spontaneous breathing under intravenous administration of dexmedetomidine and fentanyl. We could visualize the epiglottis, but could not set the target mark to the invisible glottis with AWS-T. Finally, we could accomplish uneventful tracheal intubation with FOB along with the Intlock's guides of AWS-T.
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Development of instruments for spinal cord stimulation is remarkable. We can implant two cylinder-type stimulation electrodes in parallel into the spinal epidural space. We call this method for dual-lead SCS. ⋯ Dual-lead SCS combined with low-dose ketamine drip infusion method is useful for the treatment of various kinds of neuropathic pain. Even if the direct effect of ketamine is transient, effects that provide release from central sensitization and the wind-up phenomenon may be important to increase the effects of dual-lead SCS. Based on the development of dual-lead SCS, SCS therapy has become an important and powerful method for the treatment of intractable pain.
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New diagnostic and therapeutic devices for patients with chronic intractable pain are used in Japan. The following articles describe topics of new diagnostic and therapeutic devices for patients with chronic intractable pain including thermography, functional MRI, device for the quantitative analysis of perception and pain sensation, epiduroscopy, device for phototherapy, Racz catheter and device for spinal cord stimulation (SCS).