Masui. The Japanese journal of anesthesiology
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As scoliosis surgery in children is a large invasive surgery, postoperative pain control is difficult. ⋯ The amount of fentanyl required for postoperative analgesia was decreased by combining DEX. In addition, it is thought that side effects of fentanyl are reduced in low dose fentanyl administration cases. As a result, it may bring early postoperative recovery. The IV-PCA using fentanyl with DEX may be useful for postoperative analgesia in scoliosis surgery. We will recommend using DEX (0.25 microg x kg(-1) x hr(-1)) together with fentanyl (0.5 microg x kg(-1) x hr(-1)) for this purpose.
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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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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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Much evidence has been accumulated on the cerebral mechanisms of pain perception owing to rapid and diverse development in magnetic resonance imaging and its analysis techniques over the last decades. In addition to pain-evoked cerebral activities, our knowledge now extends into chronic pain-associated alterations in cerebral connectivity over networks and in gray matter density, which characterize cerebral steady-state pathological properties underlying chronic pain conditions. A dynamic cerebral model for chronification of pain is presented, in which a bottom-up nociception via the lateral system leads to a reactive, top-down hyperactivity of the medial system, and eventually to both functional and anatomical degeneration of pain modulatory mechanisms and reward systems. All such biomarkers of "chronic pain brain" revealed by neuroimaging will hopefully help us in diagnosis of chronic pain and evaluation of therapeutics for each patient on an outpatient basis.
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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).