Masui. The Japanese journal of anesthesiology
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Tramadol/acetaminophen fixed-dose combination tablets (Tramse) combine tramadol, a centrally acting week opioid analgesic, with low-dose acetaminophen. The action of tramadol may be described as a weak agonist at the mu-opioid receptor, inhibition of serotonin reuptake, and inhibition of noradrenaline reuptake. The second component in these tablets, acetaminophen mainly appears to act through central mechanism. ⋯ It is expected that Tramset is going to induce pain relief and to improve disturbance of daily life in patients with intractable chronic pain. However overuse of Tramset may induce severe adverse effects such as addiction, abuse and hepatotoxicity. Therefore clinician should continuously assess pain intensity, activity of daily life, mode of its consumption, and adverse effects after prescription.
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Opioids are available for patients with chronic non-cancer pain. At the start of treatment, side effects such as nausea and vomiting may occur. As these symptoms appear at a dose lower than that at which analgesic actions are achieved, preventive strategies are important. ⋯ It is also effective to use opioid rotation or change the administration route from oral to continuous subcutaneous administration. However, concerning chronic, non-cancer pain, the opioid rotation regimen is limited to a combination of codeine preparations, morphine preparations, and fentanyl patches. For long-term administration, the continuous intravenous/subcutaneous injection of opioids is not indicated.
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Randomized Controlled Trial Meta Analysis Comparative Study
[Airtraq for difficult airways: A meta-analysis of randomized controlled trials].
Increased evidence indicates that the Airtraq is useful for difficult tracheal intubations. The aim of this meta-analysis was to assess the efficacy of the Airtraq in difficult airways, comparing with that of Macintosh laryngoscopy. ⋯ There is considerable evidence that Airtraq has an advantage over Macintosh laryngoscope in difficult airways.
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Randomized Controlled Trial Meta Analysis Comparative Study
[Channeled videolaryngoscope: A meta-analysis of randomized controlled trials].
The aim of this meta-analysis was to assess the efficacy of the channeled videolaryngoscopes in routine tracheal intubation. ⋯ Compared to the Macintosh laryngoscopy, channeled videolaryngoscopy offers advantages for novice laryngoscopists, while these benefits are not seen with experts' hands in normal airways. Even with skillful hands, channeled videolaryngoscopy improves the successful first-attempt intubation in difficult intubations.
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Case Reports
[Combined spinal-epidural anesthesia for caesarean section in a parturient with scoliosis].
An emergency caesarean section was performed in a 38-year-old parturient with pregnancy-induced hypertension at week 31 of gestation because of nonreassuring fetal status. A chest X-ray revealed mild spinal scoliosis. We attempted a combined spinal-epidural anesthesia in the parturient because the Cobb angle was only 28 degrees. ⋯ Analgesia was achieved from the T6 to S regions, and the caesarean section was completed uneventfully. A postoperative X-ray and computed tomography scan revealed that the rotation of the lumbar spine was so severe that the spaces between the laminae of the lumbar regions were shifted to the left and narrowed. Therefore, the puncture of the epidural and subarachnoid spaces was difficult, suggesting that the degree of lumbar spine rotation is more important than the thoracic spine curvature for successful epidural and spinal anesthesia in parturients with scoliosis.