Masui. The Japanese journal of anesthesiology
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The purpose of the treatment of chronic non-cancer pain is the improvement of the patient's quality of life, not the complete alleviation of pain. In Japan transdermal fentanyl patch can be used for the treatment of chronic intractable pain including cancer pain and chronic non-cancer pain. In prescribing transdermal fentanyl patch for patients with chronic non-cancer pain, cares should be focused on the selection of the patients and the periodic and continuous observation of analgesic effect and side effects. ⋯ However, respiratory suppression or over sedation would also occur and such side effects can sometimes be fatal. Furthermore, long term effects on endocrine and immune systems have not been clarified yet. Proper prescription of opioids during a limited period of time is definitely the primary concern of medical professionals.
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Meta Analysis Comparative Study
[Efficacy of Pentax-AWS in difficult airways: a meta-analysis of randomized controlled trials].
Increased evidence indicates that the Pentax-AWS (AWS) is useful for difficult airways. The aim of this meta-analysis was to assess the efficacy of the AWS in difficult airways, comparing that of Macintosh laryngoscopy. ⋯ There is considerable evidence that AWS has an advantage over Macintosh laryngoscope in difficult airways.
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We report a 61-year-old woman (weight 49 kg, height 156 cm) with Kugelberg-Welander disease who was scheduled for bilateral mastectomy under general anesthesia. We administered rocuronium 10 mg (0.20 mg x kg(-1)) for tracheal intubation. After 80 min, train-of-four ratio (TOFR) was 46%. ⋯ After 4 min, TOFR became above 90%, and the patient was extubated. There was no respiratory distress, muscle weakness, or neurologic untoward event after the use of sugammadex in the postoperative period. Sugammadex was effective in reversing rocuronium induced neuromuscular block in a patient with Kugelberg-Welander disease.
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A 60-year-old female with anti-phospholipid syndrome underwent amputation of her left lower limb. She had had a history of cerebral infarction, cerebral hemorrhage, coagulation abnormalities, thrombocytopenia, and pneumothorax, and just recovered from disseminated intravascular coagulation. After intravenous fentanyl 25 microg, ultrasound-guided sciatic, femoral and lateral femoral cutaneous nerve blocks were performed. ⋯ For femoral nerve block, a catheter was inserted and ropivacaine was infused at 4 ml x hr(-1) after surgery. Amputation at the left thigh was successfully performed and postoperative course was uneventful. The sciatic, femoral and lateral femoral cutaneous nerve blocks were useful for amputation of a patient with severe coagulopathy by anti-phospholipid syndrome.
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In most cases, an endotracheal tube (ETT) enters the right bronchus due to anatomical features of the trachea. The Parker Flex-Tip Tube (Parker tube) has a centered and tapered tip with a posterior facing bevel. Here, we report a case of accidental left bronchial intubation that may be associated with the tip design of the Parker tube. ⋯ To test this hypothesis, we conducted a simulation study using a standard airway mannequin. Intubation with a standard left-beveled ETT resulted in right bronchial intubation in all 20 trials, while 4 of the 20 Parker tubes entered the left mainstem bronchus. This investigation suggests that unintentional left bronchus intubation of the Parker tube may occur in the ordinary clinical setting if the tube is advanced beyond the carina.