Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Jun 2006
Case ReportsRepeated lumbar sympathetic blockade with lidocaine and clonidine attenuates pain in complex regional pain syndrome type 1 patients--a report of two cases.
Repeated lumbar sympathetic blockade (LSB) with local anesthetics is generally used in complex regional pain syndrome (CRPS) of the lower extremities if the initial block has been successful. However, the symptoms of CRPS may inevitably recur in spite of repeated LSB. ⋯ It is reasonable that clonidine has been used in chronic pain conditions such as neuropathic and sympathetically maintained pain. Here we report two cases of CRPS type 1 who got excellent analgesia and alleviation of clinical symptoms after receiving an LSB with lidocaine and clonidine.
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Acta Anaesthesiol Taiwan · Jun 2006
Physicians' knowledge about pharmacological management of cancer pain--with special reference on their prescribing responses to simulated patients with cancer pain.
Cancer pain control is unsatisfactory in Taiwan. Insufficient knowledge about cancer pain on the part of physicians is an important factor responsible for ineffective cancer pain relief. Therefore, this study was to explore the knowledge deficits of physicians on the specific aspects of pharmacological management of cancer pain (PMCP) and their influences on the prescriptions to simulated patients in a southern medical center in Taiwan. ⋯ The PMCP knowledge deficits were prevalent in physicians and thus influenced their prescription of opioids for the simulated cases. An active continuing education program on both the international guidelines and the essential practice skills should be implemented and intensified specifically upon subgroup physicians, to correct their misconceptions and consolidate their PMCP knowledge.
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Acta Anaesthesiol Taiwan · Jun 2006
Case ReportsLingual nerve injury following the use of an oropharyngeal airway under endotracheal general anesthesia.
We report a patient who presented for elective myomectomy. Laryngoscopy and endotracheal intubation were achieved smoothly without unduly force. An oropharyngeal airway was inserted after endotracheal intubation for biting and was left in the oral cavity until the end of surgery. ⋯ After reviewing the history, we speculated that the mechanism of nerve injury in this case was a direct compression of the tongue tip by the oropharyngeal airway. This is the first report of lingual nerve injury caused by improper placement of the oropharyngeal airway. We recommend careful manipulation in the use of the oropharyngeal airway and vigilant surveillance being undertaken when an oropharyngeal airway is left in place for a prolonged period.
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Acta Anaesthesiol Taiwan · Mar 2006
Randomized Controlled TrialClosed-circuit anesthesia preserves skin blood flow during surgery.
Closed-circuit anesthesia (CCA) has been suggested to provide better hemodynamic stability, but the relative contribution of CCA to the control of blood flow in microcirculation is not defined. It is hypothesized that isoflurane-based CCA provides a favorable skin blood flow mediating via lesser circulatory response to surgical stimulation. This study was purposed to compare the effects of isoflurane conveyed by CCA with that by semiclosed anesthesia (SCA) on the preservation of skin blood flow in the forearm. ⋯ Closed circuit technique for isoflurane anesthesia is feasible and advantageous. It not only facilitates favorable skin blood flow but also provides better hemodynamic stability in comparison with semiclosed technique for isoflurane anesthesia.
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Acta Anaesthesiol Taiwan · Mar 2006
Case ReportsSevere bronchospasm during laryngeal mask airway placement in an infant.
A 35-day-old male infant was scheduled for bilateral inguinal herniorrhaphy. No history of recent upper airway infection or other reactive respiratory disease was noted before anesthesia. Breath holding was noted immediately after laryngeal mask airway (LMA) insertion. ⋯ After deepening the inhalational anesthesia of sevoflurane and concomitant administration of intravenous lidocaine, the patient's respiratory condition turned for the better and became compliable. Respiratory dysfunction may be caused by severe bronchospasm induced by placement of the LMA. The pathophysiology and risk factors of bronchospasm related to the LMA placement are discussed in the text.