Masui. The Japanese journal of anesthesiology
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Case Reports
[Pulmonary aspiration during anesthetic induction in a patient with a history of distal gastrectomy].
We experienced a case of pulmonary aspiration during anesthetic induction. Posterior laminoplasty was scheduled for a 59-year-old man with ossification of posterior longitudinal ligament, who had undergone distal gastrectomy 30 years ago. Anesthesia was induced with intravenous administration of midazolam and fentanyl, and inhalation of sevoflurane was gradually increased to 7% in oxygen under spontaneous breathing, since difficult intubation had been predicted due to poor neck mobility However, the patient vomited during laryngoscopy. ⋯ After administration of fentanyl, continuous administration of intravenous dexmedetomidine was started, and 2% lidocaine viscous solution was gargled. Endotracheal intubation was successfully performed using AirWay Scope without pulmonary aspiration, and midazolam was administered intravenously. Surgery was completed without any troubles, and the patient was extubated fully awake.
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Chronic intractable pain is well known to be very difficult in management. The mechanisms of intractable chronic pain are complicated. Therefore, such a patient is often involved with multiple pain mechanisms and needs multiple drugs which have different types of analgesic actions. ⋯ Therefore, the evaluation of many factors which modulate the pain behavior is important. Opioids such as morphine and other analgesics are sometimes useful for the treatment of chronic intractable pain. Nerve blocks and interventional treatments are also helpful.