Masui. The Japanese journal of anesthesiology
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There are gene polymorphisms changing the expression or activation of the serotonin (5-HT) receptors, which are associated with pain. This review showed an availability of 5-HT2A receptor gene polymorphism in analgesic sensitivity. To search gene polymorphisms related to analgesic sensitivity is important to further effective pain management. In future 5-HT2A receptor gene polymorphisms, together with polymorphisms of other genes, may greatly contribute to effective postoperative pain management and personalized medicine.
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We describe a case of negative pressure pulmonary edema (NPPE) followed by laryngospasm occurred immediately after extubation. A 56-year-old man with a tumor at the site of ureteroneocystostomy underwent left ureterectomy and partial resection of the neobladder under general anesthesia. The tracheal intubation was difficult with glade 3 of Cormack classification. ⋯ Furosemide was administered in ICU and mechanical ventilation with 5cmH2O PEEP was started. Seventeen hours later, the pulmonary edema disappeared and he was successfully extubated without any complications. It was warned that laryngospasm would occur even after the full emergence, leading to NPPE.
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As we have no information whether target-controlled infusion (TCI) for propofol, using pharmacokinetic parameters obtained without chronic renal failure, is available to estimate the drug concentration, we examined the blood concentration of propofol on the patients with chronic renal failure to evaluate the reliability of TCI of propofol. ⋯ TCI system for propofol provided a good estimation of the blood concentration of propofol in patients with chronic renal failure undergoing living-related renal transplantation.
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The authors describe an experience of spinal cord stimulation (SCS) in a 30-year-old woman who developed complex regional pain syndrome type-I (CRPS-I) with spread phenomenon. She had received lumbar SCS under a diagnosis of CRPS-I in her left leg for 8 years. She had refractory pain in her right arm for the recent two years. ⋯ Test stimulation with cervical epidural spinal electrode showed good results and the pulse generator was implanted. It is suggested that the symptom of CRPS-I involving spread phenomenon was possibly due to a cortical reorganization. But a certain effect of SCS may be contributing to the favorable results of test stimulation for the treatment of CRPS-I with spread phenomenon in this case.
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In Japan, the re-organization of obstetrical medical system is needed and this project is ongoing under Japanese government initiative. However the ratio of using neuraxial analgesia (NA) during labor in Japan has been low and, increased demand for NA during labor is anticipated in near future. ⋯ However, there is no official training program for OB anesthesiologists in Japan. This article reports the clinical practice of the OB anesthesia in one of the biggest hospitals in the United State, the Cleveland Clinic, from the view of an OB anesthesia clinical fellow.