Masui. The Japanese journal of anesthesiology
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We describe successful pain control in a patient suffering from severe pain, using an opioid combination of transdermal fentanyl and oral oxycodone. A woman in her 40s with a giant-cell tumor of the sacrum suffered from refractory 4-5/5 pain on the Wong-Baker faces pain rating scale in her sacrum, feet and legs. Despite administration of fentanyl (2,520 microg day(-1)), she could not sleep in the supine position due to pain and dysesthesia. ⋯ Hence, we reduced the oral oxycodone dose and began a combination of transdermal fentanyl and oral oxycodone in addition to increasing doses of pregabalin. With the combination of transdermal fentanyl (25 microg x hr(-1)) and oral oxycodone (60 mg x day(-1)) her pain decreased to 1-3/5 on the faces pain rating scale. Our experience suggests that an opioid combination may provide favorable pain control in patients with severe pain, while minimizing the side effects of each drug.
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Although shoulder-tip pain during cesarean section has been reported, little is known about this entity. We investigated the incidence of shoulder-tip pain in patients undergoing cesarean delivery under combined spinal-epidural anesthesia (CSEA). Next, we studied whether head-up position during surgery reduced the incidence of shoulder-tip pain due to prevention of the spread of blood and amniotic fluid from the subphrenic space. ⋯ This study showed that women undergoing cesarean section under CSEA experience shoulder-tip pain with great frequency. Head-up position during surgery decreases shoulder-tip pain during and after cesarean delivery. The results suggest that one of the causes of this pain is the presence of blood or amniotic fluid in the subdiaphragmatic region.
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Review Comparative Study
[Properties and clinical implications of middle molecular weight low substitution hydroxyethyl starch solution].
In this review article, the properties and clinical implications of middle molecular weight low substitution hydroxyethyl starch (HES) solution are summarized. This preparation shows larger volume effect and longer duration compared to the currently available low-molecular weight HES solution and will be available in the near future in Japan. Effects on renal function and coagulation system are supposedly dependent on the persistence of larger HES molecule in the body and this middle molecular weight low substitution HES preparation may be advantageous to the older HES preparation due to its rapid metabolism. This preparation has been successfully used in the goal-directed fluid management in the early recovery program after surgery and will offer several advantages in fluid management when introduced in Japan.
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There are growing interests in perioperative preventation of surgical site infection, since the World Health Organization has published surgical safety checklist with the slogan "safe surgery saves lives" in 2008. According to the surgical safety checklist, the surgical team needs to check whether antibiotic prophylaxis has been given within 60 minutes of skin incision. In this study, we investigated whether anesthesiologists in our institution completed the administration of antibiotics before skin incision. ⋯ Anesthesiologists should have knowledge on the preventation of surgical site infection especially on antibiotic prophylaxis, because it starts in the operating room.
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A 75-year-old woman with primary pulmonary hypertension was on medical therapy and ambulatory oxygen inhalation therapy for 7 years. The patient had right femoral fracture and was admitted to our hospital. ⋯ One year after the surgery, she had left femoral fracture, and surgery was performed under spinal anesthesia using isobaric bupivacaine 6 mg with fentanyl 10 microg. With its minimal effects on hemodynamics, we speculate that spinal anesthesia using a low dose of isobaric bupivacaine can be a choice for patients with pulmonary hypertension.