Masui. The Japanese journal of anesthesiology
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Case Reports
[The use of dexmedetomidine and Airwayscope in airway management of a child with Cornelia de Lange syndrome].
We report anesthetic management of a 22-month-old child with Cornelia de Lange syndrome scheduled for palatoplasty because of cleft palate. Micrognathia and short neck of the patient suggested difficult airway management. For anesthetic induction, 1 microg x kg(-1) dexmedetomidine was loaded intravenously, followed by infusion at a rate of 0.7 microg x kg(-1) x hr(-1) with incremental inhalation of sevoflurane. ⋯ During the Airwayscope operation, pharyngeal reflex, laryngeal reflex and saliva increase were inhibited resulting in good view of the larynx and the lowest Spo2 was 94% temporarily. After intubation, anesthesia was maintained with sevoflurane, remifentanil and fentanyl. Dexmedetomidine infusion was also useful to maintain adequate spontaneous breathing and to achieve awaking before extubation.
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This article introduces the equipment used for epiduroscopy and describes its indications, procedures for use, treatment outcomes, the potential complications and future developments. Epiduroscopy is used in the treatment and diagnosis of intractable low back and leg pain in patients in whom nerve block is not efficacious and when pain recurs after operation. The characteristics of epiduroscopy are that it is: 1) safe and less invasive; 2) used for endoscopic washing of the epidural space and fluoroscopic X-ray; 3) it allows injection of an agent into the lesion; and 4) it results in no change in the normal lumbar structure after operation. Epiduroscopy is expected to provide successful outcomes for many patients with intractable low back and leg pain through further improvements in equipment related to epiduroscopy, advances in technology, the accumulation of data regarding its efficacy and safety, and the coverage of treatment by insurance.
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As scoliosis surgery in children is a large invasive surgery, postoperative pain control is difficult. ⋯ The amount of fentanyl required for postoperative analgesia was decreased by combining DEX. In addition, it is thought that side effects of fentanyl are reduced in low dose fentanyl administration cases. As a result, it may bring early postoperative recovery. The IV-PCA using fentanyl with DEX may be useful for postoperative analgesia in scoliosis surgery. We will recommend using DEX (0.25 microg x kg(-1) x hr(-1)) together with fentanyl (0.5 microg x kg(-1) x hr(-1)) for this purpose.