Masui. The Japanese journal of anesthesiology
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Opioid analgesics are widely used for managing moderate to severe pain. In cancer pain management sustained-release opioids are used for continuous pain as well as immediate-release opioids for breakthrough pain. ⋯ In Japan, the currently available oral sustained-release opioids include six types of sustained-release morphine (three are once-a-day formulations, while the rest are twice-a-day), one type of oxycodone and tapentadol. In this article, we will discuss the pharmacokinetic properties of MS Contin, Morphes, Kadian, P guard and Pacif as sustained-release morphine, Oxycontin as sustained-release oxycodone and Tapenta as sustained-release tapentadol.
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One of the key issues in the treatment of pain is to choose the appropriate route and dosage form of analgesics for each individual patient in pain. New drug forms of fentanyl absorbed by oral or nasal mucosa, and buprenorphine absorbed by rectal mucosa are described in this chapter. ⋯ However, such rapid increase in plasma concentration of fentanyl by ROO formulations may cause the risk of respiratory depression. Safe ways to use ROO analgesics are described.
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Case Reports
[A Successful Case of Recovery from the Amniotic Fluid Embolism with Cardiac Arrest during the Operation].
Amniotic fluid embolism (AFE) is a disorder with a high mortality rate. We present a case of AFE with cardiac arrest during the cesarean section who recovered sequela. A 28-year-old woman was diagnosed as low lying placenta and planned to undergo cesarean section in 38th gestational week. ⋯ After in better general condition, we removed the packed gauze from her abdomen. She could leave the intensive care unit 7 days after the first operation. In this case, the crucial points for successful resuscitation were prompt obstetric anesthesiologist involvement and good communication with obstetricians.
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A patient with medication resistant schizophrenia underwent modified electroconvulsive therapy (12 sessions). Propofol was chosen as a hypnotic agent and the adjustment of its dose and stimulus intensity was attempted. ⋯ This allowed to reach the seizure adequacy during the next and the four subsequent sessions. Although from the tenth session on, adequate seizures could no longer be induced (possibly due to the development of resistance to propofol), the patient's symptoms showed improvement after completion of all 12 sessions.
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Case Reports
[Use of a New Video-laryngoscope (McGRATH® X-blade™) in Patients with Difficult Airways].
We describe the use of a new video-laryngoscope (McGRATH® X-blade™, X-blade) in patients with difficult airways. We report four cases of difficult and failed tracheal intubation using a conventional Machintosh laryngoscope and McGRATH® MAC in which tracheal intubation was accomplished swiftly and easily using a newly designed videolaryngoscope, the X-blade. ⋯ X-blade also provided a good view of glottic opening in a patient with obesity. We believe that X-blade is useful in patients with difficult airways.