Masui. The Japanese journal of anesthesiology
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Case Reports
[A case of neuropathic cancer pain in the lower extremities successfully treated with spinal cord stimulation].
A 76-year-old man was referred to our pain clinic for the treatment of bilateral lower extremity pain due to metastasis of renal cell carcinoma to the sacrum. The pain could not be controlled with narcotics, antidepressant or the epidural block. ⋯ Therefore, spinal cord stimulation (SCS) was performed, relieving the pain until death, 6 months after its induction. This case shows the usefulness of SCS for neuropathic cancer pain that shows signs similar to those of benign disease.
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A 73-year-old woman with bilateral internal carotid artery stenosis, 80% in the left and 70% in the right, was scheduled for a laparoscopic operation for sigmoidrectal colon cancer. During the operation, general anesthesia was maintained with propofol and fentanyl, combined with epidural analgesia. Regional cerebral oxygen saturation (rSo2) was continuously monitored throughout the operation. ⋯ Thereafter, FIo2 was maintained at 60% and the rSo, was kept at 60% to 70% to the end of the operation. Neurological dysfunctions were not observed after the operation. In order to prevent cerebral ischemic damage from the operation with TP, monitoring of rSo, maybe essential during general anesthesia.
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The salivary enzyme alpha-amylase is an established non-invasive marker of psychological and physiological stress. Since there are positive correlations between salivary alpha-amylase secretion and sympathetic parameter increment during stress, salivary alpha-amylase might be an indicator of sympathetic-adrenal-medullary (SAM) system and central sympathetic activity In contrast, it is well known that sympathetic neural activity is significantly involved in development and deterioration of pain symptoms as a part of pain disorders. ⋯ Furthermore, a hand-held device, which is able to measure the activity of salivary alpha-amylase easily and quickly, was developed recently, and we can try to evaluate the condition of pain at the outpatient clinic and the bedside. Though the actual utility of this measuring device for clinical use is unclear, it is hoped that the measuring device of salivary alpha-amylase is one of helpful methods for pain assessment in the future.
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Propofol target-controlled infusion (TCI) is now commonly used for the induction and maintenance of anesthesia. In this study, we measured the propofol plasma concentrations of elderly patients to evaluate our hypothesis that propofol TCI is reliable for use in elderly patients. ⋯ We concluded that propofol TCI is a reliable method for maintaining anesthesia even in elderly patients, whereas the individual differences of the elderly patients was greater than those obtained from normal patients.
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Spinal cord stimulation (SCS) is an established treatment for intractable neuropathic pain. SCS is performed using an implantable pulse generator connected to leads with electrodes positioned in the dorsal epidural space, which are then used to stimulate the ascending and descending dorsal column fibres to achieve paresthesia covering the area of pain. ⋯ The clinical indications for SCS are mainly peripheral vascular diseases (PVD), refractory angina, failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS) type 1 and type 2, spinal cord stenosis and neuropathic pain. The new puncture trial method is less invasive and can reduce psychological resistance of the patient for SCS manipulation.