Masui. The Japanese journal of anesthesiology
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Pentazocine has activities both of kappa-opioid receptor agonist and weak micro-opioid receptor antagonist. Recent study has suggested that kappa-opioid receptor agonists have antipruritic effects. We experienced a case of pentazocine inhibiting itch evoked by intrathecal fentanyl in a patient with idiopathic pulmonary fibrosis (IPF). ⋯ Following that, when pentazocine was administered intravenously, pruritus disappeared immediately and then never recurred. Therefore, it is suggested that pentazocine can be useful in reducing pruritus on intrathecal opioid-induced itch. Future studies are necessary to evaluate the efficacy of pentazocine for the treatment and prevention of opioid-induced itch.
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Comparative Study
[Effects of amino acid infusion in preventing intraoperative hypothermia: comparison between sevoflurane versus propofol].
Amino acid infusion was reported to be effective in preventing hypothermia during surgery. We investigated whether the antihypothermic effects of amino acid infusion depend on the anesthetic agent used for surgery. ⋯ Core and peripheral temperatures increased after amino acid infusion in patients receiving sevoflurane or propofol. Our results suggest that the antihypothermic effects of amino acid infusion do not depend on the anesthetic used.
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We report the successful awake tracheal intubation in a patient with hypopharyngeal cancer and gastroesophageal regurgitation with the TaperGuard Evac tracheal tube (TaperGuard) and Pentax-AWS Airwayscope (AWS). A 63-year-old man with hypopharyngeal cancer with invasion to the glottis was scheduled for total laryngectomy under general anesthesia. ⋯ After topical anesthesia with 8% lidocaine and infusion of fentanyl and continuous dexmedetomidine, the AWS was inserted into his mouth in the sitting position from the cranial side. The AWS allowed visualizing the glottis avoiding the cancer, leading to safe placement of the tracheal tube.
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Anesthetic management of a patient with giant mediastinal tumors is challenging from the perspective of both cardiovascular and respiratory management. We report the successful use of the Pentax-AWS Airwayscope (AWS; Hoya, Japan) and a tracheal tube introducer in the left lateral position for a patient with a giant mediastinal tumor. An 18-year-old man weighing 62 kg was scheduled for resection of a giant mediastinal tumor. ⋯ The head of the double-lumen tube was placed in the right bronchus under the guidance of a bronchofiberscope. Following tracheal tube placement, posture was shifted from the left lateral position to supine position without affecting vital signs. After median sternotomy, a muscle relaxant was administered for immobilization.
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Case Reports
[Anesthetic management of a patient with severe subcutaneous and mediastinal emphysema due to pertussis infection].
A 20-month-old girl, with respiratory failure due to severe subcutaneous and mediastinal emphysema, was scheduled to undergo percutaneous drainage of emphysema and induction of extracorporeal membrane oxygenation. Paroxysm, a symptom of the infection of Bordetella pertussis, was the cause of emphysema. In patients with severe neck subcutaneous emphysema, management of difficult airway is the most important safety issue in the practice of anesthesia. ⋯ Combined with propofol and midazolam, pethidine was an effective agent for safe anesthetic induction because it produces less respiratory depression compared to other opiate analgesics. In conclusion, this case demonstrates the importance of prediction of and preparation for difficult airway. Furthermore, anesthesiologists should consider the optimization of anesthesia to avoid progression of emphysema.