Masui. The Japanese journal of anesthesiology
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Recently in Japan, more patients are receiving chronic opioid therapy for cancer pain or chronic pain, and there is an increasing number of such patients presenting for surgery. The anesthesiologist should be familiar with available opioid formulations as well as the change they induce by their chronic administra- tion, such as physical dependence, opioid tolerance and opioid-induced hyperalgesia. ⋯ Furthermore, these patients tend to have increased pain and increased opioid requirements postoperatively, most likely due to opioid tolerance and opioid-induced hyperalgesia. Peri- operative management of these patients require knowledge and skills to manage these phenomena.
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A 46-year-old woman with cervical disc herniation underwent C4-6 laminoplasty and C4-5 foraminotomy under general anesthesia. The patient complained of the tongue deviation toward the right after surgery. ⋯ The cause of hypoglossal nerve palsy was assumed to be possibly direct compression of the hypoglossal nerve by the tracheal tube. In prone position surgery, it is important to take care of pressure to the tongue because the intraoral space tends to be reduced by edema of the face and neck.
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Awake intubation preserving spontaneous ventila- tion, is essential for managing difficult airways, and is recommended by the guidelines of the American Soci- ety of Anesthesiologists. The main indication includes anatomically difficult airways, full stomach, cervical instability, and vital signs indicative of shock. ⋯ Various new airway devices and sedatives are currently avail- able, and anesthesiologists should be familiar with their strengths and limitations. Training for awake intuba- tion should include a combination of clinical experience and simulation training.
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We experienced a case of 82-years-old-man who developed anaphylactic shock immediately after admin- istration of sugammadex. He was scheduled for ventral hernia surgery. Anesthesia was induced by propofol, rocuronium and remifentanil, and maintained with des- flurane, remifentanil and intermittent rocuronium. ⋯ His respiratory state was stable and he was extubated. After administration of methylpredniso- lone, he was transferred to the surgical ward and showed no troubles thereafter. Anaphylaxis caused by sugammadex is a rare event However, considering the high frequency of sugamma- dex use in Japan, we should always keep the possibil- ity of anaphylactic shock caused by sugammadex in mind during daily general anesthetic management.
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The goal of this study was to evaluate in patients with peripheral arterial disease (PAD) whether ultrasound-guided radial artery catheterization decreased procedural time and number of attempts compared with the traditional palpation technique. ⋯ Ultrasound-guided radial artery cath- eterization took less time to establish the arterial line, and it reduced the number of attempts when com- pared with the palpation technique.