RESUMEN
OBJECTIVE: The Universal Adapter for Smartphones® c an record s till images and movies during intubation using the monitor display and recording functions of a smartphone. Here, we describe the successful use of the Airtraq Double Lumen® with the Universal Adapter for Smartphones® for airway management during anesthesia in a patient with intubation difficulty. METHODS: A 78-year-old man required thoracoscopic upper lobectomy for a pulmonary tumor. Preoperative examination revealed micrognathia, mouth opening equivalent to a three-finger width, Mallampati Class II, mentum-hyoid bone distance equal to a 2.5-finger width, hyoid bone-thyroid cartilage distance equal to a two-finger width, and Class I findings in the Upper Lip Bite Test. After inducing anesthesia and confirming the feasibility of mask ventilation, we administered 70 mg of rocuronium and inserted the Airtraq Double Lumen®. The Universal Adapter for Smartphones® connected to a 4-inch iPod Touch® was attached to its eye cup, through which the iPod Touch displayed images for easy visualization of the glottal area. RESULTS: Prompt and smooth intubation with a 35-Fr double-lumen tube (DLT) was achieved. There were no adverse events associated with intubation. CONCLUSION: Combination of the Universal Adapter for Smartphones® and the Airtraq Double Lumen® can facilitate smooth tracheal intubation with a DLT in cases of difficult intubation.
Asunto(s)
Manejo de la Vía Aérea/instrumentación , Anestesiología/instrumentación , Intubación Intratraqueal/instrumentación , Teléfono Inteligente , Anciano , Humanos , Intubación Intratraqueal/métodos , Neoplasias Pulmonares/cirugía , Masculino , Neumonectomía , Grabación en VideoRESUMEN
Neuropathic pain (NeP) results from injury to, or disease of, the peripheral or central components of the neural systems involved in pain. In contrast to inflammatory pain, NeP can persist after healing from the initial injury has resolved. Antipyretic agents, such as non-steroidal anti-inflammatory drugs, steroids, and acetaminophen are ineffective, while specific agents such as gabapentinoids, antidepressants, antiepileptics, and opioids are effective in treating NeP. In this review, we address the definition of NeP, pharmacotherapy for NeP in Japan, pain classification, setting goals for successful NeP medication, and the Japanese algorithm for the pharmacotherapy of NeP with specific prescription guidance.
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Aminas/administración & dosificación , Analgésicos Opioides/administración & dosificación , Anticonvulsivantes/administración & dosificación , Antidepresivos/administración & dosificación , Ácidos Ciclohexanocarboxílicos/administración & dosificación , Clorhidrato de Duloxetina/administración & dosificación , Neuralgia/tratamiento farmacológico , Pregabalina/administración & dosificación , Ácido gamma-Aminobutírico/administración & dosificación , Anciano , Algoritmos , Aminas/efectos adversos , Analgésicos Opioides/efectos adversos , Anticonvulsivantes/efectos adversos , Antidepresivos/efectos adversos , Ácidos Ciclohexanocarboxílicos/efectos adversos , Esquema de Medicación , Clorhidrato de Duloxetina/efectos adversos , Femenino , Gabapentina , Humanos , Japón , Neuralgia/clasificación , Manejo del Dolor , Pregabalina/efectos adversos , Ácido gamma-Aminobutírico/efectos adversosRESUMEN
PURPOSE: Previous in vitro studies have shown that degradation of opioid peptides during incubation with cerebral membrane preparations is almost completely prevented by a mixture of three peptidase inhibitors (PIs), namely, amastatin, captopril, and phosphoramidon. In the present in vivo study, we evaluate the effects of intrathecal administration of these PIs on antinociception by [Met(5)]enkephalin (ME) or PIs themselves. METHODS: Drugs were administered into the thoracolumbar level of the spinal cord in the intrathecal space in rat. Induction of antinociception was measured by the tail immersion assay, with 55 °C as the nociceptive stimulus. Effects of PIs on antinociception were evaluated by dose-response study (ME, 1-20 nmol; PIs, 1-20 nmol each), by comparison of differences among two combinations of PIs (amastatin and captopril; captopril and phosphoramidon; amastatin and phosphoramidon) and three PIs (amastatin, captopril, and phosphoramidon), and by using opioid receptor selective antagonists. RESULTS: Intrathecal administration of ME with these three PIs or PIs alone significantly and dose dependently increased antinociception in a µ- and δ-opioid receptor antagonist-reversible manner; moreover, the degree of antinociception with a combination of any two of these was less than that with all three, indicating that any residual single peptidase could inactivate significant amounts of ME. CONCLUSION: The present data, together with those of earlier studies, clearly demonstrate that amastatin-, captopril-, and phosphoramidon-sensitive enzymes play an important role in inactivation of opioid peptides at the spinal level.
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Analgésicos/farmacología , Encefalina Metionina/farmacología , Antagonistas de Narcóticos/farmacología , Inhibidores de Proteasas/farmacología , Analgésicos/administración & dosificación , Animales , Captopril/administración & dosificación , Captopril/farmacología , Sinergismo Farmacológico , Encefalina Metionina/administración & dosificación , Glicopéptidos/administración & dosificación , Glicopéptidos/farmacología , Masculino , Péptidos/administración & dosificación , Péptidos/farmacología , Inhibidores de Proteasas/administración & dosificación , Ratas , Ratas WistarRESUMEN
Some types of syringe pumps currently available for use of prefilled syringes (PFS) require setting for syringe size which varies from manufacturer to manufacturer. We conducted a questionnaire survey for 10 nurses at the emergency critical care center of this hospital on the operating procedures of two different types of syringe pump (i.e., from turning on the power to PFS setting, PFS mounting, flow rate setting, and start of drug infusion), in terms of (1) manipulation time, (2) accuracy of task performance, and (3) operability. The syringe pumps used were: type A, TE-331S0N (Terumo Corporation), and type B, CSP-100S (Daiken Medical Co., Ltd.). The PFS product used was Inovan Injection 0.3% Syringe (dopamine hydrochloride injection; Kyowa Hakko Kirin Co., Ltd.). Type A required no mode setting for exclusive use of PFS, while mode setting for exclusive use of PFS is mandatory for type B. The task process from turning on the power to drug infusion start comprised 5 and 13 steps for type A and B, respectively. Manipulation time was significantly shorter with type A, compared to type B. As for accuracy of task performance, 90% of nurses performed manipulations accurately with type A; whereas with type B, 90% of nurses were close to failing or actually failed to follow the procedures appropriately, and only 10% followed accurately. Thus, type A proved superior in 4 of the 5 points of issue except "easy to set flow rate". In conclusion, the results indicate the importance of standardizing the syringe size and other specifications through the cooperation of pharmaceutical companies and medical device manufacturers to cope with the future spread of PFS.
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Inyecciones/instrumentación , Jeringas , Diseño de Equipo , Hospitales Universitarios , Humanos , Japón , Enfermeras y Enfermeros , Preparaciones Farmacéuticas , Encuestas y Cuestionarios , Análisis y Desempeño de TareasRESUMEN
An increased dosage of propofol is frequently administered to reduce responses to insertion of the laryngeal mask airway (LMA). However, its clinical effect remains unknown. We investigated whether an increased dosage of propofol reduces responses to LMA insertion. Sixty adult patients were divided into 3 groups according to induction dosage of propofol (2.0 mg/kg, 2.5 mg/kg and 3.0 mg/kg). The patient's responses including body movement and the upper airway reflex were observed. The bispectral index (BIS) score as the index of the sedation level was monitored. There were no significant differences among the three groups in responses to LMA insertion, and no correlation was seen between the BIS score and the responses. These results suggest that propofol alone at clinical dosage levels does not completely control responses to LMA insertion. It is also suggested that the monitoring of BIS score is not effective in predicting responses to LMA insertion. Combination of propofol and analgesics such as fentanyl may be useful in reducing responses to LMA insertion.