No abstract available.
Dislocations*

The fibromyalgia syndrome (FMS) could be approached by various treatments modalities including education, aerobic exercise, cognitive behavioral therapy, tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, pregabalin, and so on. If other treatments fail, opioids including morphine should be considered. In this case report, we describe the case of a 44-year-old woman who was diagnosed with FMS three years ago, and suffered from severe intractable pain, side effects from other drugs, and opioid tolerance. Administration of morphine via an implantable drug delivery system resulted in significant improvement in the patient's pain intensity, fibromyalgia impact questionnaire score, and sleep disturbance. Our case demonstrates that an implantable drug delivery system with morphine can be a potential treatment option for refractory fibromyalgia patients.
Adult ; Analgesics, Opioid ; Antidepressive Agents, Tricyclic ; Cognitive Therapy ; Drug Delivery Systems* ; Education ; Exercise ; Female ; Fibromyalgia* ; Humans ; Injections, Spinal ; Morphine* ; Norepinephrine ; Pain, Intractable ; Pregabalin ; Serotonin

Osteonecrosis of the femoral head (ONFH) can cause femoral head depression and cortical discontinuity. Treatment for ONFH remains challenging. We performed botulinum toxin type A injection to psoas major muscle in five patients with radiological femoral head collapse (Association Research Circulation Osseus classification stage III) who were non-responsive after two years of conservative treatment (tramadol 200 mg/day, mefenamic acid 1,000 mg/day). At two weeks after the procedure, their mean hip pain was decreased from 88 ± 0.4/100 mm to 22 ± 0.4/100 mm based on visual analogue scale (VAS). The pain was maintained at a minimum of 20/100 mm and a maximum of 30/100 mm in VAS for at least six weeks after the procedure. These values were mean ± SD. These patients were followed-up for 6 months. There was no exacerbation of pain from repeated (three times) botulinum toxin type A injection to the psoas major muscle.
Botulinum Toxins* ; Botulinum Toxins, Type A* ; Classification ; Depression ; Femur Head Necrosis ; Head* ; Hip ; Humans ; Mefenamic Acid ; Osteonecrosis* ; Psoas Muscles*

Meralgia paresthetica (MP) is a painful mononeuropathy of the lateral femoral cutaneouse nerve (LFCN) characterized by localized symptoms of numbness, tingling, pain and paresthesia along the anterolateral thigh area. L4 and L5 radiculopathy is set of symptoms that include sharp, burning or shooting pain, which is usually localized to anterolateral leg area and along the dermatomal distribution. When symptoms of MP and lumbar disc disease occur together it is not easy to diagnose MP. We report a case of synchronous post-traumatic MP and radiculopathy due to intervertebral disc herniation at L3–4 and 4–5. A 59-year-old male patient was admitted to the emergency room with symptoms of low back pain with left severe L4, L5 radiculopathy. This patient also complained of numbness and paresthesia in the left anterolateral thigh. After detailed history taking and lateral femoral cutaneouse nerve block, he was diagnosed with MP.
Burns ; Emergency Service, Hospital ; Humans ; Hypesthesia ; Intervertebral Disc ; Leg* ; Low Back Pain ; Male ; Middle Aged ; Mononeuropathies ; Nerve Block ; Paresthesia ; Radiculopathy* ; Thigh

Herpes zoster is caused by the reactivation of the varicella-zoster virus, and it typically presents as single dermatomal rash and vesicles. It can cause postherpetic neuralgia as a common complication. In immunocompromised patients, the lesions can be cutaneous, disseminated into two non-contiguous dermatomes, and this entity is referred to as herpes zoster duplex unilateralis or bilateralis. We present a case of postherpetic neuralgia after herpes zoster duplex bilateralis in a 60-year-old immunocompromised man. He had a past history of acute lymphocytic leukemia and was treated with allogeneic peripheral blood stem cell transplantation 1 year before herpes zoster reactivation. His postherpetic neuralgia pain was difficult to treat and it was refractory to conservative medication and neuraxial block.
Exanthema ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Immunocompromised Host* ; Middle Aged ; Neuralgia, Postherpetic* ; Peripheral Blood Stem Cell Transplantation ; Precursor Cell Lymphoblastic Leukemia-Lymphoma

BACKGROUND: Previous studies have shown that measuring the distance from the skin to the ligamentum flavum by ultrasound preceding cervical epidural block can be beneficial in excluding false loss of resistance. However, the measurement value using ultrasound may vary depending on the degree of operator experience. Therefore, we aimed to determine the depth from skin to cervical epidural space by using lateral cervical spine X-ray, which is a more intuitive method. METHODS: We enrolled 102 adult patients who were scheduled to undergo cervical epidural anesthesia for vascular bypass surgery of upper arm. After attaching a steel rod on the needle insertion site, lateral cervical spine X-ray was taken before the epidural procedure. We measured the distance from the steel rod to the midpoint of interlaminar space on the spinolaminar line. The X-ray depth was compared with needle depth. RESULTS: Of the 102 enrolled patients, 18 patients including 13 in whom we were unable to measure X-ray depth were excluded from the analysis. In total, 84 patients were included in the analysis. Concordance correlation coefficient between the X-ray-measured depth and needle depth was 0.925. Bland-Altman analysis indicated a mean difference of ± 1.96 SD with 0.06 ± 0.56 cm. CONCLUSIONS: Lateral cervical spine X-ray can be useful for prediction of the midline depth from skin to epidural space, particularly for operators who are not skilled at spine ultrasound or the use the C-arm fluoroscopy.
Adult ; Anesthesia ; Anesthesia, Epidural ; Arm ; Cervical Vertebrae ; Epidural Space* ; Female ; Fluoroscopy ; Humans ; Ligamentum Flavum ; Methods ; Neck ; Needles ; Skin* ; Spine* ; Steel ; Ultrasonography

The most frequent perioperative cardiovascular event is cardiac dysrhythmia, defined as an abnormality of cardiac rate, rhythm or conduction. Although the occurrence of arrhythmia during the perioperative period is not uncommon, a case of newly developed perioperative atrial flutter which spontaneously converts to atrial fibrillation is rare. We report a case of atrial flutter that developed immediately after induction of general anesthesia, in a 70-year-old male patient who previously had a normal sinus rhythm. Atrial flutter changed spontaneously to atrial fibrillation after discharge to the recovery room. Dysrhythmia was unresponsive to drug therapy, and the atrial fibrillation disappeared after electric cardioversion.
Aged ; Anesthesia, General* ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Atrial Flutter* ; Drug Therapy ; Electric Countershock ; Humans ; Male ; Perioperative Period ; Recovery Room

BACKGROUND: In the present study, we investigated the effect of dexmedetomidine on the intubating conditions and hemodynamic changes during endotracheal intubation following anesthetic induction performed using propofol and remifentanil without a neuromuscular blocking agent. METHODS: We selected 70 adult patients aged 20 to 65 years scheduled to undergo general anesthesia. Induction was performed using 2 mg/kg of propofol and 1.5 µg/kg of remifentanil. The patients were divided into two groups, a dexmedetomidine group (Group D) and a control group (Group C). Group D received an infusion of dexmedetomidine 1 µg/kg for 10 minutes before induction, and Group C received the same volume of normal saline infused in the same manner. Intubating conditions were evaluated and blood pressure and heart rate were recorded at various time points to assess hemodynamic stability. RESULTS: Intubating conditions were evaluated as excellent for 34 patients and good for 1 patient in Group D, and excellent for 4 patients, good for 20 patients, poor for 4 patients, and bad for 7 patients in Group C (P < 0.001). The heart rate was significantly lower in Group D than in Group C at all measurement times. The mean arterial blood pressure was significantly lower in Group C than in Group D at 10 minutes after dexmedetomidine administration (P = 0.049), after the induction of anesthesia (P < 0.001), immediately after endotracheal intubation (P = 0.008), and 3 minutes after endotracheal intubation (P < 0.001). CONCLUSIONS: Dexmedetomidine 1 µg/kg improved the intubating conditions and stabilized hemodynamic changes following anesthetic induction performed using propofol 2 mg/kg and remifentanil 1.5 µg/kg without a neuromuscular blocking agent.
Adult ; Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Dexmedetomidine* ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal* ; Neuromuscular Blockade* ; Propofol

Tracheal injury in neonates is a rare but serious complication of endotracheal intubation. The morbidity and mortality are associated with early recognition and adequate management. Herein, we reported a case of perioperative management of neonatal tracheal injury following multiple attempts at endotracheal intubation caused by unanticipated difficulty.
Humans ; Infant, Newborn* ; Intubation, Intratracheal* ; Mortality

BACKGROUND: In emergency condition, failure in securing airway is a common and serious reason of pediatric death. Rapid intubation is required to minimize physiologic complication in children due to airway failure. Rapid loss of consciousness and rapid onset of neuromuscular blocking agent are necessary for the rapid sequence intubation. In this study, we compared the effects of thiopental sodium, ketamine, and propofol (drugs commonly used to induce anesthesia in children) on the onset time of rocuronium. We also compared the effects of these anesthesia induction drugs on intubation condition and their duration of action. METHODS: A total of 89 patients undergoing various elective surgeries were enrolled and allocated to the following three groups according to the anesthesia induction drug: 1) Group T, thiopental sodium; 2) Group P, propofol; and 3) Group K, ketamine. After loss of consciousness, neuromuscular monitoring was performed and rocurunium 0.6 mg/kg was administered. Onset time and duration of action of rocuronium were measured. Intubation condition was recorded with a tracheal intubation scoring system. Hemodynamic changes were observed before induction until 5 min after endotracheal intubation. RESULTS: The onset time of rocuronium in group K (39.9 s) was significantly faster than that in group T (61.7 s) or group P (50.7 s). There was no significant difference in duration of action of rocuronium or intubation condition among the three groups. CONCLUSIONS: Ketamine can decrease the onset time of rocuronium significantly compared to thiopental sodium or propofol.
Anesthesia ; Child* ; Emergencies ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal ; Ketamine* ; Neuromuscular Blockade ; Neuromuscular Monitoring ; Propofol* ; Thiopental* ; Unconsciousness