Historically, peripheral neuropathic pain has occasionally been difficult to treat. Both a systematic review of the evidence as well as clinical experience have demonstrated that treatment options including polypharmacy provide effective pain relief in only half of the patients with neuropathic pain. After peripheral nerve injury, the incidence of degenerative alterations in the spinal cord and central pathologic sensitization are possible. Due to this observation, It may be difficult to treat this group of patients with peripheral neuropathic pain by therapeutic intervention of the peripheral nerve. Pulsed radiofrequency (PRF) has several benefits for treatment of this condition including, accuracy and safety, and the elimination of thermal lesions due to the reduction in the target tissue temperature (below 42 degrees). We treated three cases of supraorbital neuropathic pain using PRF, and discovered that two of the patients had significant pain relief at the six month time point.
Central Nervous System Sensitization ; Humans ; Incidence ; Neuralgia ; Peripheral Nerve Injuries ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Polypharmacy ; Spinal Cord

Carpal tunnel syndrome, compression of the median nerve in the carpal tunnel at the wrist, is the most common entrapment syndrome of peripheral nerve. It is characterized by sensory and motor symptoms and signs in the distribution of the median nerve. Radiofrequency thermocoagulation is a neuroablative treatment for various chronic pain disorders, but is associated with neural injury, neuritis, and occasional neuroma. Unlike RF, pulsed radiofrequency, the use of the high current intensity and electrical fields, has been proposed for the modulation of the excited nervous system pathway of pain without neuro-destruction and other potential complications. We report a case of bilateral carpal tunnel syndrome that was relieved after PRF lesioning of both median nerves.
Carpal Tunnel Syndrome ; Chronic Pain ; Electrocoagulation ; Humans ; Median Nerve ; Nervous System ; Neuritis ; Neuroma ; Peripheral Nerves ; Wrist

Opioids are generally used to treat severe cancer pain. Usually, it is common to increase the dose of opioids to maintain analgesia. Opioid-induced hyperalgesia (OIH) is a paradoxical response to opioid resulting in increased perception of pain rather than antinociceptive effect. A 64-year-old female with pancreatic cancer was suffering from whole abdominal pain. She took massive opioid therapy, however, her pain had been worse and widen in the 3 months. Radiologic imaging was performed to exclude metastatic cancer. The result was negative. We suspected OIH, and reduced the amount of opioids, then, added to adjuvant analgesics. And also we performed celiac plexus neurolysis with the use of alcohol and continuous epidural catheter insertion. Her numeric rating pain scale (NRS) decreased from 9/10 to 3/10. This case suggests that adjuvant analgesics and interventional treatments can resolve a OIH patient with intractable cancer pain.
Abdominal Pain ; Analgesia ; Analgesics ; Analgesics, Opioid ; Catheters ; Celiac Plexus ; Female ; Humans ; Hyperalgesia ; Middle Aged ; Pain Management ; Pancreatic Neoplasms ; Stress, Psychological

There has been increased interest recently in low-flow anesthesia to minimize wastage of expensive volatile anesthetics and reduce atmospheric pollution. With the help of modern anesthetic apparatus and the availability of comprehensive gas monitoring, low-flow anesthesia can be performed safely in children. However, pediatric anesthesiologists have been more reluctant to adopt low-flow techniques. In this review article, the safety and efficacy of low-flow anesthesia will be discussed to help the anesthesiologists who want to employ this technique in children.
Anesthesia ; Anesthetics ; Child ; Humans

BACKGROUND: Laparoscopic surgery may affect the coagulation system in several ways. The purpose of this study was to compare the hemostatic changes between open and laparoscopic colorectal surgery by using thromboelastography. METHODS: Forty patients who were undergoing open (n = 15) or laparoscopic (n = 25) colorectal cancer surgery were included in this prospective study. Blood samples were drawn from a forearm vein by fresh venipunctures for determining the thromboelastography (TEG) parameters at after induction of anesthesia T0, 2 hours after the beginning of surgery T1, and immediately before discharge from the recovery room T2. RESULTS: The PT-INR and aPTT did not show significant differences between laparoscopic and open colorectal surgery. There were no significant differences of the TEG parameters (R, K, MA, alpha angle, CI, LY30 and CL30) between the two groups. CONCLUSIONS: The overall coagulation and fibrinolysis detected by TEG were not different between laparoscopic and open colorectal surgery
Anesthesia ; Colorectal Neoplasms ; Colorectal Surgery ; Fibrinolysis ; Forearm ; Humans ; Laparoscopy ; Phlebotomy ; Prospective Studies ; Recovery Room ; Thrombelastography ; Veins

The Shikani Optical Stylet(TM) (SOS, Clarus Medical, USA) is another tool to facilitate tracheal intubation. It combines the benefits of a lightwand and a fiberoptic bronchoscope. We report the application of SOS in facilitating the tracheal intubation of two-person with history of difficult airway management. A 25-year-old woman with micrognathia was scheduled to undergo an exploratory laparotomy. Intubation attemps failed with a direct laryngoscope because of difficulty in her mouth opening. Although airway management was re-attempted by a laryngeal mask airway, it also failed for the same reason. Airway management was successfully performed using the SOS instead of a laryngeal mask airway. The second case was a 38-year-old woman with ankylosing spondylitis, scheduled for spinal fusion. She had difficulty in extending her neck. Intubation was successfully performed via the SOS. We believe that intubation by the SOS is a useful and readily available alternative technique for patients with difficult airways.
Adult ; Airway Management ; Bronchoscopes ; Female ; Humans ; Intubation ; Laparotomy ; Laryngeal Masks ; Laryngoscopes ; Mouth ; Neck ; Spinal Fusion ; Spondylitis, Ankylosing

BACKGROUND: Total knee arthroplasty (TKR) is associated with a significant loss of blood. Fluid substitution with crystalloid or colloid solutions to correct perioperative hypovolemia is essential. Colloid solutions, and especially hydroxyethyl starches (HES), are used to treat hypovolemia, but they may affect blood coagulation. The purpose of this study was to test the efficacy and the safety of colloid solutions in patients undergoing TKR. METHODS: The patients undergoing TKR were divided into a group that underwent fluid management with Voluven(R) (n = 22) and a group that was managed with Hextend(R) (n = 24). The blood loss, the autotransfused blood volume, the hemoglobin level, the allogenic blood requirement, the urine output and the complications were assessed. RESULTS: There were no significant differences in the amount of blood loss, the autotransfused blood volume, the allogenic requirement, the urine output and the complications between the two groups. CONCLUSIONS: Voluven(R) and Hextend(R) are equally efficacious plasma volume substitutes when performing TKR with an autotransfusion of drained blood.
Arthroplasty ; Blood Coagulation ; Blood Transfusion, Autologous ; Blood Volume ; Colloids ; Hemoglobins ; Hetastarch ; Humans ; Hypovolemia ; Isotonic Solutions ; Knee ; Plasma Volume ; Postoperative Hemorrhage

Lung isolation in a neonate can be a challenge for the anesthesiologist. We report on our anesthetic experience with a neonate who had giant bronchopulmonary sequestration (BPS). The BPS was large enough to shift the mediastinum to the contralateral hemithorax. The trachea was immediately intubated after delivery and the lungs were mechanically ventilated in the neonatal intensive care unit. To prevent desaturation during the attempt of lung isolation, a 3 Fr Fogarty catheter was inserted into the trachea alongside the endotracheal tube without extubation. A fiberscope was then passed through the blocker port of a multiport adapter instead of the bronchoscopy port to minimize leakage by tightening the Touhy-Borst valve. Hypoxemia or leakage did not occur during the procedure. For early extubation, we provided caudal analgesia with ropivacaine and morphine. The giant BPS was successfully resected and the neonate was in excellent condition for early extubation. However, reintubation was needed for the pneumothorax caused by the inadequate placement of a chest drain 9 hours after extubation.
Amides ; Analgesia ; Analgesia, Epidural ; Anoxia ; Bronchopulmonary Sequestration ; Bronchoscopy ; Catheters ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Lung ; Mediastinum ; Morphine ; One-Lung Ventilation ; Pneumothorax ; Thorax ; Trachea

Surgical ligation of PDA is an effective treatment for symptomatic infants who do not respond to treatment with indomethacin. Transfer of unstable infants to the operating room has been shown to be associated with various problems. Thus, we describe the anesthetic management of 5 extremely low birth weight (ELBW) infants who underwent surgical ligation of PDA in a neonatal intensive care unit (NICU). General anesthesia was induced by ketamine 1 mg/kg IV. Rocuronium was used for muscle relaxation. Anesthesia was maintained with continuous infusion of remifentanil 0.15-0.4 ug/kg/min with oxygen (in 2 cases) or continuous infusion of remifentanil 0.05-0.1 ug/kg/min and 0.4-1.0 vol% sevoflurane with oxygen (in 3 cases). It was safe and effective to perform bedside PDA ligation in the NICU. We describe the successful use of remifentanil with sevoflurane or remifentanil alone in 5 extremely low birth weight infants undergoing PDA ligation.
Androstanols ; Anesthesia ; Anesthesia, General ; Ductus Arteriosus, Patent ; Humans ; Indomethacin ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Intensive Care Units ; Intensive Care, Neonatal ; Ketamine ; Ligation ; Methyl Ethers ; Muscle Relaxation ; Operating Rooms ; Oxygen ; Piperidines

BACKGROUND: The effectiveness of preemptive analgesia is still controversial. This study was designed to compare the effects of nalbuphine used in the pre-anesthesia period and after surgery for pain control when performing adenoidectomy or tonsillectomy in children. METHODS: Two hundreds four patients (aged 3 to 12 years) were randomly allocated into two groups: the preemptive group (group P, n = 98) and the intraoperative group (group I, n = 106). Nalbuphine 0.1 mg/kg was administered into the patients before induction of anesthesia in group P and it was injected at least 10 minutes after the beginning of surgery in group I. The anesthesia was performed in the conventional fashion. The pain score, the sedation score and the agitation score were checked and recorded in the postanesthetic room (PAR) at arrival (0), at 15 minutes and at 30 minutes. RESULTS: The pain scores for PAR 0, 15 and 30 minutes were significantly lower in group I than those in group P. The other sedation scores or agitation scores were similar in both groups. CONCLUSIONS: Nalbuphine used during the pre-anesthetic period was less effective than that used in the intraoperative period for pain control when performing adenoidectomy or tonsillectomy in children.
Adenoidectomy ; Analgesia ; Anesthesia ; Child ; Dihydroergotamine ; Humans ; Intraoperative Period ; Nalbuphine ; Tonsillectomy