No abstract available.
Korea*

The status of pain clinic in Japan was presented. There are 98 pain clinics in Japan. The activity in the clinical field or research field is are very apparent. They are expanding the indications for pain clinics and trying to seek new therapeutic remedies for patients in dain, but there are also some problems in running pain clinic, for example, the shortage of man power, inade quote facilities and the uneven effects of drugs. Some information about pain clinics was presented.
Humans ; Japan* ; Pain Clinics* ; Running

It is a highly risky procedure to perform general anesthesia on a patient with toxemia in whom the function of the vital organs is seriously impaired. The risk is much increased when pulmonary edema is also a complication. Recently, many physicians are increasingly interested in PEEP(positive end-expiratory pressure) as a valuable therapeutic approach for pulmonary edema. There are reports that the PEEP has contributed a great deal of the treatment of the pulmonary edema. This is a case report of a patient with toxemia and pulmonary edema who underwent cesarean section. She was treated with oxygen, diuretics, digitalis, steroids, bronchodilators and PEEP(pr.=10cm.H2O, Vt=700ml., assist mode), The therapeutic result was excellent.
Anesthesia* ; Anesthesia, General ; Bronchodilator Agents ; Cesarean Section ; Digitalis ; Diuretics ; Female ; Humans ; Oxygen ; Pregnancy ; Pulmonary Edema* ; Steroids ; Toxemia*

Disorders of coagulation and uncontrollable bleeding are major problems during a major surgical operation. The correct diagnosis, appropriate treatment and preparation for abnormal coagulation and bleeding conditions with specific factors and blood products are procedure of utmost importance. Detailed history, physical examination and performance of appropriate laboratory tests including specific factor assay are essential for the diagnosis of an abnormal coagulation and bleeding problem. We have experienced a case of factor ll deficient patient who had surgery for a glioma of the forebrain. He had a past history of two episodes of massive bleeding during operation and showed a bleeding tendency after angiography for this last admission, but he didn't show any abnormal blood coagulation tests except for a factor ll deficiency. He had received Vitamine K 20 mg/day for 7days preoperatively. All laboratory coagulstion tests became normal and he had a surgical removal of a forebrain glioma uneventfully under general anesthesia. He received only 1 unit of fresh frozen plasma during operation and had an uneventful postoperative course.
Anesthesia, General ; Angiography ; Blood Coagulation Tests ; Diagnosis ; Glioma ; Hemorrhage ; Humans ; Hypoprothrombinemias* ; Physical Examination ; Plasma ; Prosencephalon ; Vitamins

The insertion of a levine tube in the anesthetized or comatose patients who is intubated, is often difficult. Various methods used to facilitate the procedure have been reported, but none of them are completely reliable. So we are going to describe our method which showed satisfactory results. insertion of well lubricated suction catheter into the oral cavity is made iva the nose and followed by the orossophageal insertion of a Magill tube without cuff under direct laryngoscopy. At the same time, pulling out the suction catheter from the oral cavity is made by using Magill forceps under direct vision. The distal tip of the levine tube is then threaded into the guide Magill tube and advanced into the stomach. After identification of the presence of the tip of levine tube in the stomach by palpation by the surgeon or the aspiration of gastirc contents, the guide Magill tube is withdrawn from the esophagus. Next, connection between the proximal end of Levine tube and the distal tip of the suction catheter is mad and pulled out through the nose by pulling the suction catheter. The levine tube is made held by adhesive tape.
Adhesives ; Anesthesia* ; Catheters ; Coma ; Esophagus ; Humans ; Laryngoscopy ; Mouth ; Nose ; Palpation ; Stomach ; Suction ; Surgical Instruments

Successful block of the celiac plexus denervates the denervatives of the foregut and therefore can successfully interrupt nociceptive stimuli from the pancreas, stomach, liver, etc. Although permanent neurolytic block is much less successful for malignant chronic pancreatitis syndrome, it is specifically useful for treatment of intractable pain that often accompanies carcinoma of the pancreas or other upper abdominal visceral tumors. This was a case report in which intractable pain due to malignant gastric cancer was successfuly controlled by the permanent neurolytic celiac plexus block.
Celiac Plexus ; Liver ; Pain, Intractable ; Pancreas ; Pancreatitis, Chronic ; Stomach ; Stomach Neoplasms*

Many studies have shown that epidural narcotics produce prolonged analgesic action. We instillated 2mg of morphine on the dura just before wound closure which was exposed for lumbar laminectomy. Sixty patients scheduled for laminectomy were devided into two groups i.e., morphine group (30 patients) and control group(30 patients). The results of this study were as follows: 1) In morphine group, 17 patients (56.6%) tolerated the postoperative pain without narcotic injection for over 20 hours, but 13 patients(43.3%) of the control group required narcotic injection within 5 hours. 2) Severe respiratory depression was noted in two cases from the morphine group. 3) It is a very simple and effective method for postoperative pain control.
Humans ; Laminectomy ; Morphine* ; Narcotics ; Pain, Postoperative* ; Respiratory Insufficiency ; Wounds and Injuries

Acute obstruction of the upper airway in children demands prompt diagnosis and treatment. The management is complex and therefore demands serious, detalled and expert attention. An artificial airway is often required to alleviate the obstruction and due consideration should then be given to the relative merits of the passage of an endotracheal tube and tracheostomy. These are measures which should be carried out early in the illness and must not be postponed until the child is in a critical condition when emergency intervention is often associated with a high incidence of morbidity and mortality. Tracheostomy has been the procedure of choice to relieve airway obstruction; however, in recent years several investigators have reported the encouraging results of nasotracheal intubation as an alternate procedure in the management of upper airway obstruction in children. The purpose of this report is to evaluate the relative effectiveness of two procedures; nasotracheal intubation ami tracheostomy, Nasotracheal intubation or tracheostomy were employed in the management of 27 cases, and it would appear that the two methods of handling airway obstractiorr wer.e equally satisfactory. It was suggested that nasotracheal intubation was superior to tracheostomy in terms of the duration of hospitalization (13,0 days vs. 21. 3 days) and intubation (108. 4 hours vs 167. 2 hours). All patients tolerated well the nasotracheal tube without accidental extubation.
Airway Obstruction* ; Child* ; Diagnosis ; Emergencies ; Hospitalization ; Humans ; Incidence ; Intubation* ; Mortality ; Research Personnel ; Tracheostomy*

The use of the succinylcholine chloride for endotracheal intubation is a widely accepted technic during induction of inhalational anesthesia, Currently transient hyperkalemia is well known to occur in man following intravenous administratian of succinylcholine chloride. Furthermore, the massive hyperkalemia following succinylcholine chloride administration is a recognized danger in patients with severe burns, massive trauma, muscle dystrophy and skeletal muscle paralysis caused by peripheral nerve injury or lesions of the central nervous system. Increased serum potassium may lead to severe cardiac arrhythmia or cardiac arrest. We studied the effect of intravenously administered succinylcholine chloride on the serum potassium level and electrocardiographic changes in nontraumatized and traumatized (fract- ured tibia) rabbits. The following results were obtained: 1. Serum potassium was slightly increased in the non-traumatized group and slightly decreased in the traumatized group before succinylcholine chloride injection, after 5 minutes of succinyl choline chloride injection and after 10 minutes of succinylcholine chloride injection but no statistical significance was noticed in either group. 2. Serum calcium was significantly decreased in the traumatized group after intravenous succinylcholine chloride. (p<0. 05) 3. Hemoglobin and hematocrit were decreased in both non-traumatized and traumatized groups due to blood loss during the studies.4. In the non-traumatized group, the incidence of arrhythmia was increased from 25 to 40% and incidence of arrhythmia in the traumatized group was the same, 53. 3% before and after succinylcholine chloride injection.
Anesthesia ; Arrhythmias, Cardiac ; Burns ; Calcium ; Central Nervous System ; Choline ; Electrocardiography ; Heart Arrest ; Hematocrit ; Humans ; Hyperkalemia ; Incidence ; Intubation, Intratracheal ; Muscle, Skeletal ; Paralysis ; Peripheral Nerve Injuries ; Potassium* ; Rabbits* ; Succinylcholine* ; Tibial Fractures*

BACKGROUND: The purpose of this study was to investigate whether the effects of mivacurium on onset and recovery were affected by the duration of more than 2 weeks after injury of the lower motor neuron in rabbits. METHODS: The animals were divided into five groups. The control group was without lower motor neuron injury. In the experimental groups, the lower motor neuron injury was made by denervating with a 75 - 80% lesion on the common peroneal nerve to the right anterior tibialis muscle. The experimental groups were subdivided as 1, 2, 3 and 4 week groups (named group 1 wk, 2, 3 and 4 wks) according to the duration of the denervation of the common peroneal nerve. The response relationship of mivacurium on the muscle twitches induced by TOF (train of four) stimulation (supramaximal stimulus of 0.2 ms duration, square-wave pulses, 2 Hz rate and 10 mA, repeated every 10 seconds) was studied in the anterior tibialis muscles and compared between all groups. Neuromuscular responses (onset, recovery time to T1(1), T1(25), T1(75), T1(95) and recovery index) of muscle twitches to intravenous mivacurium (0.18 mg/kg) were studied. After recording the muscle twitches, macroscopic findings were observed. RESULTS: The recovery time, T1(1) of group 4 wks was significantly longer than those of group 1, 2 and 3 wks (P < 0.05), but not different from the control group. The recovery time, T1(25), T1(75) and T1(95) of group 4 wks was significantly longer than those of all other groups (P < 0.05), but the onset times of all groups were not significantly different. The recovery index of group 4 wks was significantly higher than that of the control group (P < 0.05), but those of groups 1, 2 and 3 wks were not significantly different from that of the control group. The mass of the anterior tibialis muscle was significantly decreased at 4 weeks after the lower motor neuron injury (P < 0.05). CONCLUSIONS: Our results therefore suggest that the neuromuscular response to intravenous mivacurium on recovery in rabbits becomes prolonged according to the durations of the denervation and represents sensitivity at 4 weeks after the lower motor neuron injury.
Animals ; Denervation ; Motor Neurons* ; Muscles ; Peroneal Nerve ; Rabbits