ABSTRACT
Stevens-Johnson syndrome (SJS) is a rare but life-threatening skin reaction disease and carbamazepine is one of its most common causes. We report a case of SJS secondary to carbamazepine in a patient with previous pruritus due to carbamazepine which was given for treatment of trigeminal neuralgia. We would like to caution all providers that carbamazepine readministration should be avoided in the patient with a previous history of SJS or adverse skin reaction. In addition, we strongly recommend gradual titration when initiating treatment with carbamazepine.
Subject(s)
Humans , Carbamazepine , Pruritus , Skin , Stevens-Johnson Syndrome , Trigeminal NeuralgiaABSTRACT
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.
Subject(s)
Humans , Central Nervous System Sensitization , Incidence , Neuralgia , Peripheral Nerve Injuries , Peripheral Nerves , Peripheral Nervous System Diseases , Polypharmacy , Spinal CordABSTRACT
Awake craniotomy is indicated for tumor resection involving eloquent cortex. It allows the operator to perform appropriate cortical mapping during surgery and facilitate maximum tumor resection while minimizing neurologic deficit. Therefore anesthesia should provide adequate analgesia and sedation but also importantly a full consciousness and cooperation for neurologic testing. This case reports the use of target-controlled infusion (TCI) and monitoring of sedation and anesthetic depth through bispectral index (BIS), providing good control of sedation and analgesia to meet frequent changes throughout the different levels of the procedure while maintaining good condition for intraoperative brain mapping. We propose that TCI of propofol and remifentanil in combination may be a useful alternative for awake craniotomy requiring intraoperative brain mapping surgery.
Subject(s)
Analgesia , Anesthesia , Brain Mapping , Conscious Sedation , Consciousness , Craniotomy , Neurologic Manifestations , Piperidines , PropofolABSTRACT
BACKGROUND: The effects of local and inhalation anesthesia on the contraction of the tracheal smooth muscle have been reported. However, when inhalation and local anesthesia are administered simultaneously, their effects on the contraction of the airway smooth muscle are not well known. Therefore, this study evaluated the effects of lidocaine, bupivacaine, with or without enflurane, on the histamine induced tracheal smooth muscle contraction in guinea pigs. METHODS: Isolated tracheal rings of guinea pigs were suspended in Krebs solution. The contractions were recorded isometrically using a transducer. A contraction was induced by histamine (10(-5) M). Enflurane (1 MAC) was administered for 15 min after administering the histamine. The cumulative dose responses of the lidocaine and bupivacaine (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M, 10(-4) M, and 10(-3) M), enflurane-lidocaine and enflurane-bupivacaine groups were checked. RESULTS: The contraction by histamine were inhibited by lidocaine (10(-4) M and 10(-3) M) and bupivacaine (10(-5) M, 10(-4) M and 10(-3) M). In addition, the contractions were inhibited more significantly in the bupivacaine group (10(-7) M, 10(-6) M, 10(-5) M, 10(-4) M and 10(-3) M) after administering enflurane. CONCLUSIONS: Lidocaine and bupivacaine inhibited the contractions induced by histamine. The contractions by bupivacaine were further inhibited after administering enflurane.