ABSTRACT
We report three cases of liver transplant recipients (LTRs) with postherpetic neuralgia (PHN). They were referred to our department because of poor pain control. Repeated percutaneous lidocaine (2%, 15 ml) administration to the site of the pain via an iontophoresis system and xenon-ray irradiation were effective for the three patients. Visual analogue scale for pain decreased significantly and requirements of analgesics diminished considerably during the therapy without serious side effects. PHN is relatively common in LTRs, but treatment options are restricted because of immunosuppressive therapy and hepatic and/or renal dysfunction. However noninvasive frequent iontophoretic administration of lidocaine and xenon-ray irradiation produced satisfactory pain relief for PHN in LTRs.
Subject(s)
Anesthetics, Local/administration & dosage , Lidocaine/administration & dosage , Liver Transplantation , Neuralgia, Postherpetic/therapy , Phototherapy/methods , Xenon/therapeutic use , Adolescent , Aged , Female , Humans , Immunocompromised Host , Iontophoresis , Male , Middle AgedABSTRACT
A 37-year-old man with beta-thalassemia intermedia (betaTI), a rare disease caused by partial or complete deficiency of beta-globin chain synthesis, fell into a hemolytic crisis. Severe anemia persisted despite frequent transfusions. Therefore, he was scheduled for splenectomy to alleviate the anemia. The preoperative laboratory data showed marked anemia and liver dysfunction. Echocardiography revealed hyperkinetic left ventricular motion and increased cardiac index (CI), indicating a compensatory hyperdynamic circulation induced by persistent, severe anemia. Our strategy during general anesthesia was to keep the hyperkinetic cardiovascular system steady. Hence, the hemodynamic parameters including the CI were measured using a Swan-Ganz catheter, and other physiological parameters were monitored perioperatively. Anesthesia was maintained with balanced anesthesia: isoflurane at low concentrations and fentanyl to avoid cardiovascular depression. Throughout the operation, vital signs were kept stable and the lactate/pyruvate ratio was unchanged, indicating that anaerobic metabolism did not increase. We report successful anesthetic management with attention to hemodynamic changes in a patient with betaTI.
