Effective sympathetic nerve block for chemotherapy-induced peripheral neuropathy: a case report.

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most difficult-to-alleviate side effects of chemotherapy, impacting the patient's daily activities and quality of life and frequently necessitating the discontinuation or dose reduction of anticancer drugs. An effective treatment for CIPN is yet to be established. Herein, we report the case of a patient who developed CIPN after receiving paclitaxel as postoperative chemotherapy for breast cancer. The patient experienced difficulties in performing daily activities owing to pain in her fingers and toes despite attempts to treat these symptoms with medications. Stellate and lumbar sympathetic ganglion blocks improved CIPN-induced symptoms of numbness and pain in the extremities. Thereafter, lumbar sympathetic ganglion block was performed once every 6 months, markedly improving the patient's quality of life. Accordingly, sympathetic nerve block can facilitate pain control in patients with CIPN refractory to pharmacotherapy.

[The Effect of Remifentanil on the Estimated Target Effect-site Concentration (esTEC) of Propofol during Total Intravenous Anesthesia].

BACKGROUND: Using an algorithm by which the effect-site concentration of propofol (esTEC) necessary for BIS level set from information input from BIS monitor and TCI pump is estimated, the effect of remifentanil on esTEC was investigated. METHODS: In 14 abdominal/thoracic surgical patients managed under total intravenous anesthesia with propofol and remifetanil, the distribution of relation between the effect-site concentration of remifetanil and remifentanil esTEC was analyzed in a retrospective manner. RESULTS: While the propofol esTEC decreased in accordance with the increase of the effect-site concentration of remifetanil, the effect-site concentration of propofol esTEC45 for maintaining BIS 45 became within a certain range and with less dispersion when the concentration of remifetanil exceeded 10 ng x ml(-1). CONCLUSIONS: A mutual interaction was observed between propofol esTEC and remifetanil. For anesthetic management with less variation in BIS levels, it was considered that 10 ng x ml(-1) or higher of the effect-site concentration of remifetanil would be necessary.

[Reliability of propofol target-controlled infusion in elderly patients].

BACKGROUND: Propofol target-controlled infusion (TCI) is now commonly used for the induction and maintenance of anesthesia. In this study, we measured the propofol plasma concentrations of elderly patients to evaluate our hypothesis that propofol TCI is reliable for use in elderly patients. METHODS: We measured plasma concentrations of propofol in 10 elderly patients undergoing elective general anesthesia. Propofol TCI was commenced at a target plasma concentration of 3 microg x ml(-1) using a TCI pump. The target concentration was kept at 3 microg x ml(-1) for 2-3 hours. Arterial blood samples were drawn for measurement of the propofol plasma-concentration analysis at 30, 60, 90, 120 and 180 minutes after the induction of anesthesia, and at the emergence from anesthesia. RESULTS: The measured plasma concentrations of propofol were not significantly different from the target plasma concentrations. The mean estimated and measured plasma concentrations at emergence were at about 1 microg x ml(-1), respectively. CONCLUSIONS: We concluded that propofol TCI is a reliable method for maintaining anesthesia even in elderly patients, whereas the individual differences of the elderly patients was greater than those obtained from normal patients.

[Ambulatory anesthesia preoperative evaluation and its effects on anesthetic care].

BACKGROUND: Adequate preoperative evaluation with sufficient informed consent from patients will lead to safe perioperative anesthetic managements. We started outpatient preoperative evaluation from October, 2002. METHODS: We investigated 1137 elective cases operated during one year after starting outpatient examination. They were compared with 1083 cases under the previous system. On requests from surgeons we examined the patients and obtained informed consents. Additional examinations and medications were ordered if necessary for adequate preoperative management. RESULTS: Eight hundred and twenty-three cases (72.4%) of 1137 elective operative cases visited our outpatient booth and 86.8% of them visited before admission for the surgery. Patients classified into ASA-PS II-III, 550 cases (66.9%), and their major complications were cardiovascular and pulmonary diseases. Two hundred and ninety seven cases (36.1%) required additional examinations following adequate preoperative management by another consultants. After the introduction of this system, the number of postponing or cancellation of operation after hospitalization was only 1.3% of elective operations. Furthermore the number of patients admitted on the day and the day before the operation significantly increased compared with those under the previous system (27.9 - 45.2%). CONCLUSIONS: Our preoperative consulting system will decrease average length of hospital stay and improve the quality control of patients before surgery.