Language：Japanese   Publisher：Scientific Reports  

Anesthesiologists often compare intraoperative and preoperative electrocardiogram (ECG) waveforms in patients undergoing general anesthesia. In addition, many intraoperative ECG monitors have filters for removing electrocautery noise. In pediatric anesthesiology practice, we often note the appearance of elevated T waves—specifically, an increase in their height—with the use of such filters, even though no actual clinical change has occurred, which possibly leads to misdiagnosis. We investigated changes in R and T wave heights and in the T/R ratio according to the use of the strong (S) versus the diagnostic (D) filtering mode during pediatric anesthesiology. Primary outcomes were the dependence of the heights of the R and T waves on the filter mode and the correlation between rates of change in the R- and T-wave heights and heart rate (HR). In the S mode, the height of the R wave was lower (p = 0.013, η2 = 0.28) and the T/R ratio was higher than the corresponding values in the D mode (χ2 = 20.46, p < 0.001). The T/R ratios were also higher in the S mode than in the D mode, and when the D mode was changed to the S mode during tachycardia, there was a strong correlation between the rate of reduction in the R wave and HR (r = 0. 573, p = 0.041). Significant differences in the heights of the R wave and in the T/R ratio occur when using different intraoperative ECG filtering modes. Specifically, in S mode, a greater relative increase in T wave height may occur due to a significant decrease in R wave height. To avoid spurious diagnoses, anesthesiologists should be familiar with these potentially purely filter-driven changes whenever ECG is intraoperatively monitored.

DOI： 10.1038/s41598-022-17680-4

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PubMed

Language：Japanese   Publisher：克誠堂出版(株)  

唇顎口蓋裂の外科的修正術後,病棟へ帰室移動中に分泌物が原因で気管閉塞し,心肺蘇生が必要となる症例を経験した。手術に伴う口腔領域の解剖学的変化に呼吸や嚥下がうまく対応できないと,誤嚥や窒息の危険性が高まる。これらの患者に対する全身麻酔時には解剖学的特徴をあらかじめ認識したうえで,有効な予防と処置を準備しておく必要がある。(著者抄録)

Language：Japanese   Publisher：Anesthesia progress  

OBJECTIVE: Postoperative sore throat is relatively frequent complication after orotracheal intubation. However, there are few reports about postoperative sore throat in nasotracheal intubation. In this retrospective study, we investigated the risk factors of postoperative sore throat in nasotracheal intubation. METHODS: Anesthesia records of patients 16 to 80 years of age who underwent nasotracheal intubation were included. Patients underwent oral and maxillofacial surgery from February 2015 until September 2018. Airway device (Macintosh laryngoscope, Pentax-AWS, or McGRATH video laryngoscope, or fiberoptic scope), sex, age, height, weight, American Society of Anesthesiologists classification, intubation attempts, duration of intubation, intubation time, tube size, and fentanyl and remifentanil dose were investigated. Fisher exact test, Wilcoxon rank sum test, Welch t test, and Steel-Dwass multiple test were used, and a multivariable analysis was performed using stepwise logistic regression to determine the risk factors of postoperative sore throat. RESULTS: A total of 169 cases were analyzed, and 126 patients (74.6%) had a postoperative sore throat. Based on the univariate analysis of the data, 12 factors were determined to be potentially related to the occurrence of a postoperative sore throat. However, after evaluation using stepwise logistic regression analysis, the 2 remaining variables that correlated with postoperative sore throat were airway device (P < .05) and intubation attempts (P = .04). In the model using logistic regression analysis, the fiberoptic scope had the strongest influence on the incidence of sore throat with reference to Pentax-AWS (odds ratio = 5.25; 95% CI = 1.54-17.92; P < .05). CONCLUSION: Use of a fiberoptic scope was identified as an independent risk factor for postoperative throat discomfort. Compared with direct laryngoscopy and other video laryngoscopes, the use of a fiberoptic scope had a significantly higher incidence of sore throat.

DOI： 10.2344/anpr-69-01-05

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PubMed

Language：Japanese   Publisher：Resuscitation Plus  

Introduction: When performing cardiopulmonary resuscitation (CPR) on a patient who has suffered a cardiopulmonary arrest during dental treatment, few dental chairs have sufficient stability to perform effective chest compressions. We previously proposed a method of stabilizing the backrest of a dental chair using a support stool. As a result, we confirmed that the vertical displacement of the backrest could be significantly reduced. In the present study, we verified the effectiveness of the stool stabilization method using several dental chairs (flat and curved) with significantly different backrest shapes. Methods: Vertical displacement of the backrests of dental chairs was recorded. Data were obtained at three different stool positions (without a stool, under the chest at the level that participants were performing manual chest compressions, and under the shoulders). Reduction displacement ratios were calculated to evaluate the effectiveness of the stool positions. Results: The method significantly reduced the vertical displacement of the backrest for all types. When the curvature of the backrest was large, the reduction in vertical displacement was 40% when the stool was placed under the chest at the level of manual chest compressions and 65% when placed underneath the shoulder. In the case of a flat dental chair, this reduction was 90% when using a stool in either position, compared to no stool. Conclusion: When we need to perform CPR on a patient in the dental chair, placing a stool under the shoulders allows effective manual chest compression by firmly supporting the backrest of a dental chair of any shape.

DOI： 10.1016/j.resplu.2022.100286

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PubMed

Language：Japanese   Publisher：Anesthesia progress  

In oral maxillofacial surgery, the endotracheal tube (ETT) is often inserted nasotracheally to provide surgeons a better view and easier access to the oral cavity. Use of a flexible fiberoptic scope is an effective technique for difficult intubation. While the airway anatomy can be observed as the scope is advanced, the ETT tip cannot be observed with the traditional method. It is occasionally difficult to advance the ETT beyond the glottis as impingement of the ETT tip may occur. We devised a new nasotracheal intubation technique using a fiberoptic scope. In this novel technique, the ETT and fiberoptic scope are inserted into the pharyngeal space separately through the right and left nasal cavities. This permits continuous observation of the glottis as the ETT is advanced into the trachea. The main advantage of this technique is that the ETT tip is visualized as it is advanced, which helps avoid impingement of the ETT. If resistance is noted, the ETT can easily be rotated or withdrawn without causing laryngeal damage, leading to safe and smooth intubation. This novel technique allows advancement of the ETT under continuous indirect vision, thus minimizing contact of the ETT with the laryngeal structures and aiding in unhindered passage into the glottis.

DOI： 10.2344/anpr-69-02-10

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PubMed

Language：Japanese   Publisher：Anesthesia progress  

OBJECTIVE: Most dental chairs lack sufficient stability to perform effective manual chest compression (MCC) during cardiopulmonary resuscitation (CPR). A stabilizing stool can significantly reduce backrest vertical displacement in all chair types; however, a severely curved exterior backrest may negatively impact the stool's effectiveness. This study evaluated the efficacy of 2 stool positions for stabilizing a dental chair during MCC. METHODS: Chest compressions were performed on a manikin positioned in a dental chair while vertical displacement of the chair backrest during MCC was recorded using video and measured. Vertical displacement data were captured with no stool and with a stabilizing stool in 2 different positions. Reduction ratios were calculated to evaluate the effectiveness of the 2 stool positions. RESULTS: With no stool, the backrest median (interquartile range) vertical displacement during chest compressions was 16.5 (2.5) mm as compared with 12.0 (1.5) mm for the stabilizing stool positioned under the area of MCC and 8.5 (1.0) mm under the shoulders. The stool positioned under the shoulders produced a significantly increased calculated reduction ratio of 48% (14%) compared with 27% (20%) under the area of MCC (P < .001). CONCLUSIONS: Positioning a stabilizing stool under the shoulders was more effective at reducing vertical displacement of the dental chair backrest during chest compressions than positioning the stool under the area of MCC.

DOI： 10.2344/anpr-68-03-13

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PubMed

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

症例は7歳1ヵ月の女児。先天性代謝異常症スクリーニングでメチルマロン酸血症(MMA)と診断された。経時的に腎機能障害が進行し、腎移植の方針となった。移植前の周術期口腔管理の際に歯周病を指摘され、全身麻酔下で歯科治療および歯周治療を施行した。その麻酔経過を報告した。MMA患者の麻酔管理では、急性代謝不全の発症を防ぐことが重要であり、術前絶食時間を極力短くすることに配慮し、入室4時間30分前まで胃瘻からの栄養投与を継続し、術直後は速やかに栄養投与を再開した。また、肝代謝の負担を考慮し、導入時のみプロポフォールを使用し、他の薬剤も短時間作用性で腎代謝の少ないものを選択した。麻酔時間は3時間33分、覚醒は良好で呼吸も安定していた。2ヵ月後、実父からの腎移植を受け、現在経過観察中である。

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

症例は14歳女児。生後13日に脳室周囲白質軟化症と診断され、生後3ヵ月で点頭てんかんを発症し、内服薬でコントロールされていた。12歳時の胸部CTにて気管分岐部直上の気管狭窄、縦隔の扁平化が指摘された。胸骨と腕頭動脈による気管の圧迫があり、13歳時に腕頭動脈離断術と気管吊り上げ術を受けた。今回、かかりつけ医で全顎にわたるう蝕を指摘され、全身麻酔下での歯科治療目的に紹介受診となった。その麻酔経過を報告した。右示指にパルスオキシメーターを装着し、さらに経時的脳血流量測定のため両側前額部に局所脳酸素飽和度(rSo2)センサーのプローブを貼付した。う蝕治療21歯と抜歯1本で、治療時間は3時間11分、術中のSpO2は97～100%、rSO2は右側69～88%、左側75～95%で推移した。

Language：Japanese   Publisher：Anesthesia progress  

Laryngeal granuloma development can be a postoperative complication of laryngeal trauma or irritation resulting from general anesthesia and endotracheal intubation. These rare benign lesions are located primarily over the cartilaginous portions of the larynx, particularly the vocal processes of the arytenoids. Airway manipulation during the intubation process and prolonged intubation periods can be contributing factors to intubation-related laryngeal granulomas, which may manifest 1 to 4 months after intubation. The patient in this case was a female who returned with complaints of throat pain without hoarseness or sensations of a "lump in her throat" 3 months following surgery, during which she was intubated with a 7.0-mm nasotracheal tube for 30 hours, likely contributing to her bilateral laryngeal granulomas. The patient underwent successful conservative medical management consisting of a proton pump inhibitor and an inhaled corticosteroid.

DOI： 10.2344/anpr-68-01-03

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PubMed

Language：Japanese   Publisher：Clinical Oral Investigations  

Objectives: Developmental disability children have differences in growth. Therefore, tube size selection is important for nasotracheal intubation. In our previous study for healthy children undergoing dental surgery, height was the most suitable factor to predict nasotracheal tube size. The aim of this study was to find the most suitable formula for selection of nasotracheal tube size for them, retrospectively. Material and methods: Developmental disability children aged 2 to 10 years were included in this study. They were intubated nasotracheally from April 2012 until May 2017. Their actually intubated tube sizes were checked. The predicted tube sizes were calculated according to the formulas by the backgrounds: the diameter of the trachea at the 6th cervical (C6), 7th cervical (C7), and 2nd thoracic vertebrae (T2) in X-ray. The actually intubated tube sizes were compared with predicted sizes. Data were analyzed using Spearman’s regression analysis. Results: The tube sizes with 5.0, 5.5, and 6.0 mm ID were intubated in 75 patients. The age-based formula was the most suitable; the correlation coefficients (r2) were 0.9027 (vs age), 0.5434 (vs height), 0.3779 (vs weight), 0.0785 (vs C6), 0.2279 (vs C7), and 0.3065 (Th2) (p < 0.01). However, 0.5-mm smaller size tubes were more frequently intubated actually. Their correspondence rate to the predicted size was 48% (5.0 mm), 52% (5.5 mm), and 39% (6.0 mm), respectively. Conclusion: The age-based formula could be the most suitable for predicting nasotracheal tube size in developmental disability children aged 2 to 10 years. One smaller size by the age formula was most suitable at first trial tube. Clinical relevance: The present data indicate that the selection of nasotracheal tube using one smaller size by the age formula (ID = 4 + age [years]/4) might be useful for developmental disability children.

DOI： 10.1007/s00784-020-03517-9

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PubMed

Language：Japanese   Publisher：克誠堂出版(株)  

下顎骨から両側顎関節部に至る広範囲な骨性変形に伴い開口不能となった骨パジェット病患者に対する顎関節授動術の全身麻酔を経験した。症例は39歳男で、麻酔管理上の問題は開口障害のみであったため、気管切開ではなく気管支鏡を用いた有意識下での経鼻挿管を選択した。自発呼吸消失後の舌根沈下に伴う閉塞性気道障害や、開口不能による挿管困難などを想定し、筋弛緩薬の拮抗薬(スガマデクス)と緊急用輪状甲状膜切開用カテーテルセットを準備するとともに、外科的緊急気管切開術を行えるよう麻酔導入時から術者らが待機した。結果的に手術は無事終了し、術後経過も良好であった。

Language：Japanese   Publisher：Aging Clinical and Experimental Research  

Background: The characteristics of electroencephalogram (EEG) profiles under general anesthesia may depend on age and type of anesthetic. Aim: This study investigated age-related differences in EEG waveforms between three inhalational anesthetics used at the same minimum alveolar concentration (MAC), which indicates the level of analgesia. Methods: Patients with American Society of Anesthesiologists physical status I–II were divided into three groups according to age: pediatric (≦ 15 years); adult (16–64 years); and elderly (≧ 65 years). Each group was divided into three subgroups according to the inhalational anesthetic used: sevoflurane, isoflurane, and desflurane. Anesthesia was maintained at 1 MAC, followed by assessment of 95% spectral edge frequency (SEF95) values and amplitude of EEG waveform. Results: The 3 age groups comprised a total of 180 patients. The mean (± SD) EEG waveform amplitude and SEF95 values for sevoflurane in the pediatric, adult, and elderly age groups, respectively, were: 32.9 ± 2.9 µV and 16.7 ± 2.4 Hz; 16.4 ± 3.6 µV and 12.2 ± 1.3 Hz; and 11.0 ± 2.1 µV and 13.6 ± 1.6 Hz. EEG waveform amplitude and SEF95 values were significantly higher in the pediatric group than in the other groups. SEF95 value was higher in the elderly group than in the adult group. Similar results were obtained for isoflurane and desflurane. Conclusion: The amplitude of the EEG waveform and SEF95 values varied with age, even at the same analgesic state in patients under general anesthesia. This age-dependent change in EEG waveform was observed for all three inhalational anesthetics, and should be considered in procedures requiring general anesthesia.

DOI： 10.1007/s40520-019-01378-1

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PubMed

Language：Japanese   Publisher：Anesthesia progress  

Airway management for patients with craniofacial disorders poses many challenges. Congenital infiltrating lipomatosis of the face (CILF) is an extremely rare disorder in which mature lipocytes invade adjacent tissues in the head and neck. The manifestations are typically unilateral, often with associated hypertrophy of both the hard and soft tissues of the face. This is a case report regarding the anesthetic management for a 5-year-old intellectually disabled female with CILF involving the right side of her face who underwent a successful intubated general anesthetic for dental treatment. Awake fiber-optic intubations are recommended and routinely used for patients with suspected or confirmed difficult airways. In this case, substantial distortion of the normal facial anatomy was observed clinically with noted hypertrophy of the right maxilla, mandible, and right side of the tongue. Further complicating matters was the patient's inability to fully cooperate because of her intellectual disability, precluding the option of an awake fiber-optic intubation. To secure the airway following mask induction of anesthesia, spontaneous ventilation was carefully maintained using sevoflurane, nitrous oxide, and oxygen combined with the application of a nasopharyngeal airway. Despite compression of the oral cavity and upper pharyngeal space by the hypertrophic tissues due to CILF, the space in and around the glottis was preserved. Intubation was completed easily with the use of a fiber-optic scope without any serious complications.

DOI： 10.2344/anpr-67-01-01

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PubMed

Language：Japanese   Publisher：克誠堂出版(株)  

3歳女児。高度低酸素血症とチアノーゼを呈し、当院心臓外科で心室修復術が予定されていたが、多数の齲蝕歯を認めたため、口腔内感染源除去と感染性心内膜炎予防を目的として全身麻酔下に抜歯を含む歯科治療を行うこととなった。麻酔薬は心機能抑制作用が軽度で後負荷を上昇させにくいセボフルランを用い、緩徐導入と麻酔維持を行った。術中の追加麻酔薬はミダゾラムを使用し、低血圧を生じさせやすいプロポフォールの使用は避けた。導入時の適切な前負荷維持のため、術前から補液を行うことで脱水を予防した。低血圧時の対応としてαβ刺激薬のドパミンやエフェドリンを使用した。また副交感神経遮断薬のアトロピンも併用し、後負荷の不利益な上昇を避けながら心拍出量と体血流量を適切に維持した。術中に大きな循環変動や心電図変化はなく、術後経過も良好であった。

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

29歳女。舌癌術後の頸部リンパ節転移が妊娠15週時に判明し、18週時に頸部郭清術を施行した。麻酔薬は胎児への神経毒性・催奇形性のリスクを考慮してセボフルランを選択した。麻酔導入前の体位は仰臥位であったが、腹部膨満感の訴えがあり、仰臥位性低血圧症候群の可能性が否定できなかったため、下大動脈への圧迫を軽減する目的で左半側臥位とし、腹部膨満感は改善した。術中はセボフルランの濃度を調整することで血圧維持に努め、良好な結果が得られた。

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

16歳女性。歯科矯正を目的に口腔外科治療(抜歯7歯、矯正用アンカースクリュー埋入術)を全身麻酔下に行った。術中の癲癇発作を防ぐために吸入麻酔薬は、肥大型心筋症に適するセボフルランではなく、癲癇重積発作治療薬としても使用されるイソフルランを敢えて用いたが、術中に非典型的な癲癇発作(舌の筋痙攣様の波動運動)が出現した。この波動運動は約10分で消失し、手術は問題なく終了した。

Language：Japanese   Publisher：Anesthesia progress  

Tracheotomy is occasionally performed to prevent postoperative airway obstruction especially for invasive surgical procedures involving head and neck cancer. When performed under general anesthesia, attention must be paid to avoid rupture of the tracheal tube cuff during the incision into the trachea. In this study, changes in the position of the endotracheal tube tip during extension of the head and neck for a tracheotomy were investigated. Twelve patients underwent placement of a tracheotomy during surgical procedures for oral cancer. After nasal intubation, the distance between the tube tip and the carina was measuring using a fiberoptic scope with the patient's head placed at an angle of 110°. Patients were repositioned for tracheotomy by placing a pillow under the shoulders and extending the head and neck at an angle of 140°. The distance measurements were subsequently repeated. The difference between the first and second measurements was calculated and analyzed statistically using a paired t test. On average the patients were 69.5 ± 9.0 years in age. The distance between the tube tip and the carina at an angle of 140° (3.6 ± 1.1 cm) was significantly longer than that at an angle of 110° (1.7 ± 1.0 cm) (p < 0.001). The migration in the positioning of the endotracheal tube tip was 1.9 ± 0.7 cm (range: 0.7-3.7 cm) upon extension. In 3 cases, the tube cuff was ruptured during incision of the trachea. The endotracheal tube tip may migrate in the cephalad direction approximately 2 cm as a result of the extension of the patient's head and neck during a tracheotomy. Therefore, consideration should be given to advancing the endotracheal tube tip towards the caudal side and to confirming the position of the tube and cuff during a tracheotomy.

DOI： 10.2344/anpr-66-04-05

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PubMed

Language：Japanese   Publisher：克誠堂出版(株)  

72歳男。右側下顎歯肉悪性腫瘍に対して右側選択的頸部郭清術+右側下顎区域切除術+チタンプレートと右側頸部島皮弁による再建術を施行し、その際、rSO2のモニタリングを行った。rSO2は術中に明らかな変動なく、閉創操作による頸動脈圧迫によって急激に低下した。本例の経験から、頸動脈に高度狭窄のある患者の頸部手術時には閉創などの基本的な手術操作でも脳血流を容易に減少させてしまう可能性があると考えられた。

Language：Japanese   Publisher：克誠堂出版(株)  

19歳男。多数歯齲蝕と右下顎智歯周囲炎に対して歯科治療および智歯抜歯術を予定した。精神発達遅滞を伴うペリツェウス・メルツバッハー病患者で、square mandible顔貌と幼少時からの食いしばりによる咀嚼筋群の異常発達を認め、麻酔時の問題点として意思疎通困難、錐体外路症状による開口制限、不随意的閉口および全身の筋硬直による体位保持の困難、喉頭咽頭機能不全による呼吸障害、嘔吐、誤嚥などのリスク、てんかん、股関節の痙性脱臼が挙げられた。術中、筋弛緩薬の投与により全身的には十分な筋弛緩状態であったにもかかわらず、開口量は不十分で直視下の治療は極めて困難であったが、安全に智歯抜歯を行うことができた。

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

Noonan syndrome is characterized by distinctive clinical features, including cardiovascular anomalies, mental delay and skeletal abnormalities. Orofacially, patients with Noonan syndrome have distinctive facial features that include ptosis of the eyelids, hypertelorism, and a low junction of the ears. Epilepsy is an occasional complication of Noonan syndrome. We describe the anesthetic management of a 15-year-old girl with Noonan syndrome. She had hypertrophic obstructive cardiomyopathy(HCM), mental delay, epilepsy and severe scoliosis;she was scheduled to undergo dental treatment under general anesthesia. She had experienced daily hypoxia symptoms because of HCM as well as severe scoliosis. Our anesthetic goal was to provide an adequate preload and afterload. Anesthesia was induced with midazolam, propofol, fentanyl and rocuronium and was maintained with isoflurane and remifentanil. Intraoperative monitoring included noninvasive hemodynamic monitoring and direct monitoring of the arterial pressure. During surgery, we observed a unique tongue movement. The operation was completed uneventfully. After extubation, the stable spontaneous respiration of room air was achieved. However, she experienced epileptic symptoms during which her eyes were open and rolled back into her head, she gradually fell asleep, and her breathing was shallow and slow. She became hypoxic, but she recovered with the administration of positive-pressure ventilation. However, her SpO2 decreased to 84%-88% upon spontaneous breathing only. To prevent hypoxia, respiratory support with non-invasive positive-pressure ventilation was provided for 40 minutes. Her spontaneous respiration recovered after she awakened from the epileptic symptoms. This case suggests that considerable attention is needed not just for the distinctive complications of Noonan syndrome, but for other possible complications such as epilepsy.

DOI： 10.24569/jjdsa.48.2_60

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Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

In pregnant women, non-obstetric surgery should be performed during an appropriate period to prevent congenital anomaly and to avoid miscarriage or premature labor. The second trimester of pregnancy is better for surgery because the risk of maternal, anatomical and physiological changes is lower. Neurotoxicity and the teratogenicity of anesthetic agents should be considered. In addition, blood flow to the placenta must be maintained during the surgery. We performed anesthesia for an 18-week pregnant woman who required a radical neck dissection because of the metastasis of tongue cancer. She was 29 years old, 160 cm tall, and weighed 46.1 kg. Before the induction of anesthesia, the patient was placed in a left half-lateral position by placing towels under the right lower back to avoid supine hypotension syndrome, as the patient complained of a sense of abdomen distension while in a supine position. Her face was twisted to the right to secure a surgical field. General anesthesia was induced with intravenous propofol, atropine, fentanyl and remifentanil. Two milliliters of 4% lidocaine was sprayed on the subglottic area and the glottis for topical anesthesia. A tracheal tube(ID, 6.0 mm)was intubated orally using McGRATH. The anesthesia was maintained with the inhalation of 1.5%–1.7% sevoflurane in oxygen(FIO2, 0.4), as sevoflurane may be less neurotoxic to a fetus than isoflurane or desflurane. Ephedrine was administered intravenously to maintain blood flow to the placenta when the blood pressure decreased. The operation and anesthesia were completed uneventfully. After the operation, the obstetrician performed an ultrasonography examination to confirm that the fetus had good fetal movement and a normal pulse.

DOI： 10.24569/jjdsa.48.2_69

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Language：Japanese   Publisher：Oral and Maxillofacial Surgery  

Introduction: Povidone-iodine (PI) is thought to be an effective disinfectant and safe for many surgeons. Aspiration pneumonia is usually caused by gastric contents, but if PI solution will be aspirated, pneumonia or other complications may occur. Case report: We present a case of pneumonia to aspiration of PI solution in a 91-year-old man patient who underwent oral-maxillofacial surgery. When surgeons used PI solution for disinfection into the oral cavity, the solution seems to be sinking gradually. The patient showed severe respiratory distress and developed hypoxia. There were much frothy fluids into a tracheal tube. We suctioned through the endotracheal tube and performed bronchoscopy, that revealed a redness which appeared associated to a chemical injury on the left trachea and bronchus. His condition was complicated by ARDS and DIC. Periodical bronchial suction and guideline-based treatments of ARDS were carried in ICU. He recovered without severe complication. Conclusion: Although PI solution for an oral disinfection is used routinely, all operators need to be aware of the risk for PI aspiration

DOI： 10.1007/s10006-019-00800-2

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PubMed

Language：Japanese   Publisher：Anesthesia progress  

Fanconi anemia (FA) is a type of bone marrow failure syndrome based on an autosomal recessive inherited trait with increased predisposition for other cancers. It is extremely rare and is characterized by short stature, polydactyly, and pancytopenia. At present, the only effective treatment for FA is allogeneic hematopoietic stem cell transplantation (SCT). Chemotherapy is necessary prior to allogeneic SCT. Dental treatment is usually performed before chemotherapy to reduce potential infections. We experienced the anesthetic management of a 4-year-old boy diagnosed with FA, who underwent extensive dental extractions before chemotherapy for SCT. In the preoperative examination, the platelet count was decreased to less than 3.0 × 104 cells/μL because of chronic pancytopenia. The patient received 20 units of platelet transfusion over 3 days prior to anesthesia. Dental surgery and multiple dental extractions were successfully completed under general anesthesia with sevoflurane, fentanyl, and remifentanil, and chemotherapy started 3 days postoperatively.

DOI： 10.2344/anpr-66-02-06

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PubMed

Language：Japanese   Publisher：Journal of Oral and Maxillofacial Surgery  

Purpose: Mask ventilation is a basic technique for induction of anesthesia. In head and neck surgery, we have encountered difficulty in ventilation owing to facial deformities. Recently, a new type of face mask without an air cushion, the QuadraLite face mask (Intersurgical, Berkshire, UK), was developed. The aim of this study was to compare the performance of cases with predicted difficult mask ventilation between the new type of face mask and a traditional face mask. Patients and Methods: This study was a crossover prospective study. The participants were patients (aged > 18 years) who underwent oral-maxillofacial surgery under general anesthesia. The risk factors for a difficult airway were assessed. Patients were divided into 3 risk groups: low risk, 0 or 1 risk factor for predicted difficult mask ventilation; medium risk, 2 or 3 risk factors; and high risk, 4 or more risk factors. An air cushion face mask (Koo Medical, Shanghai, China) and the QuadraLite face mask were applied in turn under the setting of pressure-controlled ventilation. The expiratory tidal volumes were compared between these face masks. Results: A total of 48 patients were included: 16 in the low-risk group, 16 in the medium-risk group, and 16 in the high-risk group. Higher expiratory tidal volumes were observed with the QuadraLite face mask than with the air cushion face mask, although the differences did not reach the statistically significant level: 574.3 ± 62.7 mL versus 553.1 ± 60.6 mL in the low-risk group (P = .44), 553.1 ± 112.9 mL versus 536.4 ± 114.2 mL in the medium-risk group (P = .38), and 560.0 ± 98.6 mL versus 548.2 ± 07.1 mL in the high-risk group (P = .22). In all cases, a sufficient ventilation volume was obtained by the QuadraLite face mask. Conclusions: The QuadraLite face mask is compact because there is no air cushion, and it can provide sufficient mask ventilation as well as a traditional face mask with an air cushion even in patients with a difficult airway.

DOI： 10.1016/j.joms.2019.08.025

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PubMed

Language：Japanese   Publisher：克誠堂出版(株)  

症例は1番染色体異常の1歳7ヵ月女児で、口蓋裂に対する口蓋形成術を行った。本例は小下顎、睡眠時に一過性の気道閉塞を認めたため、気管挿管困難に備えてビデオ喉頭鏡、気管支内視鏡を準備した。また、複数回の喉頭展開とチューブ交換を行い、適切な外径の気管チューブを選択した。麻酔導入はセボフルランを用いたが、癲癇の合併があるため高濃度での使用は避けた。入眠後にロクロニウム、フェンタニルの静脈内投与を行い、挿管後にセボフルランを中止した。麻酔維持は痙攣を起こしにくいイソフルランの他、ベタメタゾン、レミフェンタニル、フェンタニルを使用した。術後、鎮痛目的にアセトアミノフェン坐剤を用い、集中治療室入室時にミダゾラム、デクスメデトミジン投与で人工呼吸管理とした。

Language：Japanese   Publisher：Clinical Oral Investigations  

Objective: The recovery after general anesthesia is influenced by the choice of inhalational agent. Stimulations might make patient’s agitate. However, the recovery using no touch technique might be safer. In this study, we compared the recovery time, awakening end-tidal concentration, and respiratory complications among inhalational anesthetics in pediatric patients using no touch technique, retrospectively. Material and methods: The subjects were pediatric patients aged 3 months to 11 years under general anesthesia using sevoflurane, isoflurane, or desflurane. Background, awakening end-tidal concentration, respiratory complications, the time of eye open, body movement, and extubation were recorded. Results: A total of 170 patients were included in the study. There were no respiratory complications during emergence. Awakening end-tidal concentration in desflurane was 0.98%, sevoflurane (0.39%), and isoflurane (0.25%). In patients received desflurane, the time of body movement, eye open, and extubation were significantly shorter than patients who received other anesthetics (p < 0.05). Conclusions: The recovery from desflurane was significantly shorter among three inhalational anesthetics with no touch technique. In addition, no airway-related complication occurred. Clinical relevance: The recovery from desflurane might be useful to predict emergence by end-tidal inhalational concentration.

DOI： 10.1007/s00784-019-02993-y

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PubMed

Language：Japanese   Publisher：BMC Emergency Medicine  

Background: Cardiopulmonary resuscitation (CPR) requires immediate start of manual chest compression (MCC) and defibrillation as soon as possible. During dental surgery, CPR could be started in the dental chair considering difficulty to move the patient from the dental chair to the floor. However, all types of dental chairs are not stable for MCC. We previously developed a procedure to stabilize a dental chair by using a stool. EUROPEAN RESUSCITATION COUNCIL (ERC) guideline 2015 adopted our procedure when cardiac arrest during dental surgery. The objective of this study was to verify the efficacy of a stool as a stabilizer in different types of dental chairs. Methods: Three health care providers participated in this study, and 8 kinds of dental chairs were examined. MCC were performed on a manikin that was laid on the backrest of a dental chair. A stool was placed under the backrest to stabilize the dental chair. The vertical displacement of the backrest by MCC was recorded by a camcorder and measured by millimeter. Next, the vertical displacement of the backrest by MCC were compared between with and without a stool. Results: In all 8 dental chairs, the method by using a stool significantly reduced the vertical displacements of the backrest by during MCC. The reduction ratio (mean [interquartile range]) varied between nearly 27 [20] and 87 [5] %. In the largest stabilization case, the displacement was 3.5 [0.5] mm with a stool versus 26 [5.5] mm without a stool (p < 0.001). Conclusions: Our procedure to stabilize dental chairs by using a stool reduced the displacement of a backrest against MCC in all chairs. Clinical relevance: Effective MCC could be performed in dental chairs by using a stool when sudden cardiac arrest occurs during dental surgery.

DOI： 10.1186/s12873-019-0258-x

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PubMed

Language：English  

DOI： 10.1111/1756-185X.13464

PubMed

Language：Japanese   Publisher：Anesthesia Progress  

Hereditary angioedema (HAE) is a rare genetic disease that results from deficiency or dysfunction of C1 inhibitor (C1-INH). This disease is characterized by sudden attacks of angioedema. When edema occurs in the pharynx or larynx, it can lead to serious airway compromise, including death. Physical and/or psychological stress can trigger an attack. Dental treatment, including tooth extraction, is also a recognized trigger. We report a case of a 20-year-old male with HAE who required impacted third molar extractions. C1-INH concentrate was administered 1 hour before surgery, which was completed under deep intravenous sedation. This report describes the anesthetic management of a patient with HAE and reviews treatment options and concerns.

DOI： 10.2344/anpr-65-04-01

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PubMed

Language：Japanese   Publisher：Clinical Oral Investigations  

Objectives: The selection of an appropriate size of tracheal tube is important for airway management. For nasotracheal intubation, passing the nasal cavity should be taken into account for the selection of tube size. The aim of this study was to investigate the selection of appropriate size of nasotracheal tube in pediatric patients retrospectively. Materials and methods: The 1–12-year patients underwent dental procedures under general anesthesia intubated nasotracheally. The correlation between height, age, weight, the tracheal diameters at C6, C7, Th2 on the chest X-ray, and actually performed tube sizes were calculated. In addition, we compared the relationships between the predicted tube size and actually the intubated tube size. Results: The tube sizes intubated actually were between 4.0 and 6.0-mm ID. The formula by height could be most suitable for tube size. The correspondence rates for the tube with 4.5- and 5.0-mm ID were 78% and 53%. When they were predicted as 5.5- or 6.0-mm ID, 0.5 mm smaller size tube were intubated actually; 56% and 70%. When the predicted tube size was 4.0-mm ID, 0.5 mm larger size tube was intubated actually; 66%. Conclusions: The formula by height could be most suitable for the selection of size for pediatric nasotracheal intubation. When the predicted tube size was 5.5 or 6.0-mm ID, 0.5 mm smaller size should be chosen at first. In the case of 4.0-mm ID, 0.5 mm larger size should be chosen for first trial. Clinical relevance: The present data indicate that the selection of nasotracheal tube using the formula by height might be useful.

DOI： 10.1007/s00784-018-2774-6

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PubMed

Language：Japanese   Publisher：Aging Clinical and Experimental Research  

Introduction: It is important to understand the anesthetic requirements of elderly patients. However, little is known about age-related recovery from inhalational anesthetics. In this retrospective study, we compared age-related differences in recovery from three inhalational anesthetics in elderly subjects. Methods: Patients were investigated as three age groups which can be defined as age ranges pediatric (< 15 years), adult (15–64 years), and elderly patients (> 65 years) under general anesthesia using inhalational anesthetics. Anesthesia and surgery times, drug end-tidal concentrations, the time to first movement, time to eye opening, body movement, extubation, and discharge were recorded. The data were analyzed using a Kruskal–Wallis test and Steel–Dwass multiple comparisons. Results: A total of 594 patients were included in the study. In inhalational anesthetics such as sevoflurane, isoflurane, or desflurane, recovery from general anesthesia was not significantly different among age groups (P > 0.05). In inhalational group, recovery was significantly 5–40% faster in desflurane group than in other inhalational anesthetics groups (P < 0.05). There were 20% faster recovery in pediatric and adult groups with desflurane than in elderly with desflurane group. Drug end-tidal inhalational concentrations in pediatric group were significantly higher than that in adult and elderly groups of all inhalational anesthetics, respectively (P < 0.05). Conclusion: In the current study, we have found that recovery from desflurane was faster in younger patients than in other inhalational anesthetics and aged patients.

DOI： 10.1007/s40520-018-0924-y

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PubMed

Language：Japanese   Publisher：Journal of Oral and Maxillofacial Surgery  

Postoperative alopecia is an uncommon complication and its outcome is an esthetically drastic change. Although its mechanism has not been clearly reported, risk factors might be positioning and prolonged operative time during oral surgeries. In addition, perioperative stressful conditions might influence the biological clock of the hair cycle. This report presents 2 cases of postoperative alopecia after oral surgery. Prevention of alopecia with type of headrest, change in head positioning, and avoidance of continuous compression is important.

DOI： 10.1016/j.joms.2018.07.011

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PubMed

Language：Japanese   Publisher：Acta Anaesthesiologica Scandinavica  

Background: A tracheal tube is often inserted via the nasal cavity for dental surgery. The position of the tube tip is important, given that the head position sometimes changes during surgery. Head movement induces changes in the length of the trachea (t-length) and/or the distance between the nare and the vocal cords (n-v-distance). In this study, we investigated the changes in t-length and n-v-distance in children undergoing nasotracheal intubation. Methods: Eighty patients aged 2-8 year undergoing dental surgery were enrolled. After nasotracheal intubation with an uncuffed nasotracheal tube (4.5-6.0 mm), the tube was fixed at the patient's nares. The distance between the tube tip and the first carina was measured using a fibrescope with the angle between the Frankfort plane and horizontal plane set at 110°. The location of the tube in relation to the vocal cords was then checked. These measurements were repeated at angles of 80° (flexion) and 130° (extension). The t-length and n-v-distance were then calculated using these measurements. Results: On flexion, the t-length shortened significantly from 87.5 ± 10.4 mm to 82.9 ± 10.7 mm (P = 0.017) and the n-v-distance decreased from 128.1 ± 10.7 mm to 125.6 ± 10.4 mm (P = 0.294). On extension, the t-length increased significantly from 87.5 ± 10.4 mm to 92.7 ± 10.1 mm (P = 0.007) and the n-v-distance increased from 128.1 ± 10.7 mm to 129.4 ± 10.7 mm (P = 0.729). The change in t-length was significantly greater than that in the n-v-distance. Conclusion: A change in the position of the tracheal tube tip in the trachea depends mainly on changes in t-length during paediatric dental surgery.

DOI： 10.1111/aas.13207

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PubMed

Language：English  

DOI： 10.17245/jdapm.2018.18.5.301

PubMed

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

症例は77歳女性で、左側舌下腺悪性腫瘍の診断で、口腔底部分切除術、下顎骨辺縁切除術、左顎下部郭清術を全身麻酔下に施行した。手術開始前から術翌日の離床まで弾性ストッキングを着用し、間欠的空気圧迫装置を装着した。全身麻酔は、酸素、フェンタニル、レミフェンタニル、プロポフォール、ロクロニウムで急速導入を行い、酸素、空気、デスフルラン、レミフェンタニルで維持した。経過良好であり特に異常を認めなかったが、術後2日目の午前中に歩行の際に意識消失して転倒した。すぐに意識は回復したが、軽度の呼吸苦、全身発汗、嘔気を認めた。造影コンピュータ断層撮影(CT)検査では、右側優位に前肺底動脈の中枢から末梢にわたり血栓を認めた。肺血栓塞栓症(PTE)と診断し治療を開始した。リザーバー付き酸素マスクで酸素投与とヘパリンの持続投与を開始した。APTTの延長不十分であったため、発症翌日からは抗凝固薬のアピキサバン内服を開始した。術後11日目に造影CT、肺血流シンチグラフィーで両側前肺底動脈に血栓の残存を認めたが、血栓は画像上縮小し、Dダイマーは改善した。術後34日に軽快退院し、以後良好に経過している。

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

症例は23歳女性で、生後4ヵ月時に半身性間代痙攣を初発した。以後、発熱時の全身性間代痙攣や左右さまざまな部分発作を頻発し、クロナゼパム、バルプロ酸ナトリウムの内服を開始した。7歳時に染色体検査でSCNIA遺伝子の変異が判明し、Dravet症候群と診断した。頬部腫脹を主訴に受診し、下顎右側第二小臼歯の急性化膿性根尖性歯周炎と診断した。原因歯を含め多数のう蝕を認めた。応急処置として原因歯の根管開放を静脈内鎮静法下で行い、そのおよそ2ヵ月後に月経と重なる日を避け、多数歯う蝕保存処置を全身麻酔下で行う予定とした。静脈内鎮静法は、酸素吸入下にプロポフォールを開始した。局所浸潤麻酔に1/8万アドレナリン含有2%リドカインを使用した。術中はプロポフォールで鎮静を維持した。衛後鎮痛目的にアセトアミノフェンを静脈内投与した。術後経過は良好であった。全身麻酔導入は酸素、フェンタニルクエン酸塩、レミフェンタニル塩酸塩、アトロピン硫酸塩、プロポフォール、ロクロニウム臭化物で行った。麻酔維持は酸素、空気、イソフルラン、レミフェンタニルで行った。術後経過は良好で、痙攣発作を認めることなく、翌日に退院した。

Language：Japanese   Publisher：Anesthesia Progress  

Retained foreign bodies sometimes occur in various surgical procedures and can lead to severe complications. Foreign bodies in the oral and maxillofacial region are not rare because of the use of many small items and the natural communication with the outside environment in some areas. We experienced a case of foreign body in the nasal cavity, which was discovered 1 year later at a second operation for hardware removal after maxillofacial surgery. A small, soft material is usually placed between the nasal endotracheal tube and nostril to avoid nasal pressure ulcer at the ala of nose after prolonged anesthesia after our group’s experiencing some cases of this complication. The foreign body was found in the pharynx during induction of a second anesthesia. Attention should be directed to not leaving any materials in the patient after surgery. In addition to the normal counts of sponges, needles, etc, other small nonsurgical materials used should be recorded by medical staff to help ensure nothing is retained in the patient.

DOI： 10.2344/anpr-65-01-07

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PubMed

Language：Japanese   Publisher：Anesthesia Progress  

Tracheal bronchus is an ectopic bronchus almost arising from the right side of the tracheal wall above the carina. The incidence of a tracheal bronchus is reported as 0.1 to 3%. We experienced a patient with tracheal bronchus that was incidentally found at induction of anesthesia. Endotracheal intubation in a patient with tracheal bronchus might cause obstruction of the tracheal bronchus, although in this case, ventilation was not impaired.

DOI： 10.2344/anpr-64-04-02

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PubMed

Language：Japanese   Publisher：Asia Pacific Journal of Clinical Nutrition  

Background and Objectives: Preoperative oral carbohydrate therapy has been suggested to attenuate postoperative insulin resistance. The purpose of this study was to investigate the effect of a carbohydrate-rich beverage given preoperatively on intraoperative glucose metabolism. Methods and Study Design: This study was a randomised, open-label, placebo-controlled trial. Patients undergoing oral-maxillofacial surgery were divided into two groups. In the glucose group, patients took glucose (50 g/278 mL, p.o.) 2 h before anaesthesia induction after overnight fasting; control-group patients took mineral water. Primary outcome was blood concentrations of ketone bodies (KBs); secondary outcomes were blood concentrations of free fatty acids, insulin and glucose. Concentrations were measured 2 h before anaesthesia (T0), induction of anaesthesia (T1), and 1 h (T2), 3 h (T3), and 5h after anaesthesia start (T4). Results: In the control group (n=11), KBs increased continuously from anaesthesia induction. In the glucose group (n=12), KBs were maintained at low concentrations for 3h after beverage consumption but increased remarkably at T3. At T1 and T2, concentrations of KBs in the glucose group were significantly lower than those in the control group (T1, p=0.010; T2, p=0.028). In the glucose group, glucose concentrations decreased significantly at T2 temporarily, but in the control group, glucose concentrations were stable during this study (T2, p < 0.001: glucose vs control). Conclusions: Preoperative intake of glucose (50 g, p.o.) can alleviate ketogenesis for 3 h after consumption but can cause temporary hypoglycaemia after anaesthesia induction.

DOI： 10.6133/apjcn.022017.11

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PubMed

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

Dravet syndrome (DS) is characterized by severe myoclonic epilepsy, and its onset is most common during infancy. DS is associated with a mutation of the gene coding SCN1A in most patients ; however, its cause remains unclear. The epileptic seizures that are triggered by various causes are drug-resistant and intractable. Status epilepticus can cause severe cerebral function defects and be life-threatening. We treated a 23-year-old woman with DS who required intravenous sedation and general anesthesia for a dental treatment. She had been taking clonazepam, sodium valproate and topiramate for her epilepsy, but her seizures continued to be triggered semimonthly by seeing objects with a lattice-like pattern and/or in connection with menstruation. She had several dental caries with acute symptoms requiring immediate treatment. Since she had mental retardation and was uncooperative with dental treatment, temporary treatment under intravenous sedation followed by actual treatment under general anesthesia were planned. The timings of both treatments were scheduled so as to avoid her menstrual period, and objects with a lattice-like pattern were removed from the treatment room prior to her entrance. We used propofol for sedation and the induction of general anesthesia and isoflurane for the maintenance of the general anesthesia. A continuous electroencephalogram was monitored using the bispectral index(BIS). No perioperative complications, including seizures, occurred during either treatment. In the present case, we focused on preventing seizures during the perioperative period. Propofol and isoflurane were useful for intravenous sedation and general anesthesia without triggering epileptic seizures.

DOI： 10.24569/jjdsa.46.3_136

Scopus

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

Pulmonary thromboembolism (PTE) can be a fatal complication during the perioperative period of oral surgery. PTE includes symptoms such as chest pain, dyspnea and tachycardia. We present a case of postoperative PTE after cancer resection of the oral floor performed under general anesthesia. The patient was a 77-year-old woman who underwent cancer resection of the oral floor. She did not exhibit any subjective symptoms suggesting PTE. The patient did not receive any premedication. General anesthesia was induced with fentanyl, propofol and rocuronium after obtaining peripheral intravenous access. Anesthesia was maintained with desflurane in air and oxygen. The blood pressure was maintained at 80-130/40-70 mmHg, the heart rate was 60-87 bpm, and the Pao2 was 104-159 mmHg. The surgical procedure was completed in about 5 hours without any adverse events. On postoperative day 2, she suddenly complained of dyspnea and lost consciousness. Her SpO2 decreased to 70%, and her D-dimer level increased to 18.4μg/ml. Enhanced computed tomography revealed an embolism of the right anterior basal artery from the center to the periphery, and she was diagnosed as having PTE. Anti-coagulant therapy with heparin (400-900 U/hour)was started. The treatment was effective, and her condition improved gradually. She was discharged from hospital 34 days after the surgery. Although PTE is a rare complication, it has a high mortality rate. Consequently, the possibility of PTE after surgery must be kept in mind.

DOI： 10.24569/jjdsa.46.3_148

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Language：Japanese   Publisher：Anesthesia Progress  

Fasting before general anesthesia aims to reduce the volume and acidity of stomach contents, which reduces the risk of regurgitation and aspiration. Prolonged fasting for many hours prior to surgery could lead to unstable hemodynamics, however. Therefore, preoperative oral intake of clear fluids 2 hours prior to surgery is recommended to decrease dehydration without an increase in aspiration risk. In this study, we investigated the body fluid composition and hemodynamics of patients undergoing general anesthesia as the first case of the day versus the second subsequent case. We retrospectively reviewed the general anesthesia records of patients over 20 years old who underwent oral maxillofacial surgery. We investigated patient demographics, preoperative fasting time, anesthetic time, urine output, infusion volume, and opioid and vasopressor use. With respect to body fluid and hemodynamics, we extracted the data from the induction of anesthesia through 2 hours of anesthesia time. Thirty patients were suitable for this study. Patients were divided into 2 groups: patients who underwent surgery as the first case of the day (AM group: n=15) and patients who underwent surgery as the second case (PM group: n = 15). There were no significant differences between the 2 groups in patient demographics. In the PM group, fasting time for a light meal (832 minutes) was significantly longer than for the AM group (685 minutes), p =.005. In the PM group, fasting time for clear fluids (216 minutes) was also significantly longer than for the AM group (194 minutes), p =.005. Body fluid composition was not significantly different between the 2 groups. In addition, cardiac parameters intraoperatively were stable. In the PM group, vasopressors were used in 4 patients at the induction of anesthesia (p =.01). There were not statistically significant changes in cardiac function or body fluid composition between patients treated as the first case of the day vs patients who underwent surgery with general anesthesia as the second case of the day.

DOI： 10.2344/anpr-65-01-01

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PubMed

Language：Japanese   Publisher：Anesthesia Progress  

Trisomy 13 is a chromosomal disorder that occurs in complete or partial mosaic forms. It is characterized by central apnea, mental retardation, seizure and congenital heart disease. The survival of the patients with trisomy 13 is the majority dying before one month. Trisomy 13 is the worst life prognosis among all trisomy syndromes. It is reported the cause of death is central apnea. Special needs patients with mental retardation are recognized to have poorer oral health condition. Oral health related quality of life reflects daily activity and well-being. Dental treatment under general anesthesia is sometimes an option for such patients. This patient had received ventricular septal defect closure surgery at 2-year-old. In addition, he had mental retardation and seizure. Dental treatment had been completed without any cerebral and cardiovascular events under non-invasive monitoring with not only cardiac electric velocimetry, but also epileptogenic activity. In addition, postoperative respiratory condition was maintained stable in room air.

DOI： 10.2344/anpr-64-02-09

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Language：English  

DOI： 10.17245/jdapm.2017.17.3.215

PubMed

Language：English  

DOI： 10.17245/jdapm.2017.17.3.231

PubMed

Language：Japanese   Publisher：Anesthesia Progress  

A quality review revealed pressure ulcers at the ala of nose in 16 cases (2.2%) over 3 years.We therefore retrospectively investigated the risk factors for alar pressure ulcers from nasal tubes. Male gender was the highest risk factor (odds ratio=9.1411; 95% confidence interval=1.680-170.58), and the second highest risk factor was duration of anesthesia (odds ratio = 1.0048/min of anesthesia; 95% confidence interval=1.0034-1.0065). Male gender and duration of anesthesia appear to be risk factors for nasal tube pressure ulcers at the ala of nose in patients.

DOI： 10.2344/anpr-64-02-11

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PubMed

Language：Japanese   Publisher：Journal of Anesthesia  

Purpose: Surgical injury stimulates the renin–angiotensin–aldosterone system (RAAS) and causes antidiuresis, leading to postoperative oliguria. Carperitide (α-human A-type natriuretic peptide) is a cardiac peptide hormone secreted from the atrium. This peptide hormone enhances diuresis by suppressing the RAAS. In our experience, carperitide alleviates decreased hemoglobin (Hb) concentration during elective surgery. In the current study, we investigated the relationship between low-dose carperitide (0.01 µg/kg/min) and Hb concentration during oral surgery. Methods: Patients (ASA-PS: I–II, 40–80 years old) undergoing oral maxillofacial surgery (duration of operation >8 h) were enrolled in this study. Patients were divided into two groups: the carperitide group received carperitide at 0.01 µg/kg/min and the control group received normal saline. Body fluid water [including total body water (TBW), extracellular water (ECW), and intracellular water (ICW)], urine volume, and chemical parameters such as Hb concentration, PaO2, and serum electrolytes were evaluated every 2 h. Results: In the carperitide group (n = 15), Hb decreased from 12.6 ± 1.1 to 10.8 ± 1.5 g/dl, while it decreased from 12.6 ± 1.4 to 9.5 ± 1.3 g/dl in the control group (n = 15) (p < 0.05). Urine volume (2557.3 ± 983.5 mL) in the carperitide group was significantly more than it was in the control group (1108.8 ± 586.4 mL; p < 0.001). There were no significant differences in clinical characteristics, body fluid water, PaO2, and serum electrolytes between the two groups. In addition, there were no perioperative clinical respiratory and hemodynamic complications in the groups. Conclusion: The Hb concentration in the group administered low-dose carperitide at 0.01 µg/kg/min remained higher than that in the control group during surgery. Administration of low-dose carperitide may therefore reduce the risk of blood transfusion during surgery.

DOI： 10.1007/s00540-017-2309-3

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PubMed

Language：English   Publisher：(公社)日本麻酔科学会  

ヘモグロビン濃度と低用量カルペリチドの関連を明らかにするため、無作為化比較試験を実施した。口腔顎顔面外科手術を施行した患者30例をカルペリチド0.01μg/kg/分投与群15例(男性10例、女性5例、平均62.9±6.3歳)または対照群15例(男性11例、女性4例、平均60.8±8.4歳)に割り付けた。ヘモグロビン(Hb)濃度はカルペリチド群で12.6±1.1から10.8±1.5g/dL、対照群では12.6±1.4から9.5±1.3g/dLに低下した。導入後2～8時間のHb濃度はカルペリチド群の方が有意に高かった。尿量はカルペリチド群で2557.3±983.5mLであり、対照群(1108.8±586.4mL)と比較して有意に多かった。臨床的特性、体液(全体液、細胞外液、細胞内液)、PaO2、血清電解液については両群で有意差は認められなかった。また、両群とも周術期の臨床的呼吸器合併症および血行性合併症は認めなかった。以上から、低用量カルペリチド(0.01μg/kg)投与群では対照群と比較して術中のHbが高値で維持されることが示された。

Language：English  

DOI： 10.17245/jdapm.2017.17.2.139

PubMed

Language：Japanese   Publisher：克誠堂出版(株)  

クリッペル・フェール症候群(KFS)は、頸椎の癒合をはじめ、全身に及ぶ骨格異常や臓器奇形を伴う先天性疾患であり、頸部の可動域の狭さから、全身麻酔時には気管挿管の困難が予想される。今回、KFSを合併した男児に対する口蓋形成術と舌小帯延長術の麻酔を経験し、安全に管理することができたので報告した。口蓋形成術(1歳7ヵ月時)の際には、吸入麻酔による緩徐導入後にAirway Scope(AWS)を用いてRAEチューブを経口挿管した。AWSの画像は咽頭・喉頭の状況を判断するうえで有用であった。舌小帯延長術(2歳7ヵ月時)は手術時間が短く侵襲も少ないことから、緩徐導入後にフレキシブルタイプのラリンジアルマスク(LMA)で気道管理を行った。その際、LMAは換気効率に影響のない範囲内で側方(口角側)に固定し、これにより術野の確保が可能であった。

Language：Japanese   Publisher：克誠堂出版(株)  

CMOSビデオリノラリンゴスコープが新たに開発された。この機器は電子スコープであり、従来の気管内視鏡に比べて画像が鮮明で、さらにその画像処理が容易である。今回、口腔外科手術予定患者の術前診察でCMOSビデオリノラリンゴスコープを用いて気道評価を行った。気道確保困難を予見させる異常所見は認めなかったが、画像が鮮明で、術前回診において有用性を確認したので報告する。(著者抄録)

Language：English  

PubMed

Language：English  

PubMed

Language：Japanese   Publisher：Journal of Anesthesia  

Purpose: Fentanyl is a strong µ-opioid analgesic which attenuates the stimulation of surgical invasion and tracheal intubation. However, intravenous fentanyl often induces coughing [fentanyl-induced coughing (FIC)] during induction of anesthesia. We found that the swallowing action, when requested at induction of anesthesia, attenuated FIC. In the current study, we investigated the relationship between the occurrence of FIC and the swallowing action. Methods: The study included American Society of Anesthesiologists physical status I or II patients, aged 20–64 years, who were undergoing elective surgery. They were divided into two groups—one group was urged to perform the swallowing action immediately before intravenous fentanyl (S group), and the other group performed no swallowing action (non-S group). The patients first received intravenous fentanyl and were observed for 90 s. Each patient’s background, dose of fentanyl and occurrence of coughing were investigated from their records and a motion picture recording. The incidence of FIC was evaluated by chi-squared test, and severity was tested by Wilcoxon rank-sum test. P < 0.05 was considered statistically significant. Results: The incidence of FIC in the S group and non-S group was 14.0 and 40.4%, respectively. The risk of FIC was reduced in the S group by 75%; risk ratio (95% confidence interval) was 0.35 (0.20, 0.60). The number of coughs in the S group were less than in the non-S group (P < 0.001). Conclusion: The swallowing action immediately before intravenous fentanyl may be a simple and clinically feasible method for preventing FIC effectively. Clinical trial number: UMIN000012086 (https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=Rn000014126&language=J).

DOI： 10.1007/s00540-016-2300-4

Scopus

PubMed

Language：Japanese   Publisher：克誠堂出版(株)  

1歳1ヵ月男児。出生時に唇顎口蓋裂、純型肺動脈閉鎖、右室低形成、心房中隔欠損症と診断されていた。生後1週間にバルーン心房中隔裂開術、生後4ヵ月にcentral shunt手術、生後10ヵ月にグレン手術を受けていた。今回、唇顎口蓋裂に対し全身麻酔下に口唇形成術が予定された。術前検査で右心室から冠動脈への類洞交通を認め、麻酔中は冠血流を保つために類洞交通の血流を維持し、安定した血行動態で管理することとした。麻酔導入後、SpO2は通常より高めの90～95%で維持した。また、二酸化炭素の貯留を避けるため、Paco2は30～35mmHgで管理した。血行動態は、観血的動脈圧と非侵襲で持続的にモニタリングできるエスクロンミニを用いて心機能評価を行った。血圧は80～100/40～50mmHgになるように調節し、血圧低下時にはフェニレフリンを投与して管理した。手術は無事終了し、術後8日に軽快退院した。

Language：Japanese   Publisher：Egyptian Journal of Anaesthesia  

Special needs patients with mental retardation are recognized to have poorer oral health condition. Oral health related quality of life reflects daily activity and well-being. Dental treatment under general anesthesia is often an option for such patients. Trisomy 18 is characterized by congenital heart disease, craniofacial abnormality and mental retardation. Congenital heart disease can be greater risk during anesthesia. In the case of trisomy 18 with untreated tetralogy of Fallot, especially right-to-left shunting and/or pulmonary artery stenosis may reduce pulmonary blood flow, and may develop life-threatening hypoxemia. We anesthetized a patient with trisomy 18 accompanying untreated tetralogy of Fallot for dental treatment. The hemodynamics including cardiac output has been monitored non-invasively using electrical velocimetry method. Its systemic vascular resistance and pulmonary vascular resistance were maintained appropriately, and dental treatments were successfully completed.

DOI： 10.1016/j.egja.2016.09.001

Scopus

Language：English   Publisher：(公社)日本麻酔科学会  

全身麻酔下で待機手術を実施した米国麻酔学会術前状態分類I/IIの患者において、フェンタニル誘発咳嗽(FIC)の発生率と嚥下運動との関係を無作為化比較試験により調査した。患者をフェンタニル投与時に嚥下運動を実施するS群100例(男性64例、女性36例、年齢20～64歳)と嚥下運動を実施しない非S群99例(男性64例、女性35例、年齢20～64歳)に割り付けた。フェンタニル投与後、患者を心電図、パルスオキシメトリ、非侵襲的血圧測定、ビデオ撮影によって監視した。FIC発生率における違いをカイ二乗検定で評価し、重症度をウィルコクソン順位和検定あるいは共分散分析で検査した。FICの発生率はS群が14.0%、非S群が40.4%であった。S群ではFICの危険性が75%まで減少した。S群の咳数は非S群よりも少なかった。フェンタニル静注直前の嚥下運動はFICを効果的に予防する簡便かつ臨床的に実行可能な方法であることが示唆された。

Language：Japanese  

PubMed

Language：English  

DOI： 10.17245/jdapm.2017.17.1.61

PubMed

Language：Japanese   Publisher：克誠堂出版(株)  

44歳女。成長に従う精神発達遅滞、痙攣、痙性四肢麻痩、脊柱側彎、筋緊張充進、自律神経機能障害等を認めることから11歳頃にレット症候群(RTT)と診断されていた。今回、多数歯齲蝕に対して、コミュニケーションが不可能で協力が得られないため、全身麻酔下での歯科治療を予定した。術前所見として、数分間おきに15～30秒程度持続する息こらえと、RTT特有の貪気(空気嚥下)を認め、顎運動機能の退行によるものと考えられる開口障害があった。手術室へ入室後、十分な酸素化を行い、アトロピン硫酸塩、フェンタニルを投与後、プロポフォール、ロクロニウムを同時に静脈内投与し、意識消失に合わせて輪状軟骨を圧迫した。筋弛緩を得た後、経口挿管し、その後経鼻挿管へ変更した。麻酔は酸素、空気を用いてプロポフォール、レミフェンタニルの持続投与で維持した。局所浸潤麻酔にはアドレナリン含有2%リドカインを用いた。術後、覚醒時に大量の口腔内分泌物と鼻汁を認め、更に抜管直後より貪気による嚥下運動と息こらえを頻回に認めたが、病棟帰室後の経過は順調で、呼吸状態も安定しており翌日退院となった。

Language：Japanese  

PubMed

Language：Japanese   Publisher：Journal of Oral and Maxillofacial Surgery  

Purpose Postoperative shivering is a frequent complication of anesthesia. However, there are few reports about postoperative shivering in oral and maxillofacial surgery. Postoperative shivering in patients after osteotomy was observed from April 2008 to September 2015. This retrospective study investigated the risk factors of postoperative shivering in oral and maxillofacial surgery. Patients and Methods Anesthesia records of patients who underwent an osteotomy of the maxilla or mandible were checked. A patient's background (gender, age, height, and weight), anesthesia time, operative time, fentanyl, remifentanil, fluid volume, urine volume, blood loss volume, agent for anesthetic maintenance, rectal temperature at the end of surgery, and type of surgery were recorded in addition to the occurrence of postoperative shivering. In the univariate analysis, the Fisher exact test and the χ2 test were used, and a multivariable analysis was performed using stepwise logistic regression to determine risk factors of postoperative shivering. Results In this study, 233 cases were investigated, and 24 patients (11.5%) had postoperative shivering. The occurrence of postoperative shivering was correlated with blood loss volume (shivering group, 633.9 ± 404.8 mL; nonshivering group, 367.0 ± 312.6 mL; P < .01) and core temperature at the end of surgery (shivering group, 37.2 ± 0.6°C; nonshivering group, 37.5 ± 0.5°C; P < .01). Two variables were associated with postoperative shivering. Rectal temperature at the end of surgery was the highest risk factor (odds ratio = 2.560277; 95% confidence interval, 1.236774-5.327362), and blood loss volume was the next highest risk factor (odds ratio = 0.997733; 95% confidence interval, 0.999-0998). Conclusion Clinicians should pay attention to postoperative shivering not only in patients with hypothermia but also in patients with substantial blood loss.

DOI： 10.1016/j.joms.2016.06.180

Scopus

PubMed

Language：Japanese   Publisher：Anesthesia Progress  

Emanuel syndrome is associated with supernumerary chromosome, which consists of the extra genetic material from chromosome 11 and 22. The frequency of this syndrome has been reported as 1 in 110,000. It is a rare anomaly associated with multiple systemic malformations such as micrognathia and congenital heart disease. In addition, patients with Emanuel syndrome may have seizure disorders. We experienced anesthetic management of a patient with Emanuel syndrome who underwent palatoplasty. This patient had received tracheotomy due to micrognathia. In addition, he had atrial septal defect, mild pulmonary artery stenosis, and cleft palate. Palatoplasty was performed without any complication during anesthesia. Close attention was directed to cardiac function, seizure, and airway management.

DOI： 10.2344/16-00028.1

Scopus

PubMed

Language：Japanese   Publisher：Journal of Clinical Anesthesia  

Cockayne syndrome is a kind of progeria with autosomal chromosome recessiveness described first by Cockayne in 1936. Patients with this syndrome were characterized by retarded growth, cerebral atrophy, and mental retardation. We experienced an anesthetic management of a patient with Cockayne syndrome, who underwent dental treatment twice. The primary concern was discrepancy between electroencephalography and hemodynamics. The values of bispectral index showed a sharp fall to 1 digit and suppression ratio more than 40, while hemodynamics was stable during induction of anesthesia with sevoflurane 8%. We should pay attention to anesthetic depth in the central nervous system in patients with Cockayne syndrome. Titration of anesthetics should be performed by the information from electroencephalography.

DOI： 10.1016/j.jclinane.2016.09.022

Scopus

PubMed

Language：Japanese   Publisher：(一社)日本口腔顔面痛学会  

背景と目的:歯科領域の慢性痛に悩む患者の実態についての報告は少ない。本検討では、非歯原性歯痛患者の現状と診断に至るまでの経過と治療歴及び費やされた医療費について明らかにすることを目的とした。方法:2011年4月から2015年9月に九州大学病院歯科麻酔科外来を受診した非歯原性歯痛患者が対象である。電子診療録と医療面接から情報を抽出した。抽出した情報は一般的な情報に加え、病悩期間、歯科・医科の受診歴、これまでの検査、治療内容とその効果の情報を抽出した。さらに検査、治療に関わる費用を歯科診療報酬規定(平成28年度改定)に当てはめて算出した。結果:対象患者は64名(男性11名、女性53名)で、平均年齢55.0±13.8歳であった。病悩期間は平均49.6±60.9ヵ月であった。歯科、医科の受診歴は、平均3.71±1.94件であった。治療、検査では、歯内処置が48名(75%)に、抜歯が29名(45.3%)に行われていた。それまでの平均除痛率は11.3±14.51(%)だった。それまでに費やされた医療費は219,948±238,869.5円であった。考察:非歯原性歯痛患者は、診断までに、多様な治療を受けている。1人当たりの医療費がおよそ22万円とすれば5,958億円になり、年間1,441億円の医療費が費やされていると試算される。非歯原性歯痛に対する診断治療のための施策は急務であると考える。(著者抄録)

Language：English  

DOI： 10.17245/jdapm.2016.16.4.313

PubMed

Language：Japanese   Publisher：真興交易(株)医書出版部  

9歳8ヵ月男児。出生時に両側唇顎口蓋裂を認め、左側口唇形成術、口蓋形成術、右側口唇形成術を施行されていた。また、6歳時に右脳の硬膜下血腫が原因でてんかん発作を発症し、8歳9ヵ月時に迷走神経刺激療法(VNS)を施行されていた。今回、全身麻酔下に左顎裂部への腸骨移植術を施行することとなった。麻酔は前投薬はせず、導入は酸素・セボフルランで行い、入眠後はセボフルランの投与を中止し、プロポフォール・レミフェンタニルの持続静脈内投与を開始した。その後、ロクロニウム・フェンタニル・アトロピンを静脈内投与し、挿管後に直ちにVNSシステムの電源を停止した。麻酔維持は酸素・空気・プロポフォール・レミフェンタニル・フェンタニルで行った。術中問題はなく、手術終了4分後にVNSシステムの電源を入れ、終了15分後に麻酔薬投与を停止し、十分な自発呼吸を確認後に抜管した。

Language：Japanese   Publisher：真興交易(株)医書出版部  

製造企業の異なる3機種の20mLシリンジポンプを用いて、新たに開発された50mLの生理食塩液プレフィルドシリンジと1種類のディスポシリンジ(50mL)の経時的な注入量精度の比較を行い、その互換性についても検討した。シリンジポンプにはTE-351、SP-80s、SP-520の3機種を使用し、使用製剤には50mLディスポシリンジに生理食塩液、プロポフォール注射薬「1%ディプリバン注」を50mL、プレフィルド製剤の生理注シリンジである「NP」50mL、プロポフォール注射薬「1%ディプリバン注キット50mL」を使用した。各シリンジポンプに生理食塩液のプレフィルド製剤または事前に生理食塩液を50mL充填したディスポシリンジ50mLを装着して、1mL/hr、20mL/hr、100mL/hrの3種類の注入速度で流量を計測した。その結果、12種類の組合せの中で誤差が3%を超えるものはなかった。また、製造企業が異なる組み合わせの場合も注入誤差に有意差はなかった。経時的な注入量誤差は、設定流量が多いほど減少する傾向が認められた。また、シリンジポンプ注入量誤差は、シリンジの型番および設定流量の影響を受けることが示された。

Language：English  

DOI： 10.17245/jdapm.2016.16.3.193

PubMed

Language：Japanese   Publisher：真興交易(株)医書出版部  

各種シリンジおよびシリンジポンプの機種間の互換性において各種シリンジとポンプの経時的注入量誤差率について比較検討した。シリンジポンプには、テルモ社製TE-35P、ニプロ社製SP-80s、JMS社製SP-520の3機種を用いた。使用製剤には、プレフィルド製剤の生理注シリンジ「NP」20mLと生理シリンジ「オーツカ」20mLの2種類を使用した。さらに、テルモ社製ディスポシリンジ20mLに生理食塩液を20mL、プロポフォール注射薬「1%ディプリバン注」20mLを充填して使用した。プレフィルドシリンジおよびシリンジポンプの機種の12種類の組合せで、誤差が2%を超えるものはなかった。メーカーが異なる組合せにおいても、注入誤差に有意差はなかった。経時的な注入量誤差は、設定流量が多いほど減少する傾向を認めた。注入速度変化は、使用したシリンジによって変化し、生理シリンジ「オーツカ」20mLで大きく、事前に生理食塩液を20mL充填したテルモ社製ディスポシリンジ20mLで少なかった。生理食塩液とプロポフォール注射薬における注入誤差にも有意差はなかった。

Language：Japanese   Publisher：克誠堂出版(株)  

4ヵ月女児。出生時に両側性唇顎口蓋裂と哺乳障害を認めた。日齢3に肺炎、敗血症と診断され人工呼吸管理を受けた。抜管後に嗄声と吸気性喘鳴が出現し、喉頭内視鏡検査を2回施行された。生後4ヵ月に、全身麻酔下での口唇形成術の術前回診で高調性の吸気性喘鳴と努力呼吸を認めた。耳鼻咽喉科での喉頭内視鏡検査で異常は認めないという結果を受け、予定通り手術を行った。経口挿管を数回試みるも声帯後部が癒着し狭く、チューブは通過せず、内視鏡を用いて挿管を試みた。挿管操作は難渋したが最終的に内径2.5mmの気管チューブを挿管した。手術時間は4時間14分、麻酔時間は9時間32分であった。術後15日目から再び陥没呼吸が出現し、再度喉頭内視鏡検査を施行した結果、声帯の前半分に癒着と瘢痕化、後方に肉芽形成を認め、吸気時にわずかな開大を認めるのみであった。術後21日に呼吸管理目的で気管切開術を施行し、その後の呼吸状態は良好であった。

Language：Japanese   Publisher：Japanese Journal of Anesthesiology  

We report a child with vocal cord adhesion encountered during induction of anesthesia A 4-month-old girl was scheduled for bilateral lip plasty. She was intubated for one week due to pneumonia at the age of 3 days. Hoarseness and stridor appeared just after extubation. Although laryngo-fiberoptic examination had been tried several times, otorhinologists could not find any abnormality. We once decided to postpone the operation because of severe stridor. However, laryngofiberoptic examination could not reveal any abnormality, and we rescheduled the operation. Tracheal intubation using laryngoscope was not possible due to vocal cord adhesion. Finally, 2.5 mm ID tracheal tube was intubated by using a fiberscope, and lip plasty was performed. The patient stayed in the ICU for 7 days after surgery. Tracheotomy was performed 3 weeks after the operation. We should pay attention to stridor in an infant before general anesthesia, since it suggests severe airway narrowing although laryngo-fiberoptic examination could not find any abnormalities.

Scopus

Language：Japanese  

PubMed

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

症例は9歳10ヵ月男児で、生後11ヵ月時にBCG痕の発赤により精査を受け、不全型川崎病と診断された。同時に末梢性肺動脈狭窄症も明らかになった。5歳時に染色体検査(FISH法)によりWilliams症候群と診断された。全顎的な齲蝕処置と多数歯の抜歯が必要であったが、精神遅滞を伴うため通常の歯科治療に対する協力が得られなかった。全身麻酔下での全顎的なスケーリング、11歯の齲蝕処置、上顎右側乳犬歯および上下顎右側第二乳臼歯の計3歯の抜歯を計画した。術前診察時に、手術室の雰囲気に慣れるため中央手術室を訪室し、マスクを装着して呼吸の練習を行った。周囲の環境に強い好奇心を抱き、不安感や恐怖心は全く示さなかった。麻酔中にてんかん様発作やけいれんなどは認めなかった。経過は良好で、術翌日に退院した。

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

症例は7歳9ヵ月男児で、麻痺のため起立や歩行はできなかったが、四肢を動かして移動することができ、動きは活発であったが、日常生活は全介助が必要であり、特殊支援学校に通学していた。発語はできず、脳性麻痺による精神遅滞もあったが、幼児程度の理解は認めた。3歳4ヵ月、急性脳症の診断で脳低温療法およびステロイド大量療法が施行された。1ヵ月後に慢性呼吸不全のため気管切開術が施行され、7歳3ヵ月時に気管孔閉鎖術が施行された。術前の耳鼻咽喉科受診では、気管内視鏡で気管孔閉鎖部位に肉芽組織があることが確認された。齲歯による痛みを主訴として受診し、全身麻酔下での歯科治療を計画した。気管挿管には十分なスペースがないと判断し、フレキシブルラリンジアルマスク(FLMA)のままで気道管理することにした。麻酔終了後、覚醒は良好で呼吸も安定し、FLMAを抜去した後も狭窄音などは聴取しなかった。経過良好で翌日に退院した。

Language：Japanese   Publisher：真興交易(株)医書出版部  

近年、血液疾患に対して骨髄移植が行われ、優れた治療効果をあげている。しかし、骨髄移植により移植片対宿主病(graft versus host disease:GVHD)の発症、二次癌発生の可能性が高くなる。今回、両疾患を合併した患者が術直後の胸水貯留から初めて肺転移が明らかとなった。男性、GVHDの既往、口腔領域に二次癌が生じた際には呼吸器疾患も念頭に置く必要がある。(著者抄録)

Language：Japanese   Publisher：克誠堂出版(株)  

10歳5ヵ月男児。歯牙形成不全症を合併しており、歯性感染性の顎骨骨膜炎を繰り返し発症し、その治療のため、10歳から約3年の間に6回の日帰り全身麻酔を行った。ダンディー・ウォーカー症候群患者の麻酔管理で問題となるのは頭蓋圧亢進であり、本例では次のような方法で麻酔管理を行い、全6回を通して術中・術後のトラブルなく管理することができた。1)吸入麻酔法を選択し、緩徐導入時には亜酸化窒素とセボフルランを用い、麻酔維持はイソフルランで行う。2)気管挿管は麻酔導入後に行い、経鼻挿管法を用いる。3)気道確保困難に対応するため、予め様々な挿管補助具を準備しておく。

Language：Japanese   Publisher：Japanese Journal of Anesthesiology  

Dandy-Walker syndrome (DWS) is characterized by perfect or partial defect of the cerebellum vermis and cystic dilatation of the posterior fossa communicating with the fourth ventricle. Common clinical signs are mental retardation, cerebellar ataxia, and those of increased intracranial pressure (ICP). Associated congenital anomalies are craniofacial, cardiac, renal, and skeletal abnormalities. We experienced a case of intravenous sedation and six times of "the same day" general anesthesia for a school-aged boy (10-13 years old) with DWS and hypodentinogenesis. The patient underwent an examination and dental treatments. We had to pay attention to airway management tracheal tube selection and control of ICP. In addition, we should prevent tooth injuries through mishaps during tracheal intubations, since all tooth-hypoplasia with fragile dental crowns was strongly suggested in this case. Detailed postoperative care is also required for general anesthesia afflicted with DWS.

Scopus

Language：Japanese   Publisher：克誠堂出版(株)  

6歳女児。心臓移植術の準備として集中歯科治療(歯科治療6歯、抜歯処置2歯)を全身麻酔下に施行した。定期服用薬にバイアスピリンとワルファリンがあったが、予想出血は軽微と考え、両剤とも休薬はしなかった。術中管理においては、適切な肺血流量を維持することが最も重要であったため、次のような点に留意し、良好な結果が得られた。1)肺血管抵抗の増加を防止するため、低酸素血症の予防としてFIO2を0.5～1.0で維持するとともに、過度の気道内圧上昇の予防、および高二酸化炭素血症の予防として、ピーク圧(peak inspiratory pressure)25cmH2O以下を目安に、陽圧呼吸は負荷せず、やや過換気で管理する。2)PETCO2の推移だけでなくPaCO2の変化にも注意し、その測定を随時行う。3)過剰な交感神経刺激を避けるため、挿管や処置などを愛護的に行う。4)適切な体血管抵抗を得るために、通常体温の管理(直腸温で38℃以下)を徹底する。

Language：Japanese   Publisher：Japanese Journal of Anesthesiology  

The patient was a 6-year-old girl with pulmonary atresia, intact ventricular septum and major aortopulmonary collateral artery with tetralogy of Fallot Her Spo2 was around 60% under room air, and she could not walk long. She underwent dental treatment under general anesthesia. Invasive monitoring using pulmonary artery catheter should have been avoided, since the risk of monitoring greatly exceeds that of the treatment. The patient entered the operating room with her mother, and anesthesia was induced with intravenous midazolam, propofol and vecuronium. She was intubated orally first and impedance cardiography monitoring was started. FIO2 was maintained at 0.5-1.0. Increases in airway pressure and PaCo2 were appropriately avoided. Dental treatment is important for infants with cardiac disease not only to reduce their pain, but also to reduce the risk of infection. It often requires general anesthesia. We have to conduct it with less invasiveness and less stress.

Scopus

Language：Japanese  

PubMed

Language：Japanese  

PubMed

Language：Japanese   Publisher：克誠堂出版(株)  

症例は月齢6ヵ月女児で、在胎時のエコー検査で唇顎口蓋裂と診断された。生後1ヵ月より1日5～6回の頻度で数分間持続するてんかん様発作を認めた。脳梁欠損、網脈絡膜欠損、左小角膜および左視神経低形成、左角膜斑を認め、アイカルディ症候群と診断した。生後6ヵ月時に全身麻酔下で左側口唇形成術を施行した。覚醒は良好で、呼吸・循環状態が安定しているため手術室を退室した。経過良好で14日後に退院した。2歳2ヵ月、脳波所児よりウエスト症候群(点頭てんかん)の診断が追加された。最重度精神発達遅滞、脳性麻痺、両耳滲出性中耳炎の診断も追加された。口蓋裂に対して口腔内装置を装着することで経口摂取(ペースト食)および飲水は可能で、顎関節などに異常はなく、開口障害は認めなかった。全身麻酔下に左側口蓋形成術および両耳チュービング術を施行した。覚醒良好で、呼吸・循環状態が安定しているため手術室を退室した。14日後に退院した。

Language：Japanese   Publisher：Japanese Journal of Anesthesiology  

Aicardi syndrome is a rare hereditary disorder that develops in only girls with the trilogy of nutatory epilepsy, callosal agenesis and chorioretinopathy. We experienced general anesthesia twice for a patient with Aicardi syndrome in addition to heavy mental retardation. She underwent surgical correction for cleft lip and palate at 6 months of age and at 2 years of age, respectively. Anesthesia was induced slowly with inhalation of nitrous oxide, oxygen and sevoflurare. After securing an intravenous route, midazolam, thiopental and vecuronium were administered and intubated orally. Anesthesia was maintained with isoflurane safely. Patients with Aicardi syndrome have a high risk of aspiration pneumonia caused by underdeveloped swallowing ability due to callosal agenesis. We should, therefore, pay attention to prevention of seizure and aspiration pneumonia during the perioperative period.

Scopus

Language：Japanese   Publisher：(一社)医療の質・安全学会  

目的:頭頸部手術で気管チューブが抜けてしまうことは重大なトラブルだが,手術中は覆布がかかるためチューブの固定状態を確認することは困難である.そのため,気管チューブの固定を確実に行うことが重要となる.今回,経鼻挿管における気管チューブ角度とテープの長さに対する引張距離と応力について検討した.方法:マネキンを用いた経鼻挿管を行い,チューブ固定にキープシルク(KES),ソフポア(SFP;ニチバン社)の2種類を使用した.貼付方法は鼻筋からチューブを一周させ,残りを鼻翼または上口唇に貼付する.貼付長さは2cm,3.5cm,5cmで行った.引張方法は挿管チューブを30°,90°の位置から300mm/minの速度で10mm,20mm,30mmの引張を行い,その時の固定力(kgf)をそれぞれ8回計測した.統計はScheffeとMann-Whitney U検定で行い,P<0.05を有意差ありとした.結果:30°で行った固定では,引張距離30mmで上口唇固定のSFP 3.5cmと鼻翼固定のSFP 5.0cmが最大応力(3.09kgf,2.52kgf)となった.また,上口唇固定の方が強い応力となった(P=0.074).90°で引張を行った場合では,引張距離30mmで鼻翼固定のKES 3.5cmと上口唇固定のKES 2.0cmが最大応力(5.0kgf,4.02kgf)となった.また,鼻翼固定が有意に強い応力となった(P=0.027).考按:手術中の経鼻挿管では,顔面から約30°の角度で気管チューブを固定している.この場合,SFPでは上口唇に3.5cmで貼付すれば強固な固定が得られる.また,覚醒時などの自己抜管を想定した場合は,顔面より90°の角度で力がかかると考えられる.この場合はKESで鼻翼に3.5cmで固定すれば5kgfの力でも気管チューブは抜けにくい結果が得られた.(著者抄録)

Language：Japanese  

PubMed

Language：Japanese   Publisher：Biomedical Research (India)  

The analgesic effect of a local anesthetic is often insufficient in acutely inflamed tissues, due to the reduced pH and/or vasodilation. Thus, vasoconstrictors (adrenaline or noradrenaline) are often used to contain the anesthetic and prolong the analgesia, although there are minimal data regarding their effects in inflamed tissues. Therefore, we prepared a model of blood vessel inflammation (using lipopolysaccharide), and investigated the contractile effects of adrenaline or noradrenaline with and without lidocaine. Wistar rats’ thoracic aortas were cut into 3-mm-thick rings, which were stretched using a pair of hooks in an organ bath (Krebs-Henseleit solution, 37°C, pH=7.4). After lipopolysaccharide exposure (1 μg/mL), adrenaline or noradrenaline was applied in successive cumulative doses (10-9 to 10-5 M) with or without lidocaine (10-4 M), and the isometric vasocontractions were recorded. The lipopolysaccharide treatment attenuated the vasocontractions that were induced by adrenaline or noradrenaline with lidocaine in a time-dependent manner. Despite its vasodilation properties, lidocaine enhanced the contractile responses that were produced by low concentrations of adrenaline (10-8 to 10-7 M), which indicates that a sufficient analgesic effect depends on the concentration of lidocaine and adrenaline. Therefore, adrenaline should be used when injecting inflamed tissues with lidocaine.

Scopus

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

A 9-year-old boy with Williams syndrome was scheduled to receive dental treatment under general anesthesia. He had been diagnosed as having Williams syndrome based on the presence of characteristic features, including an elfin face, mental retardation, and congenital supravalvular aortic stenosis and hypercalcemia. Airway management using a mask technique was easily performed. Anesthesia was induced slowly with the inhalation of oxygen and sevoflurane. After obtaining an intravenous route, fentanyl and rocuronium were administered and the patient was intubated nasally. Tracheal intubation (using an Airway Scope®) was performed. The anesthesia was safely maintained using sevoflurane. Patients with Williams syndrome have a high risk of sudden death caused by arrhythmias or cardiac arrest. Therefore, special care to prevent heart failure during the perioperative period using a noninvasive hemodynamic monitor and appropriate management of the circulatory system, mental retardation, malignant hyperthermia, and hypercalcemia is needed in patients with this syndrome.

Scopus

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

We report the anesthetic management during dental treatment under general anesthesia using a flexible laryngeal mask airway (FLMA) in a patient with tracheal granulation tissue. The patient was a 7-year-old boy with cerebral palsy and tracheal granulation tissue after a tracheotomy. A physical examination revealed the patient to weight 17 kg and to have a height of 107 cm. He could not walk by himself, and he required total support because of a low level of activity. Anesthesia was induced by the inhalation of 8% sevoflurane and oxygen (6 l/min) after the start of SpO2 monitoring. After the loss of consciousness, the inhalation anesthetics were switched to 2%-3% sevoflurane, and BP, ECG, and BIS monitoring were initiated. A size 2.5 FLMA was easily inserted after the administration of atropine (0.1 mg). The anesthesia was maintained with sevoflurane in oxygen (FiO2 : 0.47) and air with acetoaminophen. In the surgical field, the rubber dam isolation technique was used to prevent contamination (saliva, hemorrhage). The pressure control ventilation setting was used throughout the procedure, and no episodes of desaturation occurred. The patient awakened fully after the anesthesia and his respiratory and hemodynamic conditions stabilized after extraction. The use of FLMA should be considered to avoid unexpected airway troubles during dental treatment in patients with tracheal granulation tissue.

Scopus

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

15歳男児。脳性麻痺および症候性てんかん児で、数年前から咽頭部に分泌物貯留が増加し、吸気時に上気道狭窄音を認めるようになった。また、食事中にSpO2が低下することがあった。今回、歯科治療に対し非協力なため、全身麻酔下の齲蝕治療が予定された。麻酔は酸素・セボフルラン・亜酸化窒素で導入し、就眠後はセボフルランをイソフルランに変更した。経鼻挿管後、ガーゼパッキングを挿入時に全身性間代性痙攣が約5秒間出現した。イソフルランをプロポフォールに変更し、ガーゼパッキングを挿入した。その後、タービンを使用した歯科治療を開始した直後に右上肢～下肢に強直性痙攣が約5秒間出現した。また、歯の切削時に同様の痙攣を繰り返し、レミフェンタニルを投与したところ痙攣は消失した。なお、痙攣時にはBISモニター上では適切な麻酔深度であった。抜管後に上気道が閉塞したが、気管チューブの再挿管で呼吸状態は安定した。

Language：Japanese   Publisher：Anesthesia Progress  

Apert syndrome is a rare autosomal dominant disorder characterized by craniofacial abnormalities, craniosynostosis and syndactyly. Nasotracheal intubation for a patient with Apert syndrome can be a challenge because of abnormal facial anatomy. We experienced the anesthetic management of a patient with Apert syndrome who underwent partial resection of mandible and cleft palate repair with nasotracheal intubation. Nasotracheal intubation using a gastric tube and extubation using an airway exchange catheter proved useful in this case of airway compromise.

DOI： 10.2344/0003-3006-62.3.122

Scopus

PubMed

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

口腔外科手術では、経鼻挿管や気管切開で気道管理を行うことが多く、覆布の下に気管チューブや胃管が隠れた状態で行われる。そのため、気管チューブや胃管の圧迫により、鼻孔縁に褥瘡を生じることがある。九州大学病院歯科麻酔科では2010年4月から2012年9月までに気管チューブもしくは胃管による鼻孔縁褥瘡を10例以上経験した。そこで、褥瘡が発生した原因をレトロスペクティブに検討した。当科で全身麻酔を施行した20歳以上の症例を対象とし、年齢、性別、BMI、麻酔時間(分)について検討した。褥瘡は726例中の16例に発生していた。褥瘡発生危険因子として男性(オッズ比:9.1411、95%信頼区間2.680-170.58、p=0.0069)と、麻酔時間(オッズ比:1.0048、95%信頼区間1.0034-1.0065、p<0.0001)が抽出された。男性が褥瘡発生の要因になることが考えられた。また、麻酔時間(分)が褥瘡発生の要因と考えられるため麻酔時間の短縮や、長時間手術では褥瘡予防の配慮が重要と考えられた。褥瘡は術後数週間の保存的治療で治癒したため、臨床的には大きな問題とはならなかった。しかし、このような褥瘡は審美的に問題であり、患者のQOLに影響を及ぼす。(著者抄録)

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

5歳男児。1ヵ月検診で聴覚異常を指摘され、両耳高度難聴、眼角解離、左虹彩異色症からWaardenburg症候群1型と診断した。全身麻酔下での齲蝕治療を施行した。前投薬は投与しなかった。左側補聴器は装着した状態で、右側人工内耳のみ外して人室した。セボフルランと酸素で緩徐導入した。就眠後に左側補聴器も外してBISモニターを装着した。維持は空気、酸素、イソフルランで行った。局所麻酔薬は1/8万アドレナリン含有2%リドカインを適宜使用した。術中にアセトアミノフェン注射液を投与した。手術終了後に左側補聴器を装着し、良好な覚醒を確認後に抜管した。覚醒後に右側人工内耳も装着した。術後の経過も良好で翌日に退院した。

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

症例はHajdu-Cheney Syndromeの5歳女児で、歯科治療に非協力的であるため全身麻酔下での齲蝕治療を行った。先天性骨融解による頭頸部異常や易骨折性のため十分な気道評価を行い、気管チューブは内径5.0mmのカフなしチューブ、経鼻挿管チューブは内径5.0mmの経鼻挿管用RAEチューブを用いた。緩徐導入による興奮を回避するために静脈路確保後に入室とした。挿管困難や鼻腔損傷を考慮して最初に経口挿管し、その後鼻腔の通過性を確認して経鼻挿管を行った。麻酔導入はチアミラールナトリウム、麻酔維持はイソフルラン、術後鎮痛剤はアセトアミノフェンを投与した。麻酔時間は6時間3分であった。術後経過は良好で翌日退院となった。

Language：Japanese   Publisher：真興交易(株)医書出版部  

73歳男。口底部悪性腫瘍に対し全身麻酔下での気管切開術、左側全頸部郭清術、右側顎下部郭清術、正中下顎骨区域切除術、腹直筋皮弁による再建術と長時間の手術が予定された。本例は既往に重症慢性閉塞性肺疾患があり、手術18日前より呼吸機能回復訓練を開始した。なお、術前検査ではCOPD stage III、Hugh-Jones分類IV度であった。酸素・フェンタニル・プロポフォールで麻酔導入し、入眠後にベクロニウムを投与した。また、レミフェンタニルの持続投与を開始し、維持は各段階で酸素・プロポフォール・レミフェンタニル・セボフルラン・フェンタニルを使用して行った。更に、導入後から手術終了まで低用量カルペリチドを持続投与し、利尿とPaO2の維持につとめた。術後15時間に皮弁の血行不良が生じ再吻合術を要したが、再手術を含め術中・術後の呼吸および循環動態に著変は認めなかった。

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

18歳女。出生後にDown症候群とし診断され、精神遅滞を認めた。歯科治療に非協力であった。口腔内診察、聴診を行うも強く拒否して施行できなかった。セボフルランで導入を開始した。ロクロニウム臭化物、フェンタニルクエン酸塩を投与した後に喉頭展開を行った。麻酔維持は酸素、空気、セボフルランで行った。治療終了後にデンタルチェアから搬送用ストレッチャーに移動してセボフルランの投与を中止し、覚醒を待った。覚醒は良好で、搬送用ストレッチャー上で2時間安静にさせた。その後、意識レベル、循環動態、排尿を確認して帰宅させた。

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

We experienced the anesthetic management of a patient with Down syndrome who did not undergo any preoperative examinations. A 18-year-old woman was scheduled for dental treatment. Her height was about 160 cm, and her weight was about 50 kg. We were unable to perform any physical examinations to evaluate characteristics such as possible cervical spine abnormalities, airway condition, or neurological changes, nor were we able to perform respiratory function tests, laboratory tests, electrocardiography, or thoracic X-ray examinations because the patient had mental retardation and was combative in unfamiliar places and when presented with unfamiliar devices. She had a physical activity level of 7 metabolic equivalents, and no findings suggested a difficult intubation. After the induction of anesthesia through the inhalation of 8% sevoflurane in oxygen while the patient was sitting in a wheelchair, we began monitoring the patient's blood pressure, electrocardiogram, and oxygen 'saturation level measured using a pulse oxymeter (SpO2). We then administered fentanyl (100 μg) after moving her to a dental chair and obtaining peripheral intravenous access. Rocuronium (35 mg) was also administered intravenously to facilitate the tracheal intubation. We were able to perform a smooth intubation using a laryngoscope. The anesthesia was maintained with inhaled sevoflurane, air, and oxygen. We started the dental treatment after confirming that all the examinations were within the normal ranges. The surgery proceeded uneventfully. She regained consciousness from the anesthesia while in a bed, and her vital signs were stable.

Scopus

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

We treated a special-needs dental patient with epilepsy. Convulsions without changes in the Bispectral Index (BIS®) were observed during the dental treatment, and a severe airway obstruction occurred after extubation. The patient was a 15-year-old boy with well-controlled epilepsy, cerebral palsy, and intellectual disability. On physical examination, he was 17 kg in weight and 109 cm in height. He could not walk by himself, and he had experienced frequent episodes of reduced SpO2 at meal times, probably because of weak pharyngeal muscles and increased secretion. For the dental treatment, anesthesia was induced with the inhalation of sevoflurane (8%) in nitrous oxide (4 l/min) and oxygen (2 l/min) after the start of SpO2 monitoring. Once the patient was unconscious, the inhaled anesthetics were changed to isoflurane (1%) in oxygen (6 l/min), and blood pressure monitoring, electrocardiography, and BIS monitoring were started. We administered rocuronium (10 mg), atropine (0.1 mg) and fentanyl (30 μg) after confirming easy mask ventilation. The patient was intubated with a 5.5-mm nasotracheal tube by direct laryngoscopy. A convulsion lasting five seconds occurred when the patient's throat was packed with gauze. In addition, convulsions occurred several times during the dental treatment when the teeth were shaved. Remifentanil, but not propofol, was useful for preventing the convulsions. The cause of the convulsions might have been small stimulations, such as vibrations, which were difficult to control using local anesthesia. After extubation, an upper airway obstruction occurred, probably because of the patient's weakened peripharyngeal muscles, delayed awakening from anesthesia, and increased secretion. Therefore, the patient was re-intubated until the following day. The history of complications and present condition of patients should be considered when managing unexpected troubles during the perioperative period.

Scopus

Language：Japanese   Publisher：Asia Pacific Journal of Clinical Nutrition  

Background & Aims: Insulin sensitivity often decreases after surgery in spite of normal insulin secretion, and may worsen the outcome. This post-operative insulin resistance increases according to the magnitude of surgical invasion. However, supplementation of carbohydrates before surgery attenuates the post-operative insulin re-sistance. This study aimed to investigate the effect of intra-operative administration of low-dose glucose on the post-operative insulin resistance. Methods: Patients undergoing maxillofacial surgery were randomly assigned to two groups throughout the surgical procedure: The glucose group receiving acetated Ringer solution with 1.5% glucose and the control group receiving acetated Ringer solution without glucose. Insulin resistance quantified by the mean glucose infusion rate (the glucose infusion rate) was evaluated by glucose clamp using the STG-22TM instrument on the previous day and on the next day of surgery. Blood glucose level was monitored continuously during surgery. In addition, serum insulin, ketone bodies and 3-methylhistidine were measured during periopera-tive period. Results: Patients in the glucose group (n=11) received 0.15±0.06 g/kg/h of glucose during surgery, while patients in the control group (n=11) received no glucose. In both groups, however, the mean blood glucose levels were maintained stable at less than 150 mg/dL during and after surgery. The serum ketone bodies signifi-cantly increased after surgery in the control group (p=0.0035), while it decreased significantly in the glucose group (p=0.043). The reduction rate in the glucose infusion rate was significantly lower in the glucose group, 43.3±20.7%, than that in the control group, 57.7±9.3% (p=0.041). Conclusions: Intra-operative small-dose of glucose administration may suppress ketogenesis and attenuate the post-operative insulin resistance without caus-ing hyperglycemia.

DOI： 10.6133/apjcn.2014.23.3.10

Scopus

PubMed

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

27歳男。出生時に心室中隔欠損のない完全大血管転位症(TGA)と診断し、生後数ヵ月でBAS手術を施行した。1歳時にJatene手術を施行した。3年前から運動時の胸部圧迫感を自覚し、3ヵ月前より症状が増悪したため緊急入院した。肺動脈狭窄症と冠動脈狭窄と診断し、肺動脈再建術と冠動脈バイパス手術を予定した。術前検査で成人性歯周炎を指摘された。幼少期に歯科治療中の嘔吐反射を経験してから歯科恐怖症となっていたため、スケーリングを静脈内鎮静下で施行した。術前検査で心臓超音波検査を行い、軽度大動脈弁逆流を認め、心駆出率は63%であった。感染性心内膜炎予防のために麻酔導入直後よりセファメジンナトリウムを静脈内持続投与した。全身麻酔下で肺動脈形成術と冠動脈バイパス術を施行した。術後経過も良好で16日後に退院した。

Language：Japanese   Publisher：克誠堂出版(株)  

症例は44歳女性で、先天性骨形成不全症で、幼少期～青年期まで大腿骨骨折を繰り返した。現在は歩行困難で、一部に介助が必要な車椅子生活を送っている。開口幅は1.5cm、Mallampati分類はクラスIVで、頭部後屈・回旋は可能であった。口腔内X線・CTで下顎骨にプレート破折を認めた。胸部X線で側彎と肋骨の狭小化を認め、9歳頃に下顎骨正中に腫脹を認め、骨形成線維腫と診断され、腫瘍切除術を施行した。その後、腫瘍増大を認め、16歳時に下顎区域切除術、プレートおよび肋骨細片による再建術を施行した。30歳頃に正中部で破折したため再建で破折したため再建プレートが露出していた。プレートによる褥瘡が発生しプレート削除術を行ったが感染と露出を繰り返した。プレートの露出が拡大したため麻酔下でプレート切断術を施行した。パノラマX線で両側上顎に不透過像を認めた。右側上顎洞上方、左側は上顎洞全体に石灰化した硬組織が充満していると思われた。下顎骨体部欠損による気道閉塞から重篤な転帰に至る可能性が高いと考え、導入は外科的気道確保を準備して意識下挿管で行う予定とした。経鼻エアウェイを挿入し、喉頭反射消失を確認後、気管支ファイバースコープを用い、チューブを意識下に経鼻挿管し、プロポフォール、ロクロニウム、フェンタニルを投与した。良好な自発呼吸と気道が保たれていることを確認しチューブエクスチェンジャーを抜去した。

Language：Japanese   Publisher：Japanese Journal of Anesthesiology  

Osteogenesis imperfecta (OI) is a rare hereditary disorder characterized by an excessive tendency to bone fractures and retarded growth. We report an anesthetic management of the patient with OI who has the history of vertebral bone fracture by coughing. A 44-year-old female underwent mandibular resection and reconstruction with a metal instrument due to ossifying fibroma 35 years ago. Since then, she had undergone mandibular resection and shaving the instrument several times because of recurrence of the tumor and/or fracture of the instrument. This time, some parts of the instrument were removed under general anesthesia since it had exposed from the skin. Difficulty in mask ventilation and intubation was predicted due to the defect of mandible and some muscles supporting the tongue and the pharynx. Awake fiber-optic nasotracheal intubation therefore, was performed in consideration of airway obstruction. Dexmedetomidine was administered to reduce the risk of bone fracture in addition to low doses of midazolam and fentanyl. Considering incomplete respiration after extubation, the tracheal tube was extubated after inserting the tube exchanger into the trachea through the tube. The tube exchanger was pulled out after confirming spontaneous respiration and upper airway patency. The patient was cooperative, and respiratory and hemodynamic conditions were stable throughout.

Scopus

Language：Japanese   Publisher：(一社)日本口腔診断学会  

13歳男児。12歳時、全身性エリテマトーデスと診断した。さらに骨髄染色体検査で性染色体XXYが判明し、Klinefelter症候群と診断した。プレドニゾロン、バクタ配合錠、アルファロールカプセルを内服していた。上顎前歯部の疼痛を訴え受診し、左側上顎前歯部歯肉の発赤と腫脹を認めた。X線で同部に逆生埋伏している上顎左側犬歯を認め、能動的に上顎左側乳犬歯および上顎左側犬歯の抜歯術を予定した。酸素化の後、セボフルラン2%を吸入させ、レミフェンタニル塩酸塩、フェンタニルクエン酸塩、ミダゾラム、アトロピン、ロクロニウム臭化物を静脈内投与し、経口挿管を行った。手術開始時に1/8万アドレナリン添加2%リドカイン塩酸塩による浸潤麻酔を行った。維持は、セボフルラン1.8～2.0%、酸素、笑気、レミフェンタニル塩酸塩で行った。術中、循環動態に大きな変化はなかった。経過過良好で翌日退院した。

Language：Japanese  

PubMed

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

1歳7ヵ月男児。多数のう蝕歯治療が予定された。Angelman症候群のため、顎骨は上下とも小顎でオトガイ部は前下方に突出し、両四肢の筋緊張が軽度低下していた。また、脳波検査ではF～C領域を中心に不規則性徐波を認め、染色体検査では15q11-2q13領域が欠失していた。入室後セボフルランで緩徐導入し、プロポフォール・レミフェンタニル持続投与を開始した。ロクロニウムで筋弛緩後喉頭展開し、内径4.5mmカフなしスパイラルチューブを経口挿管した。酸素・空気・プロポフォール・レミフェンタニル・ミダゾラムで維持し、術中のBIS値は40～65で推移し異常脳波は認めなかった。歯科処置はデンタルエックス線撮影後、全上顎乳歯と左右下顎の第一乳臼歯のう蝕処置を行った。手術終了後、筋弛緩モニターによる尺骨神経の四連(TOF)刺激でTOF比が1.0であることを確認して抜管した。術後、胸郭の動きは良好で痙攣や睡眠時無呼吸は認めず、翌日に退院した。

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

Scopus

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

Scopus

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

Scopus

Language：Japanese   Publisher：(一社)日本小児麻酔学会  

2008年1月～2011年12月迄の4年間に管理した日帰り全身麻酔症例(0歳以上14歳以下)を対象に、帰宅許可を判断するための術後合併症を調査し、麻酔時間、麻酔維持方法、既往症との関連性について検討した。4年間の総症例数は208名(男128名、女80名、平均5.7±3.0歳)であった。診療科別症例数は小児歯科が最も多く、77.9%を占めた。既往歴は喘息36例、精神発達遅滞29例、薬剤・食物アレルギー29例であった。術式は多数歯齲蝕に対する歯科治療120例、上顎正中過剰埋伏歯抜歯47例、舌小帯強直症9例であった。術後合併症が発生した症例は43例で、飲水困難6例、排尿困難23例、ふらつき11例、嘔気・嘔吐3例であった。各々の術後合併症が発生した症例の平均麻酔時間は、発生しなかった症例に比べ長かったが有意差はなかった。術後合併症と麻酔維持薬に関係をみると、嘔気・嘔吐が認められたのは空気・酸素・セボフルラン(AOS)で維持した症例のみであった。既往歴のない症例と各々の既往を有する症例で、術後合併症の発生率に有意差はなかった。

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

症例は0歳7ヵ月の男児で、出生時に口唇顎裂が認められた。生後3ヵ月の術前検査でクレアチニンキナーゼ(CK)値が687U/lと上昇し再検査でも796U/lで、口唇形成術を待機的に延期し、神経筋疾患や先天性異常のスクリーニングを行った。生後4ヵ月～7ヵ月の定期検査ではCKが月ごとに272、636、319、330U/lと反復性に高値でASTは33～47U/lとやや高値で推移した。高CK血症を引き起こすウイルス感染や甲状腺機能異常を認めずアルドラーゼ値も10.5U/l、CK-MB23～37U/l、LDL分画のLDH2とLDH3がそれぞれ111、75U/lと高値で神経筋疾患を鑑別疾患として除外できなかった。生後7ヵ月時に筋力低下、運動発達の遅れがないため口唇形成術を行った。前投薬は行わず、酸素で麻酔導入し、プロポフォールを静脈内投与し、入眠後、エスラックス、フェンタニルを投与し、プロポフォール、レミフェンタニルを持続投与した。筋弛緩が得られ、十分な開口が得られた後、RAEチューブを経口挿管した。プロポフォール、レミフェンタニルで維持し、鎮静にリドカインを使用した。手術終了15分後に咽頭反射が出現し十分な自発呼吸を確認し抜管した。手術時間2時間35分、麻酔時間5時間5分で、抜管後、異常所見はなく帰室した。経過良好で翌週退院した。

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

Scopus

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

Scopus

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

Ambulatory anesthesia is often performed for children who are not obedient for dental treatment. We investigated the backgrounds of cases that were adjourned, and the occurrence of respiratory complications during general anesthesia in cases that were adjourned because of common cold. The subjects were 427 pediatric cases scheduled for ambulatory anesthesia at the Department of Dental Anesthesia in Kyushu University Hospital from January 2008 to May 2012. The study was performed by retrospectively extracting information from anesthesia records. In 308 cases out of 427, general anesthesia was performed as scheduled. Six cases were cancelled as general anesthesia became unnecessary and 54 cases were adjourned due to bad general condition showing symptoms of common cold. We compared the age and seasons between the 308 cases treated as scheduled (conducted group) and 51 cases adjourned because of bad condition (adjournment group). The ages were divided into four stages, 1-2, 3-5, 6-8 and 9-15 years old. The seasons were also divided into four (spring, summer, autumn, winter) at the time of scheduled date. The rate of adjournment at the stage of 1-2 years old was significantly higher than those at other stages. There was no significant difference in the rate of adjournment between the seasons. We investigated the occurrence of respiratory complications in the adjournment group during general anesthesia. The duration of adjournment was significantly shorter in the cases with perioperative respiratory complications. These results suggest that pediatric patients tend to fall sick easily regardless of their primary disease, especially at younger ages. In addition, it is important to allow a sufficient period of adjournment to reduce the occurrence of respiratory complications. The conditions of pediatric patients may change very easily during the perioperative period, therefore it is important to contact parents appropriately. It is also important to pay attention to the conditions of pediatric patients to avoid respiratory complications and perform ambulatory anesthesia safely.

Scopus

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

治療協力が得られない患者の歯科治療を日帰り全身麻酔で行うことがある。本検討では2008年1月から2012年5月末までに九州大学病院歯科麻酔科で計画した小児の日帰り全身麻酔を対象に、計画後中止もしくは延期となった症例の背景と、風邪などで延期した症例の周術期呼吸器合併症について検討した。情報は電子カルテおよび麻酔自動記録から抽出した。対象期間に計画したのは368名427症例であったが、予定どおり実施したのは308名308症例であった。中止は6名6症例で、延期が54名113症例であった。延期となった54名のうち体調不良が51名であった。この51名の延期群と予定どおり実施された308名の非延期群とで年齢層や季節による延期の傾向を検討した。年齢層は1～2歳群、3～5歳群、6～8歳群、9～15歳群の4群に分けた。季節は延期になった当初の麻酔予定日から春群、夏群、秋群、冬群に分けた。年齢層での比較では1～2歳群で延期頻度が有意に高かった。季節間での延期頻度に有意な差はなかった。延期群で周術期呼吸器合併症の有無を検討したところ、合併症を認めた症例では延期期間が有意に短かった。今回の結果から、より若年の小児で一年を通じて体調が変化しやすいことが示唆された。また、周術期呼吸器合併症の予防には十分な延期期間を設けることが重要であると考察された。(著者抄録)

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

25歳男。2歳時にてんかんを発症した。自閉症のため意思疎通は乏しく、慣れない場所では多動がみられた。歯科訪問診療で齲蝕・歯周炎を指摘された。全身麻酔下で口腔内X線写真撮影、全顎スケーリングを施行した。非協力的で拒否反応が強いため、口腔内の診察はできなかった。プロポフォールを静注した。入眠確認後に酸素投与を開始した。一時的にSpO2が92%まで低下したが、マスク換気は可能であった。酸素とイソフルラン5%でマスク換気を開始した。その直後に強直性のてんかん発作があり、一時的に換気不能となった。ロクロニウム、プロポフォールを投与し、喉頭展開して気管チューブを経口挿管した。術中に著明な循環変動はなかった。刺激しないように覚醒を待ち、覚醒した時点で人工呼吸を中止した。呼吸状態、循環動態も安定していたため抜針後帰室させた。

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

2歳7ヵ月女児。出生後1ヵ月検診で皮膚の異常を指摘され、非水疱性先天性魚鱗癬様紅皮症と診断され、保湿剤やワセリンの外用療法を行った。今回、全身麻酔下に歯科治療を施行した。酸素、笑気、セボフルランを吸入させて緩徐導入した。ロクロニウムを静脈内投与し、十分な筋弛緩を得た後、経鼻挿管した。麻酔維持は酸素、空気、セボフルランで行った。麻酔開始1時間後に直腸温が37.5℃まで上昇したため鼠径部に保冷剤を置きクーリングを開始した。体温は直腸温36.6～37.5℃、皮膚温36.5～36.8℃で推移した。手術終了後、アセトアミノフェンを挿肛しセボフルラン投与を中止した。5分後に呼びかけと同時に体動を認めたため、頭部ならびに上腕、足を抑制し、SpO2 97～100%を確認して抜管した。帰室後の状態も良好のため翌旧退院した。

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

Scopus

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

Scopus

Language：Japanese   Publisher：(一社)日本口腔診断学会  

術前のMallampati分類(M分類)による気管挿管難易度評価の予測精度について検討するため、九大病院において2006～2012年に施行された歯科治療および口腔外科手術で歯科麻酔科が管理した全身麻酔例のうち、M分類と気管挿管時Cormack-Lehane分類(C分類)による評価を行い、かつ喉頭鏡で喉頭展開を試み挿管した471例の麻酔記録とカルテを分析した。結果、M分類で挿管困難と予測された症例の割合は42%、C分類で挿管困難と評価されたのは9%であった。C分類で挿管困難と評価された症例のうち、M分類で挿管困難が予測できたのは73%であった。C分類で挿管が容易と評価された症例のうち、M分類でも挿管容易と予測されたのは61%であった。M分類で挿管が容易と予測された症例のうち、C分類でも容易と評価されたのは96%であった。M分類で挿管困難と予測された症例のうち、C分類でも困難と評価されたのは15%であった。

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

3ヵ月の女児。口唇口蓋裂に対して全身麻酔下に口唇形成術を行った。手術室入室後、セボフルランと笑気、酸素で緩徐導入し、静脈路を確保した後、換気が容易であることを確認し、フェンタニルクエン酸塩とロクロニウム臭化物、アトロピン硫酸塩を投与した。2分後に喉頭展開を試みたが、喉頭鏡のブレードを十分に進めるも喉頭蓋を確認できず、Cormack & Lehane分類4度であった。このため、デンタルミラーを用いて喉頭の位置を確認し、デンタルミラーを保持した状態でスタイレットによるチューブ挿管を試みたが、チューブを進めることはできなかった。そこで、Two-Person Technique(一人の麻酔科医が喉頭鏡で喉頭展開を行い、もう一人の麻酔科医が十分な口腔内視野の下に気管支ファイバースコープで挿入する方法)を行い、成功した。

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

72歳女。術中管理では、体位変化によって神経症状が増悪しないよう、あらかじめ痺れの増強や疼痛の有無を患者に問診し、患者の指示した体位が手術操作に支障をきたさないかどうかを術者に確認したうえでポジショニングを行った。また、HAMでは一般に下肢の皮膚温低下が生じるとされており、本例においても左下肢の皮膚温低下を認めたため、温風式体温回復システムを用いて手術終了後まで加温した。さらに、HAMの特徴である運動神経の障害により神経支配除去性過敏状態に陥っている可能性が考えられたため、筋弛緩薬の使用には注意し、本例では非脱分極型の筋弛緩薬であるロクロニウム臭化物を用い、手術終了後に筋弛緩作用の遷延がないことを確認した。これらの配慮を行ったことで手術はトラブルなく施行でき、術後経過も良好であった。

Language：Japanese   Publisher：克誠堂出版(株)  

症例は6ヵ月男児で、先天性水頭症に脳室-腹腔シャント(V-Pシャント)が施行され、胎児期より頭囲拡大、羊水過多が認められ、帝王切開で出生した。出生後、全身性多発性皮膚血管腫、右下肢肥大が認められ、Klippel-Trenaunay症候群(KTS)と診断された。右下肢の肥大は大腿周囲径18cm、下腿周囲径16cmであった。水頭症のため、頭部の周囲径は拡大し、重量のため仰臥位でも側方しか向けない状態であった。更にビタミンK依存性の血液凝固障害が認められ、ケイツーシロップ2ml/週を内服し、APTT36.9秒(正常値28.5～41.5)、プロトロンビン時間-国際標準化比(PT-INR)1.56(正常値1.11～0.91)であった。そのほか喉頭軟化症のため、吸気時の喘鳴が認められたが治療はされなかった。術前Hb値10.2g/dl、心奇形は認めず心エコーで心収縮能などに問題なく、American Society Anesthesiologist(ASA)-Physical Status(PS)3と判断した。人手確保、ラリンジアルマスク、大量出血に備え、濃厚赤血球を準備した。麻酔前投薬は行わず、非観血的自動血圧計、パルスオキシメータ、心電図を装着した。麻酔導入後、アトロピン、レミフェンタニル、ロクロニウムを投与した。気管挿管を試みたが声門直下で抵抗を感じ細いチューブに変更し気管挿管できた。特に問題なく手術を終了し、気管挿管のまま新生児集中治療室(NICU)帰棟となった。手術68分、麻酔183分、出血量3gで、翌日抜管となり術後経過も良好である。

Language：Japanese   Publisher：Japanese Journal of Anesthesiology  

Klippel-Trenaunay syndrome (KTS) is a rare disorder associated with the triad of 1) capillary vascular malformation, 2) varicose veins and/or venous malformation, 3) and soft tissue and/or bony hypertrophy. A six-month old, 6.0-kg-weight male pediatric patient was scheduled for ventriculo-peritoneal shunt operation for hydrocephalus caused by obstructive aqueductus cerebri. At the age of three months, he was diagnosed as KTS by extensive capillary vascular malformation and soft tissue hypertrophy of the right leg. Physical examination showed prominent vascular malformation over his anterior thoracic and abdominal wall, and soft tissue hypertrophy was only on his right leg. Simultaneously, he was complicated with congenital hydrocephalus because of obstructive aqueductus cerebri. His head and skull were enlarged and his head measurement reached 55 cm (chest measurement 32 cm). Anesthetic management of KTS patients should be prepared with blood transfusion against massive hemorrhage and hypovolemic shock. Furthermore, KTS patients should be always considered to have airway difficulty due to the soft tissue hypertrophy, upper and airway hemangiomas. Therefore, we planned safer tracheal intubation following practice guidelines for management of the difficult airway.

Scopus

Language：Japanese  

PubMed

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

Scopus

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

72歳男。全身麻酔下に右頬粘膜扁平上皮癌に対する腫瘍切除術および植皮術手術が予定された。CT、超音波検査で大動脈弓に壁在性血栓を認め、左鎖骨下動脈から椎骨動脈の閉塞と両側内頸動脈および冠動脈の狭窄がみられた。術中に血栓や狭窄の進行により左上肢の虚血や脳梗塞を発症する危険が高いと考えられたため、麻酔中は収縮期血圧を100mmHg以上で維持し、右手指でSpO2をモニターした。さらに脳梗塞の発症に対しては、無侵襲性の脳内酸素飽和度モニタリング装置を使用し、有意な左右差や飽和度の低下に注意した。その結果、重篤な合併症なく麻酔を維持することができた。

Language：Japanese   Publisher：Journal of Thrombosis and Thrombolysis  

We have recently reported that a neurotransmitter for pain, substance-P (SP), promotes plateletdependent clot formation through neurokinin-1 receptors (NK1Rs), in which leukocytes appear to be involved (J Thromb Thrombolysis 2009;27:280-6). Two naturally occurring splice isoforms of NK1R with different signal transduction potency, namely the full-length and the truncated NK1Rs are identified. It is known that human leukocytes express truncated NK1Rs, while in vivo expression of the full-length NK1R has not yet been fully clarified. Modulatory effects of alternative splicing for NK1Rs on clot formation also remain to be evaluated. Expression of the transcript variant mRNA for NK1Rs in human whole blood (n = 20) was evaluated by real-time reverse transcription polymerase chain reaction (RT-PCR). A 15 min time series of the strength of clot, formed after reloading of calcium in citrated whole blood with or without SP (10 nM) and a NK1R antagonist Spantide (1 lM), was measured by using oscillating-probe viscoelastometry. The full-length transcript variant was detected in 5 samples among 20. SP significantly increased the clot strength while Spantide suppressed the SP-derived change. The extent of modulation by SP/NK1R pathway in a subgroup with expression of the full-length transcript variant was three times as potent as those in another subgroup without expression. We conclude that expression of the full-length transcript variant for NK1R can be detected in human whole blood and that such expression is associated with the enhanced reinforcement of clot by SP. Further study is required to nominate this mRNA as a biomarker for prothrombotic risks in painful conditions such as perioperative period. © Springer Science+Business Media, LLC 2012.

DOI： 10.1007/s11239-011-0650-1

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PubMed

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

Background : The auditory evoked potential index (AEP) and the bispectral index (BIS) can be used to assess the depth of general anesthesia Pentazocine is reported to increase the BIS value in anesthetized patients and may confound use of the index as a guide to administering hypnosis. In this study, we compared the effects of pentazocine on AEP values and BIS values in the absence of surgical stimulation under nitrous oxide sevoflurane anesthesia. Methods : The study was approved by the ethics committee of our institution, and written informed consent was obtained from all patients. Patients with known psychiatric, cardiovascular, neurological or endocrine disorders were excluded from the study. Twenty adult patients (ASA I) scheduled for elective oral surgery were studied, and assigned to one of two groups : AEP group (n = 10) and BIS group (n = 10). Anesthesia was induced with thiopental sodium and vecuronium bromide and maintained with a mixture of nitrous oxide (4 l·min-1), oxygen (2 l·min-1 and sevoflurane (1%). Mean arterial blood pressure (MAP), heart rate (HR), and either AEP values or BIS values were recorded every 2.5 min after intubation up to 30 min before surgery. Pentazocine (0.6 mg·kg-1) was administered intravenously (IV) 15 min after intubation. Data were presented as mean±SD, and results were analyzed by using repeated-measures analysis of variance. Post hoc comparisons were done using Tukey's test. For comparison between AEP and BIS groups, Student's test or χ2 test was used. P<0.05 was considered significant. Results : MAP and HR showed no significant differences between values before and after IV pentazocine, and between AEP and BIS groups. BIS values increased significantly (p<0.01) at 5 min after pentazocine IV, whereas AEP values showed no significant changes in response to pentazocine IV. Conclusions : IV pentazocine revealed different aspects of neural processing between AEP and BIS during nitrous oxide sevoflurane anesthesia The significant increase in BIS values, but not AEP values, elicited by pentazocine is paradoxical in that it is associated with a deepening level of hypnosis.

Scopus

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

麻酔深度判定に有用であるauditory evoked potential(AEP)モニタとbispectral index(BIS)モニタは、脳波から得た情報をおのおのAEP値およびBIS値として示している。ペンタゾシン静脈内投与は、亜酸化窒素・セボフルラン麻酔下ではBIS値を上昇させることが報告されている。今回、同じ麻酔条件でペンタゾシンを投与してAEP値とBIS値を比較検討した。方法:歯科口腔外科手術症例20名を対象とし、AEPモニタ使用群(n=10)とBISモニタ使用群(n=10)の2群に分けた。モニタ装着後チオペンタールナトリウム、ベクロニウム臭化物を投与して麻酔導入を行い、気管挿管を行った。導入後1%セボフルラン、亜酸化窒素4l・min-1、酸素2l・min-1で維持した。ペンタゾシン0.6mg・kg-1を気管挿管15分後に投与し、AEP値もしくはBIS値を気管挿管2.5分後から挿管30分後まで約2.5分間隔で記録した。その後、消毒、および手術が開始された。結果:AEP値は気管挿管2.5分後から挿管30分後までの有意の変動がなかった。BIS値は気管挿管後15分値と比較して挿管後20分値(ペンタゾシン投与後5分値)から有意に上昇した。結論:亜酸化窒素・セボフルラン麻酔下でのペンタゾシン0.6mg・kg-1の投与はBIS値を上昇させるが、AEP値には影響しないことが判明した。(著者抄録)

Language：English   Publisher：広島麻酔医学会  

子宮筋腫のため腹式子宮摘出術を予定された50名をランダムに5群に分け、1群(対照群)には生理食塩水を、他の4群にはペンタゾシン(PNT)を投与量(0.6mg/kgまたは1.2mg/kg)と投与時期を変えて(皮膚切開の5分前または5分後に)静脈内投与した。これら5群における、外科的刺激に対するエピネフリンとノルエピネフリンの血漿中濃度、切開後に生じる血液動態、交感神経アドレナリン反応を比較・検討した。外科的刺激に対する血漿カテコラミン反応の減衰は、0.6mg/kg投与の方が1.2mg/kg投与より大きかった。外科的刺激によりひとたび交感神経系が活性化されると、活性化した交感神経流出物をPNTで遮断することは難しいことが示唆された。皮膚切開前のPNT静脈内投与は外科的刺激に対する血液動態反応の減衰に臨床的に有効であった。

Language：Japanese   Publisher：Anesthesia and Resuscitation  

There are no reports in the literature regarding the effect of pentazocine (PENT) on autonomic responses to surgical stimulation. Therefore, we examined the effects of intravenously administered (iv) PENT, either before or after the skin incision, on the cardiovascular and plasma catecholamine responses, as characterized by plasma levels of epinephrine (Epi) and norepinephrine (Nor), to surgical noxious stimulation of patients. Hemodynamic and sympathoadrenergic reactions occurred after the skin incision had been made, and iv PENT (0.6 mg/kg) before the incision attenuated both cardiovascular and sympatho-adrenal responses to surgical stimulation compared with those after the skin incision under isoflurane-nitrous oxide anesthesia. The attenuation of these responses to surgical stimulation was greater at 0.6 mg/kg than at 1.2 mg/kg. Our present data suggest that it might be difficult for iv PENT to block the activated sympathetic outflows once the sympathetic nervous system has been activated by surgically noxious stimulation. According to our present results, iv PENT (0.6 mg/kg, but not 1.2 mg/kg) before a skin incision seems to be of clinical relevance for attenuation of the hemodynamic response to surgical stimulation although the effects of PENT on the autonomic nervous system appears to be complex and difficult to interpret.

Scopus

Language：Japanese   Publisher：Japanese Journal of Anesthesiology  

Background : In Japan, malignant hyperthermia susceptibility (MHS) is diagnosed by detecting an enhanced rate of CICR from the sarcoplasmic reticulum in skinned skeletal muscle fibers. We usually consider the CICR test should be completed within 48 hours of muscle excision. We measured the viability period of the CICR test in the following four treatment groups. Methods : Muscle bundles prepared from a rabbit were dissected and stored in muscle relaxant solution at -30°C, 4°C, 20°C, and 37°C. The CICR rate was measured in a part of the biopsied muscle using chemically skinned fibers that had been prepared according to Endo's method. Results : With muscle bundles stored at -30°C and 37°C, the rate of CICR could not be measured. Function related CICR of the muscle stored at 4°C and 20°C lasted for four days. Conclusions : This results showed that rate of CICR can be measured for at least 4 days when skeletal muscle bundles of rabbits are stored both at 4°C and at 20°C. Further studies are expected including the optimum conditions on stored temperature and stored days in the human muscle.

Scopus

Language：Japanese   Publisher：克誠堂出版(株)  

ウサギ骨格筋における保管温度・期間による筋小胞体からのCa2+漏れ出し速度とCICR速度の変化について検討した。細筋束にしたウサギ骨格筋を筋弛緩溶液に入れ、-30℃、4℃、20℃、37℃に保管し、それらを筋肉採取当日から7日目まで毎日測定を行った。-30℃保管では測定の可否にばらつきがあり、また37℃保管では24時間以内に採取筋の自己融解が進み実験は不可能であった。4℃および20℃での保管では、採取後4日以内であれば漏れ出しおよびCICR速度は影響されなかった。ウサギ骨格筋の保存温度は4℃から20℃までが適温であると考えられた。今後ヒト骨格筋による保存期間、保存温度の検証が必要である。(著者抄録)

Language：Japanese  

PubMed

Language：Japanese   Publisher：埼玉医科大学医学会  

腰部脊柱管狭窄症で脊椎手術施行の12名を無作為にフェンタニル使用6名(男4名、女2名、年齢64.2±13.9歳)をR群、非使用6名(男3名、女3名、年齢73.7±6.0歳)をC群に分けて検討した。両群の背景因子に有意差はなく、レミフェンタニルを除く麻酔薬使用量、昇圧・降圧薬の使用率、輸液、出血量、尿量に有意差はなく、セボフルラン使用はC群で多いが有意差はなかった。術前の下肢静脈超音波ではR群の一人に深部静脈血栓症(DVT)を認めた。血小板ピークの加速はfull-length NK1受容体のmRNA発言の有無と弱い相関があった。フィブリンゲル強度の指標(AUC)は術中の試料(Ph2)が麻酔開始の試料(Ph1)より有意に低かったが、レミフェンタニルの使用やNK1受容体刺激の有無には影響されず、周術期に発生する血栓の強度は全身麻酔管理で弱まるが、術中オピオイドの使用量には強い影響は認めなかった。SPを添加した検体のAUC(dAUC)はfull-length NK1受容体の発現、測定時相、レミフェンタニルの使用の影響を受けず、SPを添加した検体のT20(dT20)も個別要因に影響されなかったが、full-length NK1受容体の発現と測定時相には相互作用を認めた。full-length NK1受容体が発現する症例ではPh2でdT20が短縮し、SPによるフィブリンゲル形成の有意な加速を認めた。

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

22歳女。顎変形症に対し下顎枝矢状分割術が施行されたが、1週間後、筋突起が頬骨弓に接触している可能性があるため右筋突起切除術が予定された。術前、下顎角部から頸部にかけての腫脹が著しく、最大開口量は1横指程度であり、気道確保困難が予想されたため挿管を試みた。レミフェンタニル0.1μg/kg/minの持続投与を開始後、輪状甲状靱帯穿刺によりキシロカインで気管内麻酔を施行した際、バッキングを生じた。また、鼻腔より咽頭内まで挿入した気管チューブ内に気管支ファイバーを挿入し、気管チューブの気管内への挿入を確認すると同時にプロポフォールとベクロニウムを静脈内投与した際も激しくバッキングを生じた。呼吸停止や酸素飽和度の低下などの合併症は生じず、手術は問題なく終了したが、術後に患者は挿管時の苦痛感を訴えレミフェンタニル濃度が低かった可能性が窺えた。

Language：Japanese   Publisher：Journal of Japanese Dental Society of Anesthesiology  

A 24-year old woman was scheduled to undergo a Le Fort I osteotomy and SSRO. She had been administered antihistamines due to allergic rhinitis since elementary school. Three weeks prior to this admission, she had an upper airway infection (UAI) with fever (37.5°C), cough, and a congested nose. Physical examination was unremarkable and blood examination and vital signs were within normal limits, except for the above mentioned conditions. No premedications were administered. Prior to anesthesia, electrocardiographic monitoring and oxygen saturation monitoring were established. An automated system to measure blood pressure was placed on the right arm and set to cycle and recorded at 2.5 min intervals. The system also monitored the heart rate, the concentration of inhaled anesthetic agents via artificial nose, expired CO2 concentration via artificial nose, and body temperature. Anesthetics (midazolam ; 10 mg, vecuronium bromide ; 5 mg, fentanyl citrate ; 0.2 mg, droperidol ; 2.5 mg) were injected intravenously. After nasotracheal intubation, the lungs were ventilated mechanically with nitrous oxide 4 l/min, oxygen 2 l/min, and sevoflurane 1.5-2.0%. A nasogastric tube was placed at 55 cm. Before surgery was started, lidocaine with epinephrine was infiltrated at the surgical field. The duration of the operation was 2 hours. The duration of anesthesia was 3 hours. After intravenous injection of naloxone and recovery from anesthesia, extubation was performed. The total doses of fentanyl, midazolam, vecuronium, and lidocaine with epinephrine were 0.5 mg, 10 mg, 5 mg, 16 ml, respectively. Blood loss was 130 ml. Urine volume was 300 ml. The fluid volume was 1,000 ml. Intraoperative respiratory complications such as laryngospasm, bronchospasm, and breath holding, did not occur. Three days after the operation, she was diagnosed with postoperative pneumonia with fever (39.1°C), due to a slight rales with right lower lobe breath sounds and a chest radiography showed shadow at the right inferior lung fields. SpO2 was 99% under room air. She was administered cefazolin sodium (Cefamezin®) intravenously as an alternative antibiotic. However, body temperature was still high (38.5°C). Five days after the operation, the antibiotics were changed to piperacillin sodium (Pentcillin®) intravenously and clarithromycin (Clarith®) orally. The patient showed improvement 7 days after the operation. Although there is good evidence supporting that head and neck surgery appear to be the major procedure-related risk factors conferred with high risk postoperative pulmonary complications, insufficient evidence supports UAI as the risk factors. However, we recommend that patients with significant preoperative symptom of URI should have their surgery postponed.

Scopus

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

術前の上気道炎(Upper respiratory infection:以下URI)は、しばしば麻酔の術前診察時に遭遇するものである。しかし、成人に関する全身麻酔報告は少ない。患者は24歳女性、LeFort I型骨切り術、両側SSROが全身麻酔下で予定された。アレルギー性鼻炎の既往があるものの鼻閉、咳嗽、発熱(37.6℃)の症状からURIと診断された。麻酔は亜酸化窒素、酸素、セボフルラン、フェンタニルで行われた。麻酔時間は3時間、手術時間は2時間であった。術中時に問題はなかった。術後3日目39.1℃の発熱、右下肺野ラ音聴取、胸部X線写真から肺炎と診断された。抗生物質は、フルマリン1日2gからセファメジン1日3g静注に変更された。しかし、術後5日目体温が依然38℃台であったためペントシリン1日2g静注、クラリス1日400mg内服に変更した。術後5日目夜には体温が37℃台になり、術後6日目朝には、寒気、全身倦怠感などの自覚症状が改善し、術後8日目には36℃台になった。術後10日目の胸部X線写真では右下肺野の陰影像は消失していた。術後12日目に抗生物質および輸液投与を終了した。術前のURIは、術後の呼吸器系の合併症の危険因子としての明らかなエビデンスはない。しかし、術前URIを有する患者に対しては、術中、術後の呼吸器系の合併症の可能性が高くなることなど十分な説明をするべきであり、可能ならば手術を延期すべきである。(著者抄録)

Language：Japanese   Publisher：American Journal of Emergency Medicine  

DOI： 10.1016/j.ajem.2017.10.061

Scopus

PubMed

Language：Japanese   Publisher：Journal of Anesthesia  

DOI： 10.1007/s00540-017-2331-5

Scopus

PubMed

Language：Japanese   Publisher：Journal of Anesthesia  

DOI： 10.1007/s00540-017-2407-2

Scopus

PubMed

Language：English   Publisher：(公社)日本麻酔科学会  

Language：English   Publisher：(公社)日本麻酔科学会  

Language：Japanese   Publisher：Journal of Anesthesia  

DOI： 10.1007/s00540-017-2360-0

Scopus

PubMed

Language：English   Publisher：(公社)日本麻酔科学会  

Language：Japanese   Publisher：Indian Journal of Anaesthesia  

DOI： 10.4103/ija.IJA_268_17

Scopus

PubMed

Language：Japanese   Publisher：真興交易(株)医書出版部  

Language：Japanese   Publisher：真興交易(株)医書出版部  

痛みの原因が歯科疾患に由来しない"非歯原性歯痛"が歯痛全体の2～9%程度あると考えられている。非歯原性歯痛にはいくつかの原疾患別の分類があり、それぞれの特徴を踏まえた診断・治療を必要とする。そのプロセスには問診・画像診断・心理検査・テストブロックなどがあり、構造化問診で情報を整理しながら進めていく。非歯原性歯痛は、歯科領域に限らず頭頸部から全身疾患、心身医学的疾患との関連性が疑われる。したがって限られた視点だけでは患者のすべてを診ることは難しい。非歯原性歯痛に限らず、慢性痛に対しては従来の系統医学を超えた痛み診療チームで連携して、意見交換しながら診療を進めることが望ましい。(著者抄録)

Language：Japanese   Publisher：(株)メディカル・サイエンス・インターナショナル  

Language：Japanese   Publisher：日本臨床麻酔学会  

今回,強直性脊椎炎のため,セミファーラー位の体位のみ可能な患者にAirway Scope(AWS)を用い気管挿管を行った症例を報告する.通常,セミファーラー位の患者に気管挿管を行うためには,直視型喉頭鏡では難しく,気管支ファイバーが第一選択となる.しかし,気管支ファイバーは,視野が得られにくく,手技に熟練を要し,装置が高価であるなどの欠点を有する.AWSは,これらの欠点を補い,患者の体位が特殊な場合でも気管挿管をより円滑に行うことが期待される.本症例では,セミファーラー位の患者にAWSを用い問題なく気管挿管を行うことができた.AWSは,セミファーラー位の患者に対して,気管支ファイバーを用いるより,より円滑に気管挿管が行える可能性が示唆された.(著者抄録)

Language：Japanese   Publisher：(株)メディカル・サイエンス・インターナショナル  

悪性高熱症はまれな疾患だが,早期発見・早期治療がなされなければ多くの場合は死に至る重篤な疾患である。古くから,その病態生理の理解が進められてきた。本稿では,最近解析が進んでいるリアノジン受容体の変異を中心に,悪性高熱症の責任遺伝子の解析の動向について解説する。(著者抄録)

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