Language：Japanese   Publisher：Journal of Clinical Monitoring and Computing  

Perioperative stress in pediatric patients is often difficult to assess via interviews; thus, an objective measure to assess perioperative stress is needed. To visualize perioperative stress, we observed autonomic nervous system (ANS) activity, circulatory dynamics, and psychological status in pediatric patients undergoing alveolar bone grafting under general anesthesia. This prospective observational study included 40 patients aged 8–12 years who were scheduled for alveolar bone grafting in our hospital. ANS activity was analyzed using heart rate variability the day before surgery, during general anesthesia, 2 h postoperatively, 24 h postoperatively, and the day before discharge. ANS assessment included LF/HF (sympathetic nervous system activity) and HF (parasympathetic nervous system activity). Additionally, heart rate (HR), systolic blood pressure (SBP), face scale (FS) score were recorded. Data from 31 patients, excluding dropouts, were analyzed. The ratio of change to the preoperative value was compared. After surgery, the LF/HF, HR, SBP, and FS score significantly increased (P < 0.01) and HF significantly decreased (2 h postoperatively: P < 0.05, 24 h postoperatively, before discharge: P < 0.01). SBP recovered to preoperative values 24 h postoperatively, and HR and FS scores recovered to preoperative values before discharge. However, even before discharge, LF/HF remained significantly higher than preoperative values, and HF remained significantly lower than preoperative values (P < 0.01). Conclusion We observed perioperative stress from multiple perspectives. Circulatory dynamics and psychological status recovered by the day before discharge; however, ANS activity did not. Therefore, evaluating ANS activity may be useful in visualizing potential perioperative stress in pediatric patients.

DOI： 10.1007/s10877-024-01210-w

Scopus

PubMed

Language：Japanese   Publisher：Oral Science International  

Aim: The effect of listening to music before tooth extraction on the autonomic nervous system and psychological state remains unclear. This prospective study explored the hypothesis that playing music before the extraction of an impacted mandibular third molar would stabilize patients' autonomic nervous system activity and circulatory dynamics. Methods: Thirty-six patients were randomized into two groups: control and music. Patients in the music group listened to music before tooth extraction. Heart rate variability and circulatory dynamics were recorded during the procedure. The Modified Dental Anxiety Scale and State Trait Anxiety Inventory scale scores were recorded before the procedure, and the latter was used to assess postoperative anxiety scores. Results: Sympathetic nervous activity significantly increased in the control group during the administration of local anesthesia, bone removal, and extraction (p < 0.01), although this increase was lower in the music group during the administration of local anesthesia and extraction (p < 0.05). In the music group, the postoperative anxiety score was significantly lower than the preoperative score (p < 0.05). Conclusion: Playing music preoperatively may help reduce sympathetic nerve activity during the administration of local anesthesia and tooth extraction.

DOI： 10.1002/osi2.1151

Scopus

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

症例の概要:38歳女性.下顎管に近接している38抜歯後に左側オトガイ部の知覚異常を認めた.ビタミンB12製剤内服で経過観察されていたが,内服開始後1ヵ月経過しても症状に変化がなく,ペインクリニックでの加療を希望されたため,当院へ紹介となった.左側第3枝三叉神経ニューロパチーの診断のもと,星状神経節ブロックと鍼治療を行なった.星状神経節ブロックによる治療が20回終了したところで症状はDysesthesiaからParesthesiaへ変化していたが,著明な改善が認められないため,患者は治療継続を迷っていた.精密触覚機能検査,電流知覚閾値検査を行ったところ数値上改善を認め,その結果をフィードバックしたところ患者は治療継続を希望した.10回の鍼治療終了後,再度検査を行い,精密触覚機能検査,電流知覚閾値検査においてさらに改善を認め,その結果を患者にフィードバックしたところ,これまでの治療内容と現在の症状に納得し,治療終了を希望したため,終診となった.考察:本症例のように患者の訴えに著明な改善が認められなくても,検査値が改善しているケースがある.検査結果に基づいた適切な病態説明は,患者の治療継続と良好な経過へつながる可能性があると考えられた.結論:自覚症状の著明な改善が認められず,治療継続を迷っている口腔顔面痛患者において,定量的な検査と改善した検査結果のフィードバックは,患者の治療に対するモチベーションを維持し,その意思決定に有用である.(著者抄録)

Language：Japanese   Publisher：The Japanese Dental Society of Anesthesiology  

<p>  Multiple chemical sensitivity is a disease in which autonomic and neuropsychiatric symptoms, such as fatigue, headache, joint pain, insomnia, and dermatitis, occur in response to exposure to a trace amount of a chemical substance. Here, we report the management of intravenous sedation for tooth extraction and caries treatment in a patient with multiple chemical sensitivities.</p><p>  A 57-year-old woman visited a nearby dental clinic complaining of dentin hypersensitivity and requiring tooth extraction and treatment for a root fracture in the mandibular right second molar and caries in the mandibular right first premolar. However, she had a history of chemical hypersensitivity and dentophobia. She was referred to our hospital and was scheduled to undergo intravenous sedation in an environment with minimal exposure to inducers.</p><p>  We monitored her blood pressure, percutaneous arterial oxygen saturation (SpO₂), and pulse, and a single dose of midazolam (2 mg) and propofol (10 mg) was administered after securing an intravenous route. The continuous administration of propofol was started at 3 mg/kg/h under 3 L/min of oxygen after the patient fell asleep. No symptoms or risks associated with multiple chemical sensitivity were observed during the tooth extraction or caries treatment.</p><p>  The patient was successfully treated in an environment that eliminated the triggers for the onset of symptoms of multiple chemical sensitivity after meticulous interviews with specialists in collaboration with each clinical department. Intravenous sedation using midazolam and propofol under 3 L/min oxygen was a successful approach for minimizing the psychosomatic mechanisms of multiple chemical sensitivity in a patient with dentophobia.</p>

DOI： 10.24569/jjdsa.51.1_4

Language：Japanese   Publisher：Journal of Oral and Maxillofacial Surgery  

Purpose: This study assessed the relationship between changes in autonomic nervous system activity during impacted mandibular third molar extraction and a patient's postoperative psychological status, with the overarching aim of informing the development of interventions to reduce dental phobia and anxiety. We hypothesized that changes in autonomic nervous system activity during tooth extraction are related to postoperative psychology. Methods: In our prospective cohort study, heart rate variability, heart rate (HR), and systolic blood pressure (SBP) were recorded during impacted mandibular third molar extraction. Heart rate variability values were dichotomized as either low frequency (LF 0.04-0.15 Hz) or high frequency (HF >0.15 Hz). The relative ratios (intraoperative vs baseline) of LF/HF, HF, HR, and SBP were divided into high and low groups based on their median values; the State Anxiety Inventory (STAI-S) results were compared between the groups with high and low relative ratios. Results: Data of 34 female patients (age, 28.23 ± 1.05 years) were analyzed. Postoperative STAI-S values were significantly lower than preoperative values. Patients in the high LF/HF group had a significantly lower change in STAI-S values than those in the low LF/HF group (P <.05). There were no significant differences in the change in STAI-S values between the groups with high and low HF, HR, or SBP. Conclusions: Patients with low sympathetic nervous system activity had lower anxiety; the LF/HF index was the most sensitive indicator for changes in stress. Additional studies are required to develop optimal interventions for reducing sympathetic nerve activity in patients with dental phobia.

DOI： 10.1016/j.joms.2021.06.019

Scopus

PubMed

Event date： 2022.10

Language：Japanese  

Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese  

Language：English