著者

栗原 由佳 小原 明香 増田 陸雄 笠井 早貴 坂崎 麗奈 飯島 毅彦 鈴木 尚志

出版者

一般社団法人 日本歯科麻酔学会

雑誌

日本歯科麻酔学会雑誌 (ISSN:24334480)

巻号頁・発行日

vol.48, no.2, pp.51-53, 2020-04-15 (Released:2020-04-15)

参考文献数

10

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We report a case of extensive cardiogenic cerebral infarction resulting in permanent disability arising from an interruption in oral anticoagulants before dental surgery. A 71-year-old woman with a history of atrial fibrillation and hypertension was scheduled to undergo an implant placement in the maxillary molar area. She had been taking warfarin (2 mg/day) to prevent thromboembolic events, and the dosage had been titrated to maintain an international normalized ratio of prothrombin time (PT-INR) of 1.7-2.1 for the last nine months. The patient was instructed not to take warfarin for four days before or on the day of surgery by her cardiologist, and warfarin was resumed on the day after surgery. On postoperative day three, she suffered a stroke and was admitted emergently. She presented with right hemiplegia and aphasia, and her Glasgow Coma Scale (GCS) score was 8 (E3V1M4). The PT-INR was 1.17 on admission, and brain magnetic resonance imaging showed an extensive hemorrhagic infarction in the territory of the left anterior and middle cerebral artery. Despite conservative treatment, the brain edema progressed and resulted in impending brain herniation requiring an emergent decompressive craniotomy, which was performed on the sixth day after admission. She was discharged to a nursing home with an improved GCS score of 11 (E4V2M6) but with residual dysphasia 50 days after admission. Recent professional guidelines recommend that anticoagulants not be discontinued in the most patients requiring dental extraction. Following such recommendations is crucial to prevent fatal thromboembolic events in patients receiving anticoagulants who require dental implants.

著者

長澤 郁子 岩崎 多恵 増田 陸雄 五島 衣子 岡 秀一郎 吉村 節

出版者

昭和大学・昭和歯学会

雑誌

昭和歯学会雑誌 (ISSN:0285922X)

巻号頁・発行日

vol.25, no.2, pp.142-145, 2005-06-30 (Released:2012-08-27)

参考文献数

11

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静脈内鎮静法の施行時に, フルマゼニルの投与直後に血圧上昇, 頻脈および不穏状態をきたした症例を経験した.患者は59歳女性, 体重60kg.2種類の降圧薬を服用している.静脈内鎮静法下で, 下顎デンタルインプラント埋入手術を施行した.手術終了まで良好な鎮静状態で経過した.手術終了後, 鎮静状態からの回復が不十分だったため, フルマゼニルを0.1mgずつ総投与量0.2mgを静脈内投与した.その直後からめまい, 胸部不快症状を訴え, 血圧と脈拍の急激な上昇と一過性の不穏状態をきたした.約30分後には, 不快症状は緩解し, 発症から1時間後には帰宅可能となった.後日, 既往歴の再確認を行った結果, 精神安定薬の服用中であることが判明し, 今回の不快症状はフルマゼニル投与後の一過性の離脱症状と推測された