著者

澁谷 徹 丹羽 均 金 容善 高木 潤 旭 吉直 崎山 清直 市林 良浩 米田 卓平 松浦 英夫

出版者

一般社団法人 日本有病者歯科医療学会

雑誌

有病者歯科医療 (ISSN:09188150)

巻号頁・発行日

vol.6, no.1, pp.21-26, 1997-12-30 (Released:2011-08-11)

参考文献数

12

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大阪大学歯学部附属病院リスク患者総合診療室で管理を行った絞扼反射が強い患者37人について検討を行った。絞扼反射の程度を染矢の分類に従って, 軽症, 中等度, 重症の3つに分類し, 歯科治療時の管理方法と絞扼反射の有無を調べた。軽症2例, 中等度61例, 重症56例, 計119症例の管理を行った。管理内容は, (1) 笑気吸入鎮静法, (2) ジアゼバムまたはミダゾラムによる静脈内鎮静法, (3) 笑気吸入・ミダゾラム静脈内投与併用による鎮静法, (4) 笑気吸入・モルヒネ静脈内投与併用による鎮静法, (5) 笑気吸入・ジアゼパム・モルヒネ静脈内投与併用による鎮静法, (6) 全身麻酔の6種類であった。軽症2例はいずれも笑気吸入鎮静法で歯科治療が可能であった。中等度の症例では, 笑気吸入が最も多く61例中30例 (49%), ジアゼパムまたはミダゾラムの静脈内鎮静法が16例 (26%), 笑気・ミダゾラム併用が2例 (3%), 笑気・モルヒネ併用が10例 (16%) であった。また笑気・ジアゼバム・モルヒネ併用によっても歯科治療が不可能なために全身麻酔を行った症例が1例あり, 笑気・モルヒネ併用で治療は可能であったが, 患者が多数歯の集中的治療を希望したため全身麻酔を行った症例が1例あった。重症の症例はジアゼパムまたはミダゾラムによるものが最も多く56例中32例 (57%) で, 次に笑気が12例 (21%), 笑気・モルヒネ併用が11例 (20%) であった。笑気・モルヒネ併用のうち1例は治療不可能なために全身麻酔によっておこなった。

著者

井上 晶子 谷山 貴一 石田 麻依子 小川 さおり 湯川 譲治 澁谷 徹 INOUE AKIKO TANIYAMA KIICHI ISHIDA MAIKO OGAWA SAORI YUKAWA JOJI SHIBUTANI TOHRU

出版者

松本歯科大学学会

雑誌

松本歯学 = Journal of the Matsumoto Dental University Society (ISSN:21887233)

巻号頁・発行日

vol.43, no.1, pp.10-14, 2016-06-30

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The purpose of this study is to evaluate the rate of incidence and risk factor of postoperative nausea and vomiting (PONV) in patients who underwent orthognathic surgery. The subjects were 84 patients aged 1₅–₅2 years old (3₇ males and 4₇ females) who underwent orthognathic surgery under general anesthesia in Matsumoto Dental University Hospital from January 2011 to October 2016. The operation methods were sagittal split ramus osteotomy (SSRO) 44 cases, SSRO and Le Fort I osteotomy(Le Fort I)28 cases, SSRO, Le Fort I and genioplasty 6 cases, SSRO and genioplasty 4 cases, Le Fort I and anterior maxillary alveolar osteotomy 1 case, and SSRO, Le Fort I and genioplasty with upper and lower alveolar bone osteotomy 1case. Anesthesia was maintained with nitrous oxide or air in oxygen, sevoflurane or desflurane, remifentanil and fentanyl. The factors investigated were age, gender, minimum alveolar concentration hours (MAC hours), use of nitrous oxide, remifentanil dose, anesthesia time and the type of surgery. Statistical investigation was preformed using logistic regression analysis to confirm the significance between the incidence of PONV and follows; age, gender, MAC hours, use of nitrous oxide, remifentanil dose, anesthesia time and the type of surgery. The rate of incidence in nausea was ₇₇%, and that in vomiting was 3₅%. The incidence of nausea was 4.4 times higher in females than males. The incidence of vomiting was 4.6 times higher in cases with nitrous oxide than those without nitrous oxide.

著者

大野 忠男 谷山 貴一 隅田 佐知 芝 規良 澁谷 徹

出版者

松本歯科大学学会

雑誌

松本歯学 (ISSN:03851613)

巻号頁・発行日

vol.39, no.1, pp.12-15, 2013-06-30

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The allergic reactions to drugs are divided into two types ; type I (anaphylactic or fast type) and type IV (delayed type). The anaphylactic type is due to the specific IgE antibody and the reactions occur immediately after the administration of the causal drugs. On the other hand, the delayed type is due to the specific T cell and the reactions are more slowly. We experienced a case who suffered from delayed type allergic reaction twice after dental treatment. At the first time, the patient’s lower firstmolar was extracted under local anesthesia with 3% prilocaine with felypressin and he had acetaminophen for the postoperative pain. At second time, scaling was done under surface anesthesia with COPARON which contains 6% tetracaine hydrochloride. We performed the drug−induced lymphocyte stimulation test ; DLST and the challenge test. It was ascertained from the anamnesis and the results of allergic tests that the causal drugs for the allergic reactions were 3% prilocaine with felypressin and COPARON . 2%lidocaine for surface anesthesia, 2% lidocaine with adrenaline, acetaminophen and cefdinir were safely used.