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

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
川添 由貴 横江 千寿子 林 正祐 井上 美香 前川 博治 竺 珊 丹羽 均
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.4, pp.135-137, 2020-10-15 (Released:2020-10-15)
参考文献数
6

A bronchial fiberscope (BFS) is an endotracheal intubation device for obtaining a clear view of various intubation devices in difficult intubation situations. However, intubation can still be difficult even if a BFS is used, and various additional intubation aids may be required. We report a patient with cervical kyphosis in whom the insertion of a BFS into the trachea was difficult despite a clear view of the glottis.  A 24-year-old man with autism, mental retardation, and severe head anteflexion resulting from cervical kyphosis was scheduled to undergo dental treatment under general anesthesia. During tracheal intubation, the patient’s glottis could not be visualized using either a GrideScope® or a McGRATHTM because of a narrow oral cavity caused by trismus and impaired anterior sliding of the mandibles. We used a BFS and obtained a clear view of the glottis but were unable to advance the tip of the BFS to the glottis because of the large distance between the glottis and the BFS tip. We then used a Deschamps needle inserted into the oral cavity to change the direction of the intubation tube and succeeded in achieving tracheal intubation. Deschamps needles are instruments that were originally used in ophthalmic surgery. We believe that Deschamps needles could be useful instruments during intubation, especially in cases with narrow oral cavities.
著者
藤澤 俊明 水田 健太郎 望月 亮 松村 朋香 立浪 康晴 杉村 光隆
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.50, no.2, pp.52-65, 2022-04-15 (Released:2022-04-15)
参考文献数
9

【要約】 本邦の歯科医院における全身的合併症発症時の院内救急体制の整備状況と実態を明らかにするため,全国の郡市区歯科医師会および歯科医院を対象にアンケート調査を行った.歯科医院および回答した歯科医師会は392団体(回収率51.2%),歯科医院は392施設(回収率25.5%)であった.救急薬剤を配布している歯科医師会は48.5%,歯科医院における救急薬剤の常備率は74.5%であり,歯科医師会による配布薬剤,歯科医院における常備薬剤ともアドレナリン,アトロピン,ニトログリセリンが多かった.救急薬剤を投与した経験のある歯科医院の割合は5.6%であった.また,医療用酸素,生体情報モニタ,AEDの配備率はそれぞれ82.7%,66.3%,71.5%であった.「救急薬剤を配布している」と回答した歯科医師会190団体のうち,救急薬剤投与法の講習/研修会を開催していた歯科医師会は75.8%であった.また,過去5年間に緊急時対応・救急蘇生法の講習/研修会を開催していた歯科医師会は68.9%を占めた.歯科診療においては,生命に関わる重篤な全身的合併症を予防することはもちろん,その発症時に適切に対応するには,救急薬剤および器材を常備し,研修を怠らないことが医学的および倫理的見地から重要である.歯科医師が現実的に使用可能な救急薬剤の選定とその適正使用についての卒前・卒後教育の充実が今後の課題であると考えられた.
著者
樋口 仁 若杉 優花 川瀬 明子 前田 茂 宮脇 卓也
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.49, no.3, pp.81-96, 2021-07-15 (Released:2021-07-15)
参考文献数
19

【要約】 緒言 : アーティカイン塩酸塩 (アルチカイン塩酸塩) は, 歯科治療に際して世界的に広く使用されているアミド型の局所麻酔薬であるが, 現在日本では薬事承認を受けていない. そこで本邦での歯科用アルチカイン製剤 (OKAD01) の導入を目指し, OKAD01を日本人の口腔粘膜下に投与した際の安全性および血中薬物動態を検討するため, 日本人を対象としたOKAD01の第Ⅰ相試験を行った. 方法 : 健康な日本人成人男性を対象とした. OKAD01 1カートリッジ (1.7ml) および3カートリッジ (5.1ml) を口腔粘膜下にそれぞれ6名ずつに投与した. OKAD01投与前, 投与終了15, 30, 60分後, および2, 4, 12, 24時間後の血漿中アルチカイン濃度の測定を行った. またOKAD01投与前, 投与後に臨床検査, バイタルサインなどの測定を行い, OKAD01投与による有害事象を検討した. 結果 : 1カートリッジ群の薬物動態パラメータ値 [平均値±標準偏差 (最小値-最大値)] は, 最高血中薬物濃度 (Cmax) が374.35±97.65 (252.7-514.5) ng/ml, 最高血中薬物濃度到達時間 (Tmax) が0.25±0.00 (0.25-0.25) hであった. また3カートリッジ群では, Cmaxが694.00±175.23 (517.9-970.4) ng/ml, Tmaxが0.42±0.13 (0.25-0.5) hであった. 有害事象は1カートリッジ群に 「頭痛」 が1件認められたが, OKAD01との因果関係はなしと判断された. 結論 : OKAD01を日本人の口腔粘膜に投与した際のCmaxは, 本治験の安全域とした5.0 μg/ml未満であることが確認された. また, OKAD01に関連した有害事象は認められず, OKAD01は, 20歳以上の健常日本人男性に対して忍容性が認められ, 安全性に問題はないと考えられた.
著者
佐藤 會士
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.50, no.1, pp.19-26, 2022-01-15 (Released:2022-01-15)
参考文献数
10
著者
坂井 洵子 大島 優 衛藤 希 山中 仁 守永 沙織 塚本 真規 佐藤 泰司 横山 武志
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.69-71, 2020-04-15 (Released:2020-04-15)
参考文献数
13

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.
著者
岸本 敏幸 中西 康典 小杉 謙介 後藤 隆志 玄 景華 櫻井 学
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.46, no.1, pp.34-36, 2018 (Released:2018-01-15)
参考文献数
12

Dissociative identity disorder (DID) is characterized by the existence of two or more separate and distinct personalities on an ongoing basis. Although the incidence of DID has been increasing in Japan, dental treatments for such patients remain rare. Here, we report our experience providing general anesthesia to a patient with DID and generalized anxiety disorder.  A 30s woman had been diagnosed as having DID at the age of 24 years, and her condition was being managed with medication. Although more than nine personalities had appeared as of the presently reported treatment, her original personality had not appeared for several years. She had numerous dental caries and an extreme fear of dental treatments. Therefore, we planned to perform dental treatments under general anesthesia.  Anesthesia was maintained with 3.0 μg/ml of propofol and 0.05-0.1 μg/kg/min of remifentanil hydrochloride. Since DID patients can respond to anesthetics differently than healthy adults, we used a BIS monitor to ascertain the depth of the anesthesia. Furthermore, the dentists, nurses, and other staff members shared information during the perioperative period. As a result, while changes in the patient’s personality were observed, no serious mental disturbances occurred.