Language：English   Publishing type：Research paper (scientific journal)  

Remimazolam, an ultra-short-acting benzodiazepine, is a new intravenous anesthetic used for sedation and general anesthesia. Because remimazolam is primarily metabolized by carboxylesterases in the liver and other tissues including the lung and has metabolites with little or no bioactivity, its anesthetic effect is not significantly influenced by renal dysfunction. Therefore, remimazolam may be considered an appropriate agent for hemodialysis patients and may have added benefits beyond midazolam and propofol. Remimazolam has also been suggested to cause less cardiac depression than propofol. This case report presents an 82-year-old female hemodialysis patient with chronic heart failure who underwent partial glossectomy for squamous cell carcinoma of the tongue under general anesthesia with remimazolam and remifentanil. Hemodynamic control was stable during the anesthetic, which was safely completed without any adverse events and resulted in a rapid, clear emergence without flumazenil. Remimazolam and remifentanil may be appropriate as first-line general anesthetic agents for hemodialysis patients with heart failure.

DOI： 10.2344/anpr-70-02-06

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Language：Japanese   Publisher：岡山歯学会  

2012年4月～2022年3月の歯科外来での麻酔管理症例9543例(全身麻酔1062例、鎮静8481例)を対象に、経年的推移を検討した。その結果、全身麻酔は2018年度以降増加傾向で、鎮静は近年は著明な減少を認めた。また、近年のスペシャルニーズ歯科外来(知的能力障害、脳性麻痺、自閉スペクトラム症、注意欠如・多動症などの患者・児対象)での鎮静症例数の割合は減少し全身麻酔の割合が増加していた。

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Structured summary: Rationale: Nasal high-flow (NHF), a new method for respiratory management during procedural sedation, has greater advantages than conventional nasal therapy with oxygen. However, its clinical relevance for patients undergoing oral maxillofacial surgery and/or dental treatment remains uncertain and controversial, due to a paucity of studies. This scoping review compared and evaluated NHF and conventional nasal therapy with oxygen in patients undergoing oral maxillofacial surgery and/or dental treatment. Materials and methods: A literature search of two public electronic databases was conducted, and English writing randomized controlled trials (RCTs) of nasal high flow during dental procedure with sedation reviewed. The primary and secondary outcomes of interest were the incidence of hypoxemia and hypercapnia during sedation and the need for intervention to relieve upper airway obstruction, respectively. Results: The search strategy yielded 7 studies, of which three RCTs met our eligibility criteria, with a total of 78 patients. Compared with conventional nasal therapy with oxygen, NHF significantly reduced the incidence of hypoxemia and hypercapnia during procedural sedation. Conclusion: NHF can maintain oxygenation and possibly prevent hypercapnia in patients undergoing dental treatment. Additional RCTs are needed to clarify and confirm these findings.

DOI： 10.1016/j.jdsr.2022.05.003

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Language：English   Publishing type：Research paper (scientific journal)  

Patients with neurodegenerative diseases are at an increased risk of dysphagia and aspiration pneumonia. In this study, we examined whether ingestion of capsaicin prior to swallowing changes the temporal dynamics of swallowing in such patients. In a crossover, randomized controlled trial, 29 patients with neurodegenerative diseases were given a soluble wafer containing 1.5 μg capsaicin or an identical placebo 20 min prior to testing. For evaluation with video fluoroscopy (VF), patients consumed a barium-containing liquid plus thickening material. The durations of the latency, elevating and recovery periods of the hyoid were assessed from VF. Overall, no significant differences were observed in the duration of each period between capsaicin and placebo treatments. However, reductions in the latency and elevating periods were positively correlated with baseline durations. In subgroup analyses, that correlation was observed in patents with amyotrophic lateral sclerosis (ALS) but not in patients with Parkinson's disease. The consumption of wafer paper containing capsaicin before the intake of food may be effective in patients with dysphagia related with certain neurodegenerative diseases, particularly ALS patients. Further studies will be needed to validate this finding.

DOI： 10.18926/AMO/63412

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Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.joms.2021.06.031

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Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

BACKGROUND: Deep sedation relieves a patient's anxiety and stress during the procedure by inducing patient unconsciousness. However, it remains unclear whether deep sedation actually improves patient satisfaction with the procedure. Therefore, we performed a systematic review and meta-analysis to compare the satisfaction of patients undergoing deep sedation with that of those undergoing light/moderate sedation during non-surgical procedures. METHODS: A comprehensive literature search was performed using electronic databases (search until September 2020). The primary outcome was whether patient satisfaction was higher after deep sedation or light/moderate sedation. The secondary outcome was the relative safety of deep sedation compared with light/moderate sedation in terms of oxygen saturation, systolic blood pressure, and heart rate. The tertiary outcomes were the relative procedure and recovery times for deep versus light/moderate sedation.Data from each of the trials were combined, and calculations were made using DerSimonian and Laird random effects models. The pooled effect estimates for patient satisfaction were evaluated using relative risk (RR) with the 95% confidence interval (CI). The pooled effect estimates for continuous data are expressed as weighted mean difference with the 95% CI. We assessed heterogeneity with the Cochrane Q statistic and the I2 statistic. The risk of bias assessment and Grading of Recommendations Assessment, Development and Evaluation approach were used as the quality assessment method. RESULTS: After removing unrelated studies and applying the exclusion criterion, 5 articles satisfied the inclusion criteria. Patient satisfaction was significantly higher in those who received deep sedation compared with light/moderate sedation (relative risk = 1.12; 95% CI, 1.04-1.20; P = .003; Cochrane Q = 25.0; I2 = 76%).There was no significant difference in oxygen saturation, systolic blood pressure, heart rate, and procedure times according to whether the procedures were performed under deep or light/moderate sedation. However, the recovery time was significantly prolonged in patients under deep sedation. CONCLUSIONS: Our meta-analysis suggests that deep sedation resulted in improved patient satisfaction compared with light/moderate sedation. Deep sedation is recommended for patients undergoing procedures because it improves patient satisfaction. However, respiration and circulation should be carefully monitored both intra-operatively and postoperatively.

DOI： 10.1097/md.0000000000027176

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

PURPOSE: In anesthetic management, it is widely accepted that obese patients are more likely to suffer airway obstructions and reductions in arterial oxygen saturation (SpO2). Therefore, it is important to take special measures to prevent oxygen desaturation during the deep sedation of obese patients. This clinical study examined whether the use of nasal high-flow systems (NHFS) keep higher SpO2 and reduced hypoxemia than conventional nasal cannula during the deep sedation of obese patients with intellectual disabilities for dental treatment. MATERIALS AND METHODS: Eighteen obese patients (body mass index: >25) with intellectual disabilities who underwent dental sedation were enrolled. In each case, sedation was induced using propofol and maintained at a bispectral index of 50 to 70. The subjects were randomly assigned to the control oxygen administration (5 L/min via a nasal cannula) or NHFS (40% O2, 40 L/min, 37 °C) arm in alternate shifts as a crossover trial. The primary endpoint was the minimum SpO2 value, and the incidence of hypoxemia during dental treatment was also evaluated. RESULTS: The mean minimum SpO2 value was significantly higher in the NHFS arm than in the control arm (95.8 ± 2.1 % vs 93.6 ± 4.1 %, P = 0.0052, 95% confidence interval: 0.608-3.947). Hypoxemic episodes (SpO2: ≤94%) occurred 3 cases (16.7%) in the NHFS arm and 11 cases (61.1%) in the control arm (P = 0.0076, odds ratio: 0.127, 95% confidence interval 0.0324 - 0.630). CONCLUSION: NHFS resulted in higher minimum SpO2 and reduced hypoxemia than nasal cannula in obese patients during deep sedation for dental treatment.

DOI： 10.1016/j.joms.2021.04.004

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Dental Society of Anesthesiology  

<p>  Purpose : Articaine hydrochloride is commonly used as a local anesthetic for dentistry in many countries. However, this compound has not been approved for use in Japan. To support the approval of articaine hydrochloride and adrenaline bitartrate (OKAD01) in Japan, we performed a phase Ⅰ clinical trial to clarify the pharmacokinetics and safety of injecting OKAD01 into the oral mucosae of healthy Japanese adults.</p><p>  Methods : The subjects were healthy Japanese male adults. One (1.7 ml) or 3 cartridges (5.1 ml) of OKAD01 were injected into the oral mucosae of 6 subjects each. The blood concentration of articaine was measured before the injection and at 15 min, 30 min, 60 min, 2 h, 4 h, 12 h, and 24 h after the injection. Clinical laboratory tests and vital sign measurements were also performed, and adverse events were evaluated during this clinical trial.</p><p>  Results : In the 1-cartridge trial, the maximum blood concentration (Cmax) and the time taken to reach it (Tmax) were 374.35±97.65 (252.7-514.5) ng/ml and 0.25±0.00 (0.25-0.25) h, respectively (mean±SD (minimum-maximum)). In the 3-cartridge trial, the Cmax and Tmax were 694.00±175.23 (517.9-970.4) ng/ml and 0.42±0.13 (0.25-0.5) h, respectively. Regarding adverse events, we encountered 1 case of headache in the 1-cartridge trial ; however, this event was not thought to be associated with the OKAD01 injection.</p><p>  Conclusion : Injecting OKAD01 into the oral mucosae of healthy Japanese adults resulted in a Cmax of <5.0 μg/ml and did not cause any adverse events. This study demonstrated the safety and tolerability of OKAD01 in the Japanese population.</p>

DOI： 10.24569/jjdsa.49.3_81

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Dental Society of Anesthesiology  

<p>  Patients with intellectual disabilities frequently have concomitant epilepsy requiring medication with multiple antiepileptic drugs. Some previous studies have reported a drug interaction between propofol and antiepileptics. We report an outpatient with a delayed emergence from a general anesthesia with propofol that was attributed to multi-drug therapy for epilepsy.</p><p>  The patient was a 44-year-old man who was scheduled to undergo dental treatment requiring two sessions of ambulatory anesthesia using propofol. His preoperative tests were normal, including a routine blood examination, liver and kidney function, ECG and chest radiograph. He was receiving multiple antiepileptic drugs for the treatment of epilepsy. </p><p>  Anesthesia was induced using propofol, remifentanil, and rocuronium bromide. After the discontinuation of propofol administration, spontaneous eye opening and a response to verbal commands were both delayed, occurring about 1 hour after the first session of general anesthesia and about 1.5 hours after the second session.</p><p>  The patient was not obese, and his perioperative liver and renal functions were normal. Hypothermia and central nervous system (CNS) abnormalities caused by sequela were both ruled out. He had been receiving multiple antiepileptic drugs, so synergistic effects at propofol's site of action in the CNS were suspected as the main cause of the delayed emergence. Furthermore, hypovolemia could have resulted in an elevated blood level of propofol and its delayed metabolism/excretion, delaying the emergence from sedation.</p><p>  We could not identify a clear cause because we did not measure the blood concentrations of the antiepileptics or propofol in the patient. In the presently reported patient, a drug interaction between propofol and antiepileptics was thought to be a possible cause of the delayed emergence from sedation.</p><p></p>

DOI： 10.24569/jjdsa.49.1_1

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：American Dental Society of Anesthesiology (ADSA)  

Perioperative pulmonary aspiration of gastric contents can induce complications of varying severity, including aspiration pneumonitis or pneumonia, which may be lethal. A 34-year-old man with no significant medical history presented to Okayama University Hospital for extraction of the third molars and incisive canal cystectomy under general anesthesia. He experienced pulmonary aspiration of clear stomach fluid during mask ventilation after induction. After aspiration occurred, the patient was immediately intubated, and suctioning was performed through the endotracheal tube (ETT). An anteroposterior (AP) chest radiograph was obtained that demonstrated atelectasis in the left lower lobe, in addition to increased peak airway pressures being noted, although SpO2 remained at 96% to 99% at an FiO2 of 1.0. The decision was made to proceed, and the scheduled procedures were completed in approximately 2 hours. A repeat AP chest radiograph obtained at the end of the operation revealed improvement of the atelectasis, and no residual atelectasis was observed on the next day. Although the patient reported following standard preoperative fasting instructions (no fluids for 2 hours preoperatively), more than 50 mL of clear fluid remained in his stomach. Because vomiting can occur despite following NPO guidelines, the need for continued vigilance by anesthesia providers and proper timely management is reinforced.

DOI： 10.2344/anpr-67-02-03

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Language：English   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)  

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

症例は9歳6ヵ月男児で、乳歯4歯の晩期残存を認めたが、複雑心奇形の合併、最重度の知的障害および身体障害により通法下での抜歯が困難であるため、麻酔管理下での抜歯を目的に当科を紹介され受診した。浸潤麻酔は1/8万アドレナリン含有2%リドカインを生理食塩液で2倍に希釈したものを総量1.2mL投与した。術中に体動が再度出現した際はケタミンを5mgずつ静脈内投与した。スケーリング終了後、酸素投与量を2L/minに減量し、聴診器にて肺音が正常であることを確認した。その25分後、開眼、体動によって覚醒を確認し、心拍数は126回/分、SpO2は87%と術前と変わりないことを確認した後に酸素投与量を1L/minとして退室した。鎮痛指示はカロナール細粒150mgを処方したが、痛がる様子がなかったため内服させなかった。その後も経過良好のため翌日退院となった。

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

17歳女性。開口障害があり、開口量は10mm程度であった。夜間睡眠時に一時的な呼吸停止を認めた既往があり、睡眠時無呼吸の疑いを指摘されていた。開口障害に対して開口量改善および睡眠時無呼吸の改善を目的に下顎骨延長術の実施が検討され、それに先立ち今回、全身麻酔下での筋突起切除術が予定された。麻酔管理上の問題として、骨格異常と小顎による気道確保困難および気管挿管困難が危惧されたが、自発呼吸が残る程度に適度な鎮静を図ったうえで、気管支ファイバースコープを用いて意識下挿管することにより安全な気道管理が行えた。

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Some previous studies have indicated that valproate (VPA) might change the pharmacokinetics and enhance the effects of propofol. We evaluated whether clinical VPA therapy affected the propofol blood level, the protein-unbound free propofol level, and/or the anesthetic effects of propofol in the clinical setting. The subjects were divided into the control group (not medicated with antiepileptics), the mono-VPA group (medicated with VPA alone), and the poly-VPA group (medicated with VPA, other antiepileptics, and/or psychoactive drugs). General anesthesia was induced via the administration of a single bolus of propofol and a remifentanil infusion, and when the bispectral index (BIS) exceeded 60 sevoflurane was started. There were no significant differences in the total blood propofol level at 5, 10, 15, and 20 min or the protein-unbound free propofol level at 5 min after the intravenous administration of propofol between the 3 groups. However, the minimum BIS was significantly lower and the time until the BIS exceeded 60 was significantly longer in the poly-VPA group. In the multivariate regression analysis, belonging to the poly-VPA group was found to be independently associated with the minimum BIS value and the time until the BIS exceeded 60. Clinical VPA therapy did not influence the pharmacokinetics of propofol. However, multi-drug therapy involving VPA might enhance the anesthetic effects of propofol.

DOI： 10.1038/s41598-020-58460-2

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

日本歯科麻酔学会歯科麻酔専門医全員292名と歯科麻酔認定医資格のみ有する歯科麻酔医から無作為に抽出した308名を対象として、2018年8月に電子メールにより深鎮静に対する現状意識に関するアンケート調査を実施した。回答率は40.2%であり、歯科麻酔専門医が154名、歯科麻酔認定医資格のみを有する者が87名であった。所属する施設で深鎮静が行われていた割合は71.4%であった。アメリカ麻酔学会(ASA)の呼びかけや刺激に対する反応から見た鎮静深度区分(「ASA鎮静深度区分」)とRamsay's sedation scaleを融合かつ改変して鎮静深度スコア1〜6を作成し、回答者が考える深鎮静の深度範囲を調査した結果、「ASA鎮静深度区分」で中等度鎮静に属するスコア5-aを「最浅」と選択したものが多く(40.7%)、「最深」と考えるスコアはスコア5-cとスコア6がそれぞれ41.9%、36.1%で拮抗するなど、「最浅」「最深」ともにその範囲の選択は多様であった。

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

歯科麻酔医が勤務する歯科施設を対象に深鎮静管理に関するアンケート調査を行った。その結果、189施設中109施設(57.7%)から回答が得られた。深鎮静の定義に関しては56.9%の施設で共通した定義がなく、また、定義のある施設でも文書化されているのは10.6%であった。実際に深鎮静を行っている施設は76.1%であった。気道管理に関わる偶発症を経験した施設の割合は、重複を含め、喉頭痙攣が12.0%、誤嚥が24.1%、気管挿管やBag-valve-maskによる対応を要した気道閉塞・呼吸抑制が36.1%であった。今回の検討ではスタッフ間で深鎮静に対する共通した認識があるとは限らないことや、意識下鎮静と比べ偶発症のリスクが高い可能性が示唆された。

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BACKGROUND: Recently, attention has been focused on the role of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels in the mechanism of and as a treatment target for neuropathic and inflammatory pain. Ivabradine, a blocker of HCN channels, was demonstrated to have an effect on neuropathic pain in an animal model. Therefore, in the present study, we evaluated the effect of ivabradine on inflammatory pain, and under the hypothesis that ivabradine can directly influence inflammatory responses, we investigated its effect in in vivo and in vitro studies. METHODS: After approval from our institution, we studied male Sprague-Dawley rats aged 8 weeks. Peripheral inflammation was induced by the subcutaneous injection of carrageenan into the hindpaw of rats. The paw-withdrawal threshold (pain threshold) was evaluated by applying mechanical stimulation to the injected site with von Frey filaments. Ivabradine was subcutaneously injected, combined with carrageenan, and its effect on the pain threshold was evaluated. In addition, we evaluated the effects of ivabradine on the accumulation of leukocytes and TNF-alpha expression in the injected area of rats. Furthermore, we investigated the effects of ivabradine on LPS-stimulated production of TNF-alpha in incubated mouse macrophage-like cells. RESULTS: The addition of ivabradine to carrageenan increased the pain threshold lowered by carrageenan injection. Both lamotrigine and forskolin, activators of HCN channels, significantly reversed the inhibitory effect of ivabradine on the pain threshold. Ivabradine inhibited the carrageenan-induced accumulation of leukocytes and TNF-alpha expression in the injected area. Furthermore, ivabradine significantly inhibited LPS-stimulated production of TNF-alpha in the incubated cells. CONCLUSION: The results of the present study demonstrated that locally injected ivabradine is effective against carrageenan-induced inflammatory pain via HCN channels. Its effect was considered to involve not only an action on peripheral nerves but also an anti-inflammatory effect.

DOI： 10.1371/journal.pone.0217209

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

症例は10歳男児で、生後1ヵ月時に中顔面の低形成、多関節拘縮、尿道下裂、小下顎症、体幹が細いことなどから染色体検査を受け、Marshall-Smith症候群の診断を受けた。今回、正中過剰埋伏歯に対して抜歯術が予定された。酸素6L/minを吸入させ、プロポフォール20mgを投与し、引き続き10mg/kg/hで持続的に投与した。気道確保の後、セボフルランを3%の濃度で開始し、徐々に人工呼吸に移行した。その後セボフルラン濃度を5%に変更し、McGRATH MACで愛護的に喉頭展開を試みたところ声帯が確認でき、挿管可能と判断した。術中はプロポフォールとフェンタニルで維持した。手術終了後、自発呼吸の回復および十分な覚醒を確認した後、抜管を行った。抜管に際して、骨折を誘発するような体動および興奮は認めなかった。周術期を通して経皮的動脈血酸素飽和度の低下はみられず、術後も経過良好のため翌日退院となった。

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OBJECTIVE: The aim of this study was to determine the effects of prolonged hyperoxia on salivary glands and salivary secretion in mice. DESIGN: Male C57BL/6 J mice were kept in a 75% oxygen chamber (hyperoxia group) or a 21% oxygen chamber for 5 days. We measured the secretion volume, protein concentration, and amylase activity of saliva after the injection of pilocarpine. In addition, we evaluated the histological changes induced in the submandibular glands using hematoxylin and eosin and Alcian blue staining and assessed apoptotic changes using the TdT-mediated dUTP nick end labeling (TUNEL) assay. We also compared the submandibular gland expression levels of heme oxygenase-1 (HO-1), superoxide dismutase (SOD)-1, and SOD-2 using the real-time polymerase chain reaction. RESULTS: In the hyperoxia group, salivary secretion was significantly inhibited at 5 and 10 min after the injection of pilocarpine, and the total salivary secretion volume was significantly decreased. The salivary protein concentration and amylase activity were also significantly higher in the hyperoxia group. In the histological examinations, enlargement of the mucous acini and the accumulation of mucins were observed in the submandibular region in the hyperoxia group, and the number of TUNEL-positive cells was also significantly increased in the hyperoxia group. Moreover, the expression levels of HO-1, SOD-1, and SOD-2 were significantly higher in the hyperoxia group. CONCLUSION: Our results suggest that hyperoxia reduces salivary secretion, and oxidative stress reactions might be involved in this.

DOI： 10.1016/j.archoralbio.2018.11.001.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s00540-018-2548-y

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1371/journal.pone.0201986

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s00540-018-2540-6

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/jir.12448

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Intravenous sedation is useful for dental treatment in patients with intellectual disabilities. However, it is often necessary to manage such patients with deep sedation because their cooperation cannot be obtained. During deep sedation, undetected hypoventilation can lead to severe complications, such as hypoxia. Recently, capnographic monitoring has been advocated as a useful technique for preventing hypoxia during sedation. This randomized control trial evaluated whether the use of capnography reduces the incidence of hypoxia during the deep sedation of patients for dental treatment. This study involved patients with intellectual disabilities who underwent dental treatment under sedation. The subjects were randomized to the intervention group (I-group) or control group (C-group). All of the patients underwent routine monitoring, as well as bispectral index (BIS) and capnographic monitoring; however, only an independent observer had access to the patients’ capnographic data during the dental procedures. Sedation was maintained at a BIS of 50 to 70 by administration of propofol. In the I-group, the independent observer signaled to the dental anesthesiologist if the capnogram indicated that the patient had been suffering from alveolar hypoventilation or apnea for >15 s. In the C-group, the observer signaled to the dental anesthesiologist if the capnogram indicated that the patient had been suffering from alveolar hypoventilation or apnea for >60 s. In both groups, the dental anesthesiologists responded to the signals using appropriate airway management strategies. The primary endpoint of this study was the incidence of hypoxia during dental treatment, which was defined as oxygen saturation of <95%. Hypoxemic episodes occurred in 13.4% and 34.8% of cases in the I-group and C-group, respectively. The incidence of hypoxia was significantly lower in the I-group. These results suggest that capnographic monitoring during deep sedation for dental treatment prevents hypoxemic episodes by allowing the early detection of hypoventilation. Knowledge Transfer Statement: This is the first randomized controlled trial to examine whether the use of capnography reduces the incidence of hypoxia during deep sedation for dental treatment. The findings of this study can be used by clinicians to aid decision-making regarding dental sedation standards at individual clinics. Moreover, they can be used as high-level evidence during the production or updating of clinical guidelines for dental sedation by leading associations.

DOI： 10.1177/2380084416674670

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BACKGROUND: The extraction of lower wisdom teeth is often performed under general anesthesia in patients with intellectual disabilities. However, the choice of analgesics has not yet been investigated. OBJECTIVE: To analyze the use of analgesics during general anesthesia for extraction including lower wisdom teeth in patients with intellectual disabilities. METHODS: This research is a retrospective observational study. The study population was composed of all patients presenting for extraction of lower wisdom teeth under ambulatory general anesthesia in the clinic of Special Needs Dentistry in Okayama University Hospital from April 2011 to March 2016. The distribution of the combination of analgesics and the relationship between the use of analgesics and the type of extraction were investigated. RESULTS: One hundred and twelve cases were enrolled in this study. Intravenous injections of flurbiprofen, acetaminophen and betamethasone were used in 96 (85.7%), 12 (10.7%) and 26 cases (23.2%), respectively. Flurbiprofen is a non-steroid anti-inflammatory drugs (NSAIDs). Acetaminophen is an old analgesic, but an injection of acetaminophen is new, which was released in 2013 in Japan. And betamethasone is not an analgesic, but a steroid. Betamethasone was used in combination with other analgesics, and was used at a higher dose in a case in which four wisdom teeth were extracted. CONCLUSION: Flurbiprofen was the main analgesic used for extraction of wisdom teeth under general anesthesia in patients with intellectual disabilities. Betamethasone was used to support flurbiprofen or acetaminophen for extractions of multiple wisdom teeth, with the aim of controlling swelling rather than relieving pain.

DOI： 10.2174/1874210601711010181

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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DOI： 10.7554/eLife.19264

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Sedation may minimize physiologic and behavioral stress responses. In our facility, the infusion rate of propofol is adjusted according to the bispectral index (BIS) in all cases of implant-related surgery; multivariate analysis of retrospective data enabled us to extract independent factors that affect the dose of propofol in sedation that are considered useful indicators for achieving adequate sedation. The study population comprised all patients undergoing implant-related surgery under intravenous sedation in Okayama University Hospital from April 2009 to March 2013. The infusion rate of propofol was adjusted to maintain the BIS value at 70-80. The outcome was the average infusion rate of propofol, and potential predictor variables were age, sex, body weight, treatment time, and amount of midazolam. Independent variables that affected the average infusion rate of propofol were extracted with multiple regression analysis. One hundred twenty-five subjects were enrolled. In the multiple regression analysis, female sex was shown to be significantly associated with a higher average infusion rate of propofol. Females may require a higher infusion rate of propofol than males to achieve adequate sedation while undergoing implant-related surgery.

DOI： 10.2344/0003-3006-63.2.67

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本歯科麻酔学会  

症例は40歳男性で、重度の知的障害を有しておりコミュニケーションが不可能であったため、通常の方法では歯科治療のみならず診察も行うことができなかった。半年に1度の頻度で静脈内鎮静法下での定期検診を受けていた。静脈路確保が困難であることから、麻酔前投薬としてジュースにミダゾラムを混ぜて内服させた。入眠後は舌根沈下することが多かったため、入眠直後より経鼻エアウェイを挿入するとともに経鼻カニューラから酸素を投与したが頻繁にSpO2は90〜95%になった。過去の経過を踏まえ、静脈内鎮静法中の低酸素血症を予防するために、経鼻高流量酸素供給システム(Optiflow)を用いることを計画した。歯科処置中は気道確保を容易に行うことができ、気道閉塞および呼吸状態の異常を認めることはなく、経鼻エアウェイを使用する必要もなかった。歯科治療中のSpO2は終始98〜99%で推移した。プロポフォール投与終了後60分で覚醒し、ミダゾラム投与2時間45分後に帰宅した。術後合併症はなかった。

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Japan  

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Other Link： http://search.jamas.or.jp/link/ui/2016344090

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

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PURPOSE: Recently, attention has been paid to dexmedetomidine, a selective α-2 adrenoceptor agonist, as a possible additive for local anesthesia. However, the effect of locally injected dexmedetomidine on the anesthetic action in humans has not fully been clarified. Thus, the purpose of the present study was to evaluate the effect of dexmedetomidine injected into the oral mucosa in combination with lidocaine on local anesthetic potency in humans. MATERIALS AND METHODS: Twenty healthy volunteers were included in the present crossover double-blinded study. Lidocaine solution or lidocaine plus dexmedetomidine solution was submucosally injected into the alveolar mucosa in a crossover and double-blinded manner. The local anesthetic effect of the solutions was evaluated by measuring the current perception threshold (CPT) in the oral mucosa for 120 minutes after injection. Furthermore, the sedation level, blood pressure, and heart rate of the volunteers were evaluated. For statistical analysis, the Wilcoxon signed rank test and 2-way repeated measures analysis of variation were used. RESULTS: The CPT was increased with the 2 solutions and peaked 10 minutes after injection. CPT values 10 and 20 minutes after injection of lidocaine plus dexmedetomidine solution were considerably higher than those with lidocaine solution. The duration of an important increase in the CPT after injection with lidocaine plus dexmedetomidine solution was longer than that with lidocaine. Furthermore, the area under the time curve of CPT was considerably higher with lidocaine plus dexmedetomidine solution than with lidocaine solution. No volunteer showed a change in sedation level, blood pressure, or heart rate after injection with either test solution throughout the experiment. CONCLUSION: The present study showed that a combination of dexmedetomidine plus lidocaine considerably enhances the local anesthetic potency of lidocaine without any major influences on the cardiovascular system when locally injected into the oral mucosa.

DOI： 10.1016/j.joms.2014.09.029

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Purpose : The purpose of this study was to identify independent factors associated with prolonged recovery time after intravenous sedation for dental treatment in patients with intellectual disabilities. Methods : This study was designed as a prospective cohort study. Participants were patients with intellectual disabilities, for whom sedation for dental treatment was planned in Okayama University Hospital. The outcome variable was recovery time. The predictor variables were patient background, antiepileptic and psychotropic drugs, and anesthesia-related variables. Factors affecting the outcome were examined with multiple regression analysis. Results : We enrolled 260 cases in this study. Oral midazolam was a strong independent determinant in prolonged recovery time. Teeth extraction, short treatment time and lower body mass index were significant independent predictors of prolonged recovery time. Conclusion : Oral midazolam is a clear independent determinant of prolonged recovery time after sedation, while psychotropic drugs and antiepileptic drugs were not independent determinants in this study.

DOI： 10.2174/1874210601509010146

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Some patients with intellectual disabilities spend longer than others in emergence from ambulatory general anesthesia for dental treatment. Although antiepileptic drugs and anesthetics might be involved, an independent predictor for delay of the emergence remains unclear. Thus, a purpose of this study is to identify independent factors affecting the delay of emergence from general anesthesia. This was a retrospective cohort study in dental patients with intellectual disabilities. Patients in need of sedative premedication were removed from participants. The outcome was time until emergence from general anesthesia. Stepwise multivariate regression analysis was used to extract independent factors affecting the outcome. Antiepileptic drugs and anesthetic parameters were included as predictor variables. The study included 102 cases. Clobazam, clonazepam, and phenobarbital were shown to be independent determinants of emergence time. Parameters relating to anesthetics, patients' backgrounds, and dental treatment were not independent factors. Delay in emergence time in ambulatory general anesthesia is likely to be related to the antiepileptic drugs of benzodiazepine or barbiturates in patients with intellectual disability.

DOI： 10.2344/0003-3006-62.1.8

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本歯科麻酔学会  

5歳1ヵ月男児。骨形成不全症の亜型のBruck症候群を有し、生下時より十数回の骨折歴があった。診断時からビスフォスホネート製剤のパミドロン酸二ナトリウム水和物を1ヵ月半ごとに静脈内投与した。口腔所見として齲蝕で抜歯・歯肉内療法を要する歯を多数認めた。2回の全身麻酔下歯科治療を行うこととなった。全身麻酔は1回目と2回目ともに同様の方法で行った。周術期を通して経皮的動脈血酸素飽和度、脈拍数の低下はみられず、デクスメデトミジン塩酸塩による呼吸抑制、循環抑制はみられなかった。RASSも抜管後から病棟に帰室するまで、2以下で推移し、興奮した状態は認めず、良好な鎮静状態が得られた。治療当日は入院したが、危惧された骨折もなく、経過良好であったため、翌日退院した。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：岡山歯学会  

大学歯学部の教職員または学生で、研究参加に同意した健康な成人10名を被験者として、知覚痛覚定量分析装置と口腔用ディスポ電極を用い、リドカイン溶液を口腔内に注射した際の電流識別閾値を測定し、局所麻酔時の電流識別閾値を評価できるか検討した。測定値の再現性を確認するため、個体間変動、個体内変動および日内変動を調べた。電流識別閾値の個体間変動、個体内変動、日内変動における変動係数(CV)はほぼ10%未満であった。被験者10名の全てのリドカイン濃度(0%、0.25%、0.5%、1.0%、2.0%)において電流識別閾値の上昇量を算出し、リドカイン濃度別に平均した結果、対象間のばらつきはあるものの、同一対象ではリドカイン濃度が上がるにつれて、電流識別閾値の上昇量も上昇した。知覚痛覚定量分析装置と口腔用ディスポ電極を用いることで、局所麻酔時の電流識別閾値を評価できることが示唆された。

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Language：Japanese   Publisher：岡山歯学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本歯科麻酔学会  

症例は14歳男児で、自閉症、知的障害の既往があった。下顎臼歯部にう蝕を認め、静脈内鎮静下で歯科治療が予定された。11歳時の歯科治療の際に麻酔前投薬としてミダゾラム注射薬をジュースに混ぜて経口投与を試みたが、口を付けた直後に内服を拒否され難渋したことがあったため、麻酔前投与としてデクスメデトミジン塩酸塩をジュースに混ぜて内服させ、傾眠傾向となって酸素マスクを当てセボフルラン、酸素を吸入させた。意識消失後に静脈路を確保し、プロポフォールによる静脈内鎮静法を行った。術中に循環動態の変化はなく、処置終了と同時にプロポフォール投与を停止し、6分後に覚醒した。覚醒60分後、ふらつかずに歩行可能を確認して帰宅を許可した。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Okayama University Medical School  

DOI： 10.18926/AMO/52895

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Other Link： http://search.jamas.or.jp/link/ui/2015229713

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Adrenaline (epinephrine) is included in dental local anesthesia for the purpose of vasoconstriction. In Japan, adrenaline is contraindicated for use in patients receiving antipsychotic therapy, because the combination of adrenaline and an antipsychotic is considered to cause severe hypotension; however, there is insufficient evidence supporting this claim. The purpose of the present study was to clarify the changes in hemodynamics caused by drug interaction between adrenaline and an antipsychotic and to evaluate the safety of the combined use of adrenaline and an antipsychotic in an animal study. Male Sprague-Dawley rats were anesthetized with sodium pentobarbital. A catheter was inserted into the femoral artery to measure blood pressure and pulse rate. Rats were pretreated by intraperitoneal injection of chlorpromazine or chlorpromazine and propranolol, and after 20 minutes, saline or 1 of 3 different doses of adrenaline was administered by intraperitoneal injection. Changes in the ratio of mean arterial blood pressure and pulse rate were measured after the injection of adrenaline. Significant hypotension and tachycardia were observed after the injection of adrenaline in the chlorpromazine-pretreated rats. These effects were in a dose-dependent manner, and 100 μg/kg adrenaline induced significant hemodynamic changes. Furthermore, in the chlorpromazine and propranolol-pretreated rats, modest hypertension was induced by adrenaline, but hypotension and tachycardia were not significantly shown. Hypotension was caused by a drug interaction between adrenaline and chlorpromazine through the activation of the β-adrenergic receptor and showed a dose-dependent effect. Low-dose adrenaline similar to what might be used in human dental treatment did not result in a significant homodynamic change.

DOI： 10.2344/0003-3006-61.4.150

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本歯科麻酔学会  

76歳男。口腔底の腫脹を主訴に受診した。左側口腔底癌の診断で、腫瘍切除術、下顎骨辺縁切除術および左側頸部郭清術を予定した。深部静脈血詮症を発症し、IVCフィルターが留置され、ワルファリンカリウム、アスピリンを服用していた。手術前から抗腫瘍薬TS-1の内服を開始したが、血小板数減少により1週間後に中止した。麻酔導入前から逐次型空気圧式マッサージ器を用いて間欠的空気圧迫法を行った。手術翌日にヘパリンの持続静脈内投与を再開した。顔面および頸部の腫脹が増加し、ヘパリンの投与を中止した。術後3日目には顔面および頸部の腫脹は改善傾向となった。術後4日目にヘパリンの投与を再開したが、口腔内創部より出血を認め、再度中止した。術後5日目にヘパリンの投与を再開し、出血、顔面および頸部の腫脹の増強は認めなかったため、ワルファリンカリウムの投与を追加した。術後経過のなかで呼吸・循環動態における問題は生じなかった。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本歯科麻酔学会  

症例1は17歳男で、粘膜下口蓋裂および閉塞性睡眠時無呼吸症候群を合併し、下顎骨形成術を予定した。マッキントッシュ型喉頭鏡、ビデオ喉頭鏡で気管挿管を試みたが挿管できなかった。ビデオ咽頭鏡で気管チューブの位置を確認しながら気管支ファイバースコープを気管チューブの中に通して、気管支ファイバースコープをガイドとして気管挿管を行った。症例2は14歳女で、副耳、左側上肢先天性奇形、左側眼球白色病変を合併し、下顎骨形成術を予定した。マッキントッシュ型喉頭鏡、ビデオ喉頭鏡で気管挿管を試みたが挿管できなかった。気管支ファイバースコープを用いて試みても困難であったが、複数回試みた後に気管挿管できた。症例3は17歳男で、知的障害、心雑音、漏斗胸、口蓋裂、両外耳道閉塞を合併し、上顎骨形成術を予定した。マッキントッシュ型喉頭鏡は挿管困難であった。ビデオ喉頭鏡を用いて気管挿管できた。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本歯科麻酔学会  

37歳女。前歯部審美修復を希望し、歯科治療恐怖症のためドルミカムおよびプロポフォール静脈内鎮静法下で歯科治療を計画した。計11回の静脈内鎮静法を施行し、歯科用タービン音などの聴覚刺激が加わらない治療では1.25mg/hg/hで良好な鎮静効果が得られたが、聴覚刺激が加わる治療では強い拒否反応を示し、プロポフォール投与量を3.12mg/kg/hまで増加しても緩和されなかった。耳栓装着では2.78gm/kg/hで効果がみられなかったため、ノイズキャンセリングヘッドフォンを装着してクラシック音楽を流し、ヘッドフォンに付随したマイクで主治医および歯科麻酔医の指示を必要時のみ聞こえるようにした結果、2.48mg/kg/hで歯科用タービンを用いた治療を予定通り行うことが可能であり、術後の患者の満足度も高かった。

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BACKGROUND:: Dexmedetomidine, a highly selective agonist of α2-adrenoceptors, is a commonly used sedative; however, a potent anti-inflammatory effect has also been found. In the present study we evaluated the inhibitory effect of locally injected dexmedetomidine on inflammatory responses in the injected region. METHODS:: Local inflammation was induced in the hindpaws of male mice (aged 6-8 weeks) by intraplantar injection of lambda-carrageenin. To offset the central effect of tested agents, different agents were blindly injected into the left and right paws in the pairs of comparison. The effect of dexmedetomidine on edema (increase in paw volume), the accumulation of leukocytes, and production of tumor necrosis factor-α (TNF-α) and cyclooxygenase-2 (COX-2) were evaluated after carrageenin injection, using water displacement plethysmometry, histological imaging, immunohistochemistry, and Western blotting analysis. Furthermore, we also evaluated the effect of yohimbine, a full antagonist of α2-adrenoceptors, and phenylephrine, an agonist of the α1-adrenoceptor, on dexmedetomidine's action on inflammatory responses. RESULTS:: Paw volume and amount of leukocytes in the injected region significantly increased after the injection of carrageenin. Similarly, TNF-α and COX-2 production was found in the subcutaneous region injected with carrageenin, 4 hours after injection. Dexmedetomidine significantly inhibited all increases in paw volume, leukocytes, and production of TNF-α and COX-2. Furthermore, yohimbine significantly antagonized the anti-inflammatory effects of dexmedetomidine, whereas phenylephrine did not significantly alter them. CONCLUSIONS:: The findings suggest that locally injected dexmedetomidine exhibits an anti-inflammatory effect against local acute inflammatory responses, mediated by α2-adrenoceptors. © 2013 International Anesthesia Research Society.

DOI： 10.1213/ANE.0000000000000060

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PURPOSE: Some patients with intellectual disabilities (IDs) who undergo total intravenous anesthesia (TIVA) have complications associated with the anesthesia such as prolonged recovery. The purposes of this study were to estimate the frequency of TIVA complications among patients with IDs and to identify factors associated with TIVA complications. MATERIALS AND METHODS: This study was designed as a retrospective cohort study. Study samples were selected from the clinical records of patients with IDs who underwent ambulatory general anesthesia in a special dental clinic at the Okayama University Hospital, Okayama, Japan. Predictor variables were patient background, anesthesia-related variables, and dental treatment. Outcome variables were delayed recovery and the complication of agitation. Factors affecting delayed recovery and complications were examined with multivariable analysis. RESULTS: We enrolled 106 cases (81 male and 25 female patients) in this study. The mean age was 23.9 years. Serious complications were not observed in any cases. The amount of intravenous midazolam was an independent determinant of delayed recovery. Oral midazolam contributed to delayed recovery, although it is very useful for induction in patients with a high level of fear. Oral midazolam and a younger age were independent predictors of agitation. CONCLUSIONS: Intravenous midazolam may not have an advantage in ambulatory general anesthesia. Oral midazolam contributes to delayed recovery and is an independent predictor of agitation.

DOI： 10.1016/j.joms.2012.01.004

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DOI： 10.1016/j.joms.2009.09.083

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DOI： 10.1016/j.joms.2009.09.083

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Language：English   Publisher：SPRINGER TOKYO  

DOI： 10.1007/s00540-009-0827-3

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Our aim was to find out the optimal dose of oral midazolam to sedate children according to age. Thirty-five patients aged 10 or under who had minor oral operations under sedation with midazolam were enrolled. Correlations between age (X) and dose of midazolam (mg/kg; Y) were analysed by Pearson's correlation coefficient, and relations were fitted by simple regression. Doses of midazolam were significantly reduced as age increased (Y = 0.969 - 0.04X; R = 0.48) in the satisfactory group (n = 25), whereas those in the overdose group (n = 10) (patients who vomited, became agitated, or took some time to come round) were significantly higher, decreased with age, and showed a better correlation coefficient (Y = 1.375 - 0.65X; R = 0.78). These findings suggest that both the requirement and threshold of midazolam decreases with age. © 2007 The British Association of Oral and Maxillofacial Surgeons.

DOI： 10.1016/j.bjoms.2007.07.203

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Delirium occurs in 23% of sepsis patients, in which pro-inflammatory cytokines and nitric oxide are suggested to be involved. However, in animal experiments, even a subseptic dose of lipopolysaccharide (LPS) injection induces both pro-inflammatory cytokines and inducible nitric oxide synthase in the brain, suggesting that the brain oxidative reaction can be induced in the subseptic condition. Then, we evaluated the changes of heme oxygenase-1 (HO-1), a sensitive oxidative marker, as well as interleukin (IL)-1β, IL-6, and inductible nitric oxide synthase (iNOS) mRNA in the hypothalamus and hippocampus of rats using real-time PCR after peripheral injection of LPS (2.0 mg/kg). As a result, these four kinds of mRNAs were induced significantly in both areas after LPS injection. These results suggest that peripheral inflammation induces an oxidative reaction in the brain, even if the inflammation is not lethal. It is also considered that several pathways are involved in brain HO-1 induction. © 2008 Maeda et al, publisher and licensee Dove Medical Press Ltd.

DOI： 10.2147/ndt.s3063

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

口腔外科の術後鎮静における、塩酸デクスメデトミジンとプロポフォールの健忘効果と苦痛緩和への効果を検討するため、術後鎮静を行った患者を対象に行われているアンケート調査票を分析した。無作為に抽出した患者30名を対象とし、塩酸デクスメデトミジンで鎮静を行った群(D群)とプロポフォールで鎮静を行った群(P群)に分け、アンケートの設問の、1)挿管中の記憶、2)抜管時の記憶、3)苦痛の程度の3項目について検討した。挿管中および抜管時の健忘効果は、いずれもD群と比較してP群で有意に強く認められた。苦痛の程度は、D群と比較してP群で有意に緩和されていた。健忘効果と苦痛緩和の関係については、有意な関係が認められ、健忘効果があるほうが苦痛は緩和されていた。塩酸デクスメデトミジンとプロポフォールを用いた口腔外科における術後鎮静において、健忘効果と苦痛緩和について比較検討したところ、塩酸デクスメデトミジンのほうが健忘効果は乏しく、患者の苦痛緩和は乏しいことが示唆された。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J01093&link_issn=&doc_id=20070420240009&doc_link_id=%2Feq9shika%2F2007%2F003502%2F009%2F0197-0201%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feq9shika%2F2007%2F003502%2F009%2F0197-0201%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Language：Japanese  

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Language：Japanese   Publisher：岡山歯学会  

Bispectral Index(BIS)およびTarget Controlled Infusion(TCI)を応用した新しい精密鎮静法を知的障害者歯科治療において試みた。ミダゾラムとプロポフォールの併用による静脈内鎮静法下での歯科治療を予定した3例を対象とした。処置内容等によりBIS値が変動したため、一定のBIS値を持続的に維持することは難しかったが、BIS値により浅鎮静および深鎮静を早期に予測することが可能であった。さらにTCIシステムを用いることにより、速やかに鎮静度を調節することができたため、至適鎮静度の維持は極めて容易であった。術中の合併症は、各症例で時折舌根沈下をみとめたがSpO2の低下は軽度で、下顎挙上にて対応可能であり、経鼻エアウェイ等が必要であった症例はなかった。また、術後合併症を認めたものはなく、全例が当日に帰宅可能であった。

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

自院における1999年4月から2004年3月までに行われた待機手術145例を対象に,手術室における同種輸血準備量,輸血実施状況,出血量およびcrossmatch-to-transfusion ratio(C/T比)を術式ごとに分類し,検討した.輸血実施率およびC/T比はType & Screen導入後は,導入前に比べて有意に少なく,いずれの時期でも出血量は術式に関係なく平均500ml以下であり,Type & Screenで問題なく対応できると思われた

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Publishing type：Research paper (scientific journal)  

In order to use transfusion blood effectively, maximum surgical blood order schedule (MSBOS) and Type and Screen (T & S) have been recommended. At Okayama University Dental Hospital, each responsible physician decided the blood preparation. A goal of this study was to analyze data related to transfusion during operation in Okayama University Dental Hospital, and compare it with the guidelines issued by the Ministry of Health, Labour and Welfare. Surgeries were divided into 6 categories: Tumorectomy, Tumorectomy and Neck dissection (ND), Radical and immediate reconstruction, Reconstruction, Benign tumorectomy, and Others. The cases were 145 cases operated from April 1, 1999 to March 31, 2004. Since Type and Screen (T & S) were introduced in the hospital in the middle of this period, the data were segregated by the introduction of the T & S. A transfusion ratio (percentage of transfusion per preparation) and ratio of cross-match to transfusion (C/T ratio) were calculated and compared with the guideline. Blood loss rate (> 600ml) was also figured out in each surgical category. Before the introduction of the T & S, in the "Radical and immediate reconstruction" category, transfusion ratio (percentage of transfusion per preparation) and ratio of cross-match and transfusion (C/T ratio) were 35.5% and 6.6, respectively. In the "Tumorectomy" category, the transfusion ratio and C/T ratio were 13.3% and 6.0, respectively. In the "Tumorectomy and ND" category the transfusion ratio and the C/T ratio were 7.9% and 24.9, respectively (Table 1, Fig. 2). In the "Radical and immediate reconstruction" category, much blood loss in occurred in 42% (Fig. 3) of the cases. Since the ideal value of the C/T ratio is 1.5 according to the guidelines, an amount of blood preparation before the introduction of the T & S was considered excessive in our facility (Fig. 1, 2). After the introduction of the T & S, all of the surgeries could be managed with the T & S (Table 2). However, in the "Radical and reconstruction" category, blood preparation should be considered for each case because of higher rate of large blood loss. Due to the introduction of the T & S, it became unnecessary to take the blood from the transfusion unit to an operation unit only for preparation. Thus, risks related to handling and transfer of blood can be reduced.

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DOI： 10.1111/j.1365-2788.2004.00598.x

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DOI： 10.1111/j.0001-5172.2004.0320a.x

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PubMed

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Language：English  

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Responsible for pages：1699-1705   Book type：Scholarly book

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Total pages：v, 167p   Language：Japanese

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J-GLOBAL

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J-GLOBAL

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Language：Japanese  

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Language：Japanese  

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Language：Japanese  

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Language：Japanese  

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Language：Japanese   Publisher：(一社)日本障害者歯科学会  

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

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

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Event date： 2023.10.6 - 2023.10.8

Language：English   Presentation type：Poster presentation  

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Event date： 2023.1.26 - 2023.1.27

Language：Japanese   Presentation type：Oral presentation (invited, special)  

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Event date： 2022.11.4 - 2022.11.6

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2022.10.27 - 2022.10.29

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2022.10.27 - 2022.10.29

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2022.10.27 - 2022.10.29

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2022.10.27 - 2022.10.29

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2022.6.20 - 2022.6.25

Language：English   Presentation type：Oral presentation (general)  

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Event date： 2021.10.9 - 2021.11.7

Presentation type：Symposium, workshop panel (nominated)  

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Event date： 2021.10.9 - 2021.11.7

Presentation type：Poster presentation  

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Event date： 2021.10.9 - 2021.11.7

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Event date： 2021.7.21 - 2021.7.25

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Event date： 2020.10.10 - 2020.11.10

Language：Japanese   Presentation type：Oral presentation (invited, special)  

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Event date： 2019.10.25 - 2019.10.27

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

Venue：岡山  

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Event date： 2019.6.1 - 2019.6.3

Language：English   Presentation type：Oral presentation (general)  

Venue：Vienna, Austria  

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Event date： 2018.10.5 - 2018.10.7

Language：English   Presentation type：Symposium, workshop panel (nominated)  

Venue：奈良  

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Event date： 2017.3.22 - 2017.3.25

Language：English   Presentation type：Poster presentation  

Venue：Moscone West Building, San Francisco, Calif, USA  

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Event date： 2017.3.22 - 2017.3.25

Language：English   Presentation type：Oral presentation (general)  

Venue：Moscone West Building, San Francisco, Calif, USA  

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Event date： 2016.6.22 - 2016.6.25

Language：English   Presentation type：Poster presentation  

Venue：COEX, Seoul, Republic of Korea  

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Event date： 2016.6.22 - 2016.6.25

Language：English   Presentation type：Oral presentation (general)  

Venue：COEX, Seoul, Republic of Korea  

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Event date： 2015.10.31 - 2015.11.1

Language：Japanese   Presentation type：Poster presentation  

Venue：学術総合センター（東京都）  

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Event date： 2015.10.31 - 2015.11.1

Language：Japanese   Presentation type：Poster presentation  

Venue：学術総合センター（東京都）  

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Event date： 2015.10.31 - 2015.11.1

Language：Japanese   Presentation type：Poster presentation  

Venue：学術総合センター（東京都）  

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Event date： 2015.10.31 - 2015.11.1

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：学術総合センター（東京都）  

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Event date： 2015.10.31 - 2015.11.1

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：学術総合センター（東京都）  

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Event date： 2015.10.31 - 2015.11.1

Language：Japanese   Presentation type：Poster presentation  

Venue：学術総合センター（東京都）  

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Event date： 2015.10.31 - 2015.11.1

Language：Japanese   Presentation type：Poster presentation  

Venue：学術総合センター（東京都）  

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Event date： 2015.6.28

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山大学病院歯学部棟４階 第一講義室 （岡山市）  

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Event date： 2015.6.28

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山大学病院歯学部棟４階 第一講義室 （岡山市）  

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Event date： 2015.6.28

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：岡山大学病院歯学部棟４階 第一講義室 （岡山市）  

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Event date： 2015.3.11 - 2015.3.14

Language：English   Presentation type：Poster presentation  

Venue：Boston, MA, USA  

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Event date： 2015.3.11 - 2015.3.14

Language：English   Presentation type：Poster presentation  

Venue：Boston, MA, USA  

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Event date： 2015.3.11 - 2015.3.14

Language：English   Presentation type：Oral presentation (general)  

Venue：Boston, MA, USA  

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Event date： 2015.3.11 - 2015.3.14

Language：English   Presentation type：Poster presentation  

Venue：Boston, MA, USA  

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Event date： 2015.3.11 - 2015.3.14

Language：English   Presentation type：Poster presentation  

Venue：Boston, MA, USA  

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Event date： 2014.11.15 - 2014.11.19

Language：English   Presentation type：Poster presentation  

Venue：Washington, D.C, USA  

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Event date： 2014.10.26

Presentation type：Oral presentation (general)  

Venue：岡山大学歯学部４階  

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Event date： 2014.10.11 - 2014.10.12

Language：Japanese   Presentation type：Poster presentation  

Venue：日本歯科大学新潟生命歯学部（新潟市）  

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Event date： 2014.10.11 - 2014.10.12

Language：Japanese   Presentation type：Poster presentation  

Venue：日本歯科大学新潟生命歯学部（新潟市）  

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Event date： 2014.10.11 - 2014.10.12

Language：Japanese   Presentation type：Poster presentation  

Venue：日本歯科大学新潟生命歯学部（新潟市）  

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Event date： 2014.10.11 - 2014.10.12

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：日本歯科大学新潟生命歯学部（新潟市）  

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Event date： 2014.10.11 - 2014.10.12

Language：Japanese   Presentation type：Poster presentation  

Venue：日本歯科大学新潟生命歯学部（新潟市）  

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Event date： 2014.7.21

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：徳島大学病院西病棟11階 日亜メディカルホール  

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Event date： 2014.7.21

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：徳島大学病院西病棟11階 日亜メディカルホール  

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Event date： 2014.7.21

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：徳島大学病院西病棟11階 日亜メディカルホール  

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Event date： 2014.6.25 - 2014.6.28

Language：English   Presentation type：Poster presentation  

Venue：Cape Town, South Africa  

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Event date： 2007.11.24 - 2007.11.25

Presentation type：Poster presentation  

Venue：長崎  

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Event date： 2007.11.3 - 2007.11.7

Presentation type：Poster presentation  

Venue：San Diego, California  

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Event date： 2007.10.13 - 2007.10.17

Presentation type：Poster presentation  

Venue：San Francisco, California  

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Event date： 2007.10.4 - 2007.10.5

Presentation type：Poster presentation  

Venue：北九州  

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Presentation type：Poster presentation  

Venue：北九州  

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Event date： 2007.10.4 - 2007.10.5

Presentation type：Poster presentation  

Venue：北九州  

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Event date： 2007.7.7

Venue：広島  

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Event date： 2007.7.7

Venue：広島  

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Event date： 2006.11.12

Venue：岡山  

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Event date： 2006.10.20 - 2006.10.21

Venue：仙台  

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Event date： 2006.10.14 - 2006.10.18

Venue：Atlanta, Georgia  

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Event date： 2006.10.6 - 2006.10.7

Venue：横浜  

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Venue：横浜  

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Event date： 2006.10.4 - 2006.10.7

Venue：Yokohama, Japan  

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Event date： 2006.10.4 - 2006.10.7

Venue：Yokohama, Japan  

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Event date： 2006.7.29

Venue：岡山  

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Event date： 2006.7.29

Venue：岡山  

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Event date： 2005.11.12 - 2005.11.16

Venue：Washington, D.C.  

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Event date： 2005.10.27 - 2005.10.28

Venue：鹿児島  

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Event date： 2005.10.15 - 2005.10.16

Venue：山梨  

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Event date： 2005.7.23

Venue：徳島  

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Event date： 2004.10.1 - 2004.10.2

Venue：東京  

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Event date： 2004.10.1 - 2004.10.2

Venue：東京  

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Event date： 2004.7.17

Venue：広島  

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Event date： 2003.11.9

Venue：福山  

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Event date： 2003.9.20 - 2003.9.21

Venue：岡山  

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Event date： 2003.9.20 - 2003.9.21

Venue：岡山  

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Event date： 2003.3.21 - 2003.3.25

Venue：New Orleans, Louisiana  

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Event date： 2002.11.2 - 2002.11.7

Venue：Orlando-Florida  

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Event date： 2002.11.2 - 2002.11.7

Venue：Orlando-Florida  

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Event date： 2002.10.4 - 2002.10.5

Venue：東京  

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Event date： 2002.9.20 - 2002.9.21

Venue：東京  

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Event date： 2002.9.20 - 2002.9.21

Venue：東京  

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Event date： 2002.6.29

Venue：徳島  

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Event date： 2002.6.29

Venue：徳島  

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Event date： 2002.3.28 - 2002.3.30

Venue：広島  

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Event date： 2001.11.10 - 2001.11.15

Venue：San Diego  

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Event date： 2001.9.20 - 2001.9.21

Venue：大宮  

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Event date： 2001.8.4

Venue：広島  

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Event date： 2000.10.29

Venue：岡山  

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Event date： 2000.10.1

Venue：大阪  

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Event date： 2000.9.4 - 2000.9.6

Venue：横浜  

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Event date： 1999.10.17

Venue：岡山  

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Event date： 1999.10.17

Venue：岡山  

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Event date： 1999.10.7 - 1999.10.8

Venue：東京  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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