研究者詳細 - 宮脇　卓也

論文 - 宮脇　卓也

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プロポフォールによる日帰り全身麻酔において覚醒遅延がみられた抗てんかん薬多剤併用療法患者の1例査読

若杉優花, 川瀬明子, 宇治田仁美, 濱岡緑, 樋口仁, 前田茂, 宮脇卓也

日本歯科麻酔学会雑誌 49 ( 1 ) 1 - 3 2021年1月

担当区分：最終著者記述言語：日本語出版者・発行元：(一社)日本歯科麻酔学会

症例は44歳男性で、既往歴に知的障害およびてんかんがあった。多数歯う蝕を認めたが、歯科治療に非協力的であるため2回の日帰り全身麻酔下での歯科治療が予定された。常用薬はゾニサミド、レベチラセタム、ペランパネル水和物、ハロペリドールであった。第1回目の治療では、術中はプロポフォールTCI 2.0〜2.5μg/mL、レミフェンタニル塩酸塩0.15μg/kg/minで維持し、BIS値は37〜56程度で経過した。抜管直前のプロポフォールの推定効果部位濃度は0.99μg/mL、BIS値は61であったが、覚醒反応は認めなかった。プロポフォール停止1時間後に覚醒反応を認めた。第2回目の治療では、術中はプロポフォールTCI 2.0〜2.3μg/mL、レミフェンタニル塩酸塩0.1μg/kg/minで維持し、BIS値は33〜53程度で経過した。プロポフォール停止後90分経過後に覚醒反応を認め、前回よりさらに覚醒が遅延したため、1泊入院を提案したが適応できず退院となった。

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01093&link_issn=&doc_id=20210331260001&doc_link_id=%2Feq9shika%2F2021%2F004901%2F001%2F0001-0003%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feq9shika%2F2021%2F004901%2F001%2F0001-0003%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Pulmonary Aspiration During Induction of General Anesthesia. 査読国際誌

Reina Hayashi, Shigeru Maeda, Taninishi Hideki, Hitoshi Higuchi, Takuya Miyawaki

Anesthesia progress 67 ( 4 ) 214 - 218 2020年12月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

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

知的障害を伴ったGlenn術後患者の静脈内鎮静法の経験査読

宇治田仁美, 若杉優花, 中納麻衣, 西岡由紀子, 樋口仁, 前田茂, 宮脇卓也

日本歯科麻酔学会雑誌 48 ( 4 ) 138 - 140 2020年10月

担当区分：最終著者記述言語：日本語出版者・発行元：(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。

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01093&link_issn=&doc_id=20201021380004&doc_link_id=%2Feq9shika%2F2020%2F004804%2F004%2F0138-0140%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feq9shika%2F2020%2F004804%2F004%2F0138-0140%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Assessing the Effectiveness of Combined Analgesics for Bilateral Ramus Osteotomies. 査読国際誌

Shigeru Maeda, Hitoshi Higuchi, Maki Fujimoto, Saki Miyake, Yuka Honda-Wakasugi, Takuya Miyawaki

Anesthesia progress 67 ( 3 ) 140 - 145 2020年9月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

Pain management is important for alleviating patients' suffering and early recovery. Although analgesic combinations are known to be effective, a comparison of the effectiveness of different combinations has never been performed specifically for ramus osteotomy procedures. Therefore, the purpose of this observational retrospective cohort study was to identify an effective combination for pain management throughout the intraoperative and immediate postoperative period for patients undergoing bilateral ramus osteotomy procedures. Inclusion criteria consisted of patients who had undergone bilateral mandibular ramus osteotomies over a 2-year period. The analyzed predictor variables included patient gender, age, body weight, operation, anesthetic method, duration of operation, intraoperative use of fentanyl, nonsteroidal anti-inflammatory drugs (NSAIDs), and intravenous acetaminophen administered in the operating room at the end of the surgery. The outcome variable was the necessity for additional rescue analgesics (yes/no) in the recovery room. Bivariate statistics and multivariate analysis were computed with a p-value of <0.05. The study sample was comprised of 78 patients requiring bilateral mandibular ramus osteotomies. From the multivariate analysis, the combination of NSAIDs-acetaminophen-fentanyl was an independent factor for no additional rescue analgesics during the first 1 hour after bilateral ramus osteotomies, indicating that the combination is significantly effective for bilateral ramus osteotomies compared with the other combinations. Considering that this study consisted of a small sample size, the results of this study suggest that some of the combinations, particularly NSAIDs-acetaminophen-fentanyl, are more effective than NSAIDs alone for postoperative pain control immediately following bilateral ramus osteotomy procedures.

DOI： 10.2344/anpr-67-01-05

大腿骨低形成・特異顔貌症候群患者の全身麻酔経験査読

松田怜奈, 濱岡緑, 三宅沙紀, 若杉優花, 樋口仁, 前田茂, 宮脇卓也

日本歯科麻酔学会雑誌 48 ( 2 ) 57 - 59 2020年4月

担当区分：最終著者記述言語：日本語出版者・発行元：(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。

Multi-drug therapy for epilepsy influenced bispectral index after a bolus propofol administration without affecting propofol's pharmacokinetics: a prospective cohort study. 査読国際誌

Matsuri Kodama, Hitoshi Higuchi, Minako Ishii-Maruhama, Mai Nakano, Yuka Honda-Wakasugi, Shigeru Maeda, Takuya Miyawaki

Scientific reports 10 ( 1 ) 1578 - 1578 2020年1月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

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

Marshall-Smith症候群患児の全身麻酔経験査読

中納麻衣, 藤本磨希, 三宅沙紀, 谷村博史, 樋口仁, 前田茂, 宮脇卓也

日本歯科麻酔学会雑誌 47 ( 2 ) 47 - 49 2019年4月

担当区分：最終著者記述言語：日本語出版者・発行元：(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。

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01093&link_issn=&doc_id=20190628280005&doc_link_id=%2Feq9shika%2F2019%2F004702%2F005%2F0047-0049%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feq9shika%2F2019%2F004702%2F005%2F0047-0049%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Hyperoxia reduces salivary secretion by inducing oxidative stress in mice. 査読国際誌

Ayako Tajiri, Hitoshi Higuchi, Takuya Miyawaki

Archives of oral biology 98 38 - 46 2019年2月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

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

Locally injected ivabradine inhibits carrageenan-induced pain and inflammatory responses via hyperpolarization-activated cyclic nucleotide-gated (HCN) channels. 査読国際誌

Saki Miyake, Hitoshi Higuchi, Yuka Honda-Wakasugi, Maki Fujimoto, Hotaka Kawai, Hitoshi Nagatsuka, Shigeru Maeda, Takuya Miyawaki

PloS one 14 ( 5 ) e0217209 2019年

担当区分：最終著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

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

局所麻酔剤に添加されたアドレナリン投与量の違いによる循環動態の検討査読

松田怜奈, 藤本磨希, 栗田恵理佳, 西岡由紀子, 三宅沙紀, 川瀬明子, 若杉優花, 樋口仁, 前田茂, 宮脇卓也

岡山歯学会雑誌 38 ( 2 ) 2019年

Remifentanil suppresses increase in interleukin-6 mRNA in the brain by inhibiting cyclic AMP synthesis. 査読

Shigeru Maeda, Tsugunobu Andoh, Rieko Onishi, Yumiko Tomoyasu, Hitoshi Higuchi, Takuya Miyawaki

Journal of anesthesia 32 ( 5 ) 731 - 739 2018年10月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: Neuronal inflammation is caused by systemic inflammation and induces cognitive dysfunction. IL-6 plays a crucial role in therapies for neuronal inflammation and cognitive dysfunction. Remifentanil, an ultra-short-acting opioid, controls inflammatory reactions in the periphery, but not in the brain. Therefore, the anti-inflammatory effects of remifentanil in neuronal tissue and the involvement of cAMP in these effects were investigated in the present study. METHODS: Mice were divided into 4 groups: control, remifentanil, LPS, and LPS + remifentanil. Brain levels of pro-inflammatory cytokine mRNA, and serum levels of corticosterone, catecholamine and IL-6 were measured in the 4 groups. The co-localization of IL-6 and astrocytes in the mouse brain after the LPS injection was validated by immunostaining. LPS and/or remifentanil-induced changes in intracellular cAMP levels in cultured glial cells were measured, and the effects of cAMP on LPS-induced IL-6 mRNA expression levels were evaluated. RESULTS: Remifentanil suppressed increase in IL-6 mRNA levels in the mouse brain, and also inhibited the responses of plasma IL-6, corticosterone, and noradrenaline in an inflammatory state. In the hypothalamus, IL-6 was localized in the median eminence, at which GFAP immunoreactivity was specifically detected. In cultured cells, remifentanil suppressed increase in IL-6 mRNA levels and intracellular cAMP levels after the administration of LPS, and this enhanced IL-6 mRNA expression in response to LPS. CONCLUSION: Remifentanil suppressed increase in IL-6 mRNA levels in the brain in an inflammatory state, and this effect may be attributed to its direct action on neuronal cells through the inhibition of intracellular cAMP rather than corticosterone.

DOI： 10.1007/s00540-018-2548-y

In vitro changes in the proportion of protein-unbound-free propofol induced by valproate. 査読

Minako Ishii-Maruhama, Hitoshi Higuchi, Mai Nakanou, Yuka Honda-Wakasugi, Akiko Yabuki-Kawase, Shigeru Maeda, Takuya Miyawaki

Journal of anesthesia 32 ( 5 ) 688 - 693 2018年10月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: It has been reported that oral valproate (VPA) reduces the dose of propofol required for sedation. As a potential reason for this, it is considered that VPA displaces serum protein-bound propofol and increases the proportion of protein-unbound-free propofol. To examine this hypothesis, the present in vitro study investigated the influence of VPA on the proportion of protein-unbound-free propofol in human serum samples. METHODS: Serum samples were collected from 10 healthy volunteers, who were not taking any medication. VPA (final concentration: 0.05, 0.1 or 1 mg/mL) and propofol (final concentration: 1 or 5 µg/mL) were mixed with serum samples with normal (4.0 g/dL) or low (2.5 g/dL) albumin concentrations. Then, protein-unbound-free propofol was extracted from the samples, and its concentration was measured using high-performance liquid chromatography. We compared the proportion of protein-unbound-free propofol in each of the VPA-containing samples with that in serum samples without VPA (control). RESULTS: In the serum samples with normal albumin concentrations, 1 mg/mL VPA significantly increased the proportion of protein-unbound-free propofol at 1 and 5 µg/mL propofol. Furthermore, in the serum samples with low albumin concentrations, the proportion of protein-unbound-free propofol was significantly increased by both 0.1 and 1 mg/mL VPA at propofol concentrations of 1 and 5 µg/mL. CONCLUSION: VPA might increase the proportion of protein-unbound-free propofol in human serum via displacement reactions.

DOI： 10.1007/s00540-018-2540-6

咀嚼筋腱・腱膜過形成症と診断された前後で全身麻酔を行った1症例査読

藤本磨希, 三宅沙紀, 川瀬明子, 丸濱美菜子, 樋口仁, 前田茂, 宮脇卓也

日本歯科麻酔学会雑誌 46 ( 4 ) 167 - 169 2018年10月

担当区分：最終著者記述言語：日本語出版者・発行元：(一社)日本歯科麻酔学会

症例は39歳女性で、下顎左側智歯部の自発痛を訴え、当該歯の歯冠周囲炎との診断を受けた。約10年前から開口障害を自覚しており、初診時開口量が1.5横指であったため、外来での処置は困難と判断され、全身麻酔下での抜歯術が計画された。抜歯術は開口器で開口を保持して行われ、術中の全身状態は安定していた。手術後のMRI所見では、咬筋前縁部に腱様の低信号領域を認め、これが過形成した腱・腱膜と考えられた。咀嚼筋腱・腱膜過形成症との診断を受け、全身麻酔下で咬筋・側頭筋腱膜切除術および筋突起切除術が予定された。手術室入室後に100%酸素6L/minでマスク換気を行った後、レミフェンタニルを0.2〜0.3μg/kg/minで開始した。鎮静が得られたのち自発呼吸を残したまま、鎮静下で気管支ファイバースコープを用いて経鼻挿管を実施した。術中・術後の全身状態は良好であり、術後の最大開口量は3横指と大幅に改善された。

A Multidisciplinary Approach to the Management of Chronic Pain through a Self-managed Behavioral Exercise Program : A Pilot Study in Japan. 査読

Hiroyuki Nishie, Tomoko Tetsunaga, Hirotaka Kanzaki, Koji Oda, Shinichiro Inoue, Yuta Ryuo, Haruyuki Ota, Takuya Miyawaki, Kyosuke Arakawa, Tomonori Tetsunaga, Yoshihisa Kitamura, Toshiaki Sendo, Hiroshi Morimatsu, Toshifumi Ozaki, Keiichiro Nishida

Acta medica Okayama 72 ( 4 ) 343 - 350 2018年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

We conducted this study to determine the short-term treatment outcomes of multidisciplinary approaches to chronic pain management for outpatients in Japan. We evaluated pain reduction and improvement in quality of life (QOL) after treatment. We analyzed 32 patients who had experienced intractable chronic pain for > 3 months. The patients received multidisciplinary therapeutic self-managed exercise instructions and then underwent evaluations 1 and 3 months after the treatment. We used the Pain Disability Short Form-36 (SF-36), Pain Catastrophizing Scale (PCS), and Pain Disability Assessment Scale (PDAS) to evaluate QOL. Although the pain levels were the same before and after the physical exercise program, the patients showed significant improvements in physical function on the SF-36 (48.5 vs. 54.5, 3 months vs. 1 month; p=0.0124), the magnification subscale on the PCS (6.8 vs. 5.9, 1 month vs. before; p=0.0164) and the PDAS (29.2 vs. 23.4, 3 months vs. before; p=0.0055). Chronic pain should be treated with a biopsychosocial approach, but time constraints and costs have limited the implementation of multidisciplinary and behavioral approaches to chronic pain management. Our findings demonstrate that clinical improvements are possible for patients with chronic pain, using multidisciplinary team resources widely available in Japanese clinical practice.

DOI： 10.18926/AMO/56169

悪性褐色細胞腫をもつ患者に対する口腔外科手術の全身管理経験査読

栗田恵理佳, 大西梨恵子, 樋口仁, 若杉優花, 川瀬明子, 前田茂, 宮脇卓也

日本歯科麻酔学会雑誌 46 ( 3 ) 139 - 141 2018年7月

担当区分：最終著者記述言語：日本語出版者・発行元：(一社)日本歯科麻酔学会

症例は44歳男性で、31歳時から高血圧を指摘されていたが、未治療であった。右股関節痛のため歩行困難となり、右腸骨骨腫瘍を指摘された。MIBGシンチグラフィーで右腸骨、脊椎に高集積を認めた。MRIと蓄尿検査で、悪性褐色細胞腫と診断した。デバルキング目的で右腎を摘出した。その後、病変の増大を認め、放射線療法を行った。全身の骨転移を認めたためCVD療法を開始した。上顎前歯部歯根嚢胞、上顎小臼歯部残根を認め、局所麻酔下で嚢胞摘出術および4本の抜歯を予定した。術前にドキサゾシンの内服量の調整を行った。アドレナリンの投与を避けるため、局所麻酔には歯科用メピバカイン製剤を用いることとしたが、手術が比較的広範囲に及ぶため、歯科用メピバカイン製剤で疼痛の抑制が不十分な場合は、1/16万アドレナリン含有リドカイン製剤を使用する予定とした。初回の浸潤麻酔として歯科用メピバカイン製剤を投与した。その後、前歯部嚢胞摘出時に痛みを訴えたため、歯科用メピバカイン製剤を追加投与した。さらに痛みを訴えたため、16万アドレナリン含有2%リドカイン製剤による浸潤麻酔を行った。特に不快症状はなく、手術は終了した。

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01093&link_issn=&doc_id=20180830380007&doc_link_id=%2Feq9shika%2F2018%2F004603%2F006%2F0139-0141%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feq9shika%2F2018%2F004603%2F006%2F0139-0141%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Intellectual disability is a risk factor for delayed emergence from total intravenous anaesthesia 査読

H. Higuchi, S. Maeda, M. Ishii-Maruhama, Y. Honda-Wakasugi, A. Yabuki-Kawase, T. Miyawaki

Journal of Intellectual Disability Research 62 ( 3 ) 217 - 224 2018年3月

歯科教育における診療参加型臨床実習のための電子版連携ログブック(電子ログブック)の開発と今後の課題について査読

川瀬明子, 宮脇卓也, 小河達之, 窪木拓男, 久保田聡, 浅海淳一

岡山歯学会雑誌 36 ( 2 ) 53 - 59 2018年1月

記述言語：日本語出版者・発行元：岡山歯学会

当大学歯学部にて診療参加型臨床実習・臨床研修連携手帳(連携ログブック)として、独自に開発・運用してきた電子版連携ログブックについて検討した。平成27年10月〜平成28年9月に診療参加型臨床実習に参加した臨床実習生55名のデータを分析した結果、全データ数は13610件で、臨床実習生1名当たりの平均入力数は247件、自験率(総症例数を自験数で除したもの)は平均32.6%であった。実習内容を分析すると、最も入力数が多かったのは「歯周治療」で、次いで「クラウン・ブリッジ」、「予防歯科」であった。臨床実習生1名当たりの自験数でみると、最も多かったのは「歯周治療」で、次いで「予防歯科」、「医療面接」であった。一方、臨床実習生1名当たりの自験数が少なかったのは、「歯科麻酔」、「顎関節症・口腔顔面痛」、「診療の基本」であった。

Diamond-Blackfan貧血にチアノーゼ性先天性心疾患を合併した患児の口唇形成術における全身麻酔管理症例査読

西岡由紀子, 谷村博史, 大西梨恵子, 若杉優花, 川瀬明子, 樋口仁, 前田茂, 宮脇卓也

日本歯科麻酔学会雑誌 45 ( 5 ) 669 - 671 2017年10月

担当区分：最終著者記述言語：日本語出版者・発行元：(一社)日本歯科麻酔学会

症例は12歳7ヵ月男児で、手術は両側性唇顎口蓋裂に対し初回口唇形成術を行った。出生時より唇顎口蓋裂に加えて貧血症状、先天性心疾患があり、その後の遺伝子検査からDiamond-Blackfan貧血と確定診断した。貧血に対してプレドニゾロンを内服し、定期的な血液検査でHb値10g/dl以下の場合は赤血球輸血を行っていた。出生後より低酸素血症があり、生後22日目に肺動脈絞扼術および大動脈縮窄症修復術が施行された。静脈路よりチオペンタールを投与した。入眠後、ロクロニウム、フェンタニルを投与し、筋弛緩状態を得たのち気管挿管を試みたがCormack Gradeが3であったため、McGRATH喉頭鏡に変更し経口挿管した。麻酔は酸素、空気、セボフルランで維持した。術中の疼痛コントロールを図るためフェンタニルを適宜投与した。導入後、感染性心内膜炎予防のためにアンピシリンを手術開始前までに投与した。術野への局所麻酔薬は1/24万アドレナリン含有2%リドカイン製剤を投与した。術中の血圧および心拍数に大きな変動は認めなかった。手術終了後、十分な呼吸の回復と開眼を認めたところで抜管した。

Capnography Prevents Hypoxia during Sedation for Dental Treatment: A Randomized Controlled Trial 査読

K. Takaya, H. Higuchi, M. Ishii-Maruhama, A. Yabuki-Kawase, Y. Honda, Y. Tomoyasu, S. Maeda, T. Miyawaki

JDR Clinical & Translational Research 2 ( 2 ) 158 - 167 2017年4月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：{SAGE} Publications

<jats:p> 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. </jats:p><jats:p> 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. </jats:p>

DOI： 10.1177/2380084416674670

全身麻酔により口腔外科手術が予定された術前検査においてD-ダイマー値の異常が発見された無症候性PTE/DVTの症例査読

川瀬明子, 三宅沙紀, 樋口仁, 西岡由紀子, 若杉優花, 前田茂, 宮脇卓也

日本歯科麻酔学会雑誌 45 ( 2 ) 235 - 237 2017年4月

担当区分：最終著者記述言語：日本語出版者・発行元：(一社)日本歯科麻酔学会

症例は86歳女性で、上顎歯肉癌の診断で上顎骨部分切除術を予定した。D-ダイマーが高値であった。造影CT検査を実施し、両側肺動脈下葉枝と両側下腿レベルに多数の血栓像を認めた。第1病日より、ヘパリンを静脈内投与後、持続静脈内投与による抗凝固療法を開始した。第3病日に、ヘパリンを停止し、第X因子阻害剤であるエドキサバンの内服を開始した。第10病日、造影CT検査で両側肺動脈下葉枝と両側下腿レベルにおける血栓像の消失を確認した。第11病日のD-ダイマーも0.5μg/ml以下に低下した。第13病日よりエドキサバンを中止し、第15病日に予定手術を施行した。深部静脈血栓塞栓症リスク分類は最高リスクに分類されたが、術中のVTE予防法は間欠的空気圧迫法のみ行った。抗凝固療法は、手術部位からの出血がないことを確認し、術後2日目(第17病日)からエドキサバンの内服を再開した。術後VTEの再発はなく、術後26日目に退院した。

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