Faculty Profiles - HIGUCHI Hitoshi

Papers - HIGUCHI Hitoshi

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上下顎骨切り術中に発生した背部褥瘡の1症例 Reviewed

佐藤理子, 三宅康太, 藤本磨希, 西岡由紀子, 三宅沙紀, 樋口仁, 宮脇卓也

岡山歯学会雑誌 42 ( 2 ) 55 - 59 2023

SedLineによる歯科治療時の静脈内鎮静法の鎮静レベルの評価ケースシリーズ研究 Reviewed

三宅康太, 樋口仁, 三宅沙紀, 西岡由希子, 藤本磨希, 栗田恵理佳, 川瀬明子, 若杉優花, 宮脇卓也

日本歯科麻酔学会雑誌 50 ( 2 ) 91 - 93 2022.4

Effects of isoflurane-induced and prostaglandin E-1-induced hypotension on cytokine responses to oral and maxiflofacial surgery

T Miyawaki, A Kohjitani, S Maeda, H Higuchi, M Shimada

JOURNAL OF CLINICAL ANESTHESIA 16 ( 3 ) 168 - 172 2004.5

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

Study Objective: To evaluate the effect of induced hypotension with isoflurane or prostaglandin E-1 (PGE(1)) on cytokine responses to surgery.
Design: Prospective, randomized study.
Setting: University hospital.
Patients: 24 ASA physical status I and II patients undergoing elective oral and maxillofacial surgery.
Interventions: Patients were randomly allocated to three groups be anesthetized in the normotension (Control group), isoflurane-induced hypotension (Isoflurane-H group), and PGE(1)-induced hypotension (PGE(1)-H group). Mean arterial pressure during hypotension was maintained at approximately 80% of baseline values.
Measurements and Main Results: Blood samples were taken before induction of anesthesia and during and after hypotension. Plasma tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels were measured using enzyme-linked immunosorbent assay. There were no differences in TNF-alpha or IL-10 levels among the groups. However, the elevation of the plasma IL-6 level in the PGE(1)-H group was found during hypotension, compared with the control group (p < 0.05).
Conclusions: PGE(1)-induced hypotension has an effect on IL-6 response to oral and maxillofacial surgery. (C) 2004 by Elsevier Inc.

DOI： 10.1016/j.jclinane.2003.07.002

岡山大学病院歯科麻酔科部門における過去5年間のインシデント事例の検討

西岡由紀子, 三宅沙紀, 宇治田仁美, 井上緑, 三宅康太, 佐藤理子, 田中譲太郎, 橋本史華, 樋口仁, 宮脇卓也

岡山歯学会雑誌 43 ( 2 ) 27 - 33 2024.12

Intranasal Premedication With Dexmedetomidine in an Adult Patient With Intellectual Disabilities: A Case Report. International journal

Jotaro Tanaka, Saki Miyake, Maki Fujimoto, Yukiko Nishioka, Hitoshi Higuchi, Takuya Miyawaki

Anesthesia progress 71 ( 3 ) 147 - 148 2024.9

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

Recently, intranasal dexmedetomidine (DEX) has been reported to be effective as a preanesthetic medication, mostly in healthy pediatric patients. We attempted to administer intranasal DEX premedication in this case to an adult patient with intellectual disability who previously had difficulty tolerating premedication with oral midazolam. Using an intranasal atomization delivery device (MAD Nasal, Teleflex), we administered 1.5 µg/kg of DEX intranasally and were able to achieve adequate sedation, which facilitated a smooth mask induction of general anesthesia with sevoflurane. Premedication with intranasal DEX may be a useful method for enabling induction of general anesthesia in adult patients with intellectual disabilities.

DOI： 10.2344/anpr-23-0057

緩徐導入後に気管支痙攣様となり2度手術を中止した小児に対して急速導入による麻酔導入を試みた1症例

橋本史華, 関原磨希, 樋口仁, 佐藤理子, 宮脇卓也

日本歯科麻酔学会雑誌 52 ( 抄録号 ) 163 - 163 2024.9

当院歯科麻酔科に係わるインシデント事例の検討過去5年間のインシデントレポートの分析

西岡由紀子, 井上緑, 秦泉寺紋子, 花澤郁恵, 松田怜奈, 若杉優花, 丸濱美菜子, 齊田拓也, 平野彩加, 三宅康太, 田中譲太郎, 宇治田仁美, 三宅沙紀, 樋口仁, 宮脇卓也

日本歯科麻酔学会雑誌 52 ( 抄録号 ) 158 - 158 2024.9

高齢者におけるレミマゾラムを用いた全静脈麻酔後の術後せん妄発症に関する後ろ向き調査

宇治田仁美, 三宅沙紀, 樋口仁, 秦泉寺紋子, 三宅康太, 花澤郁恵, 石田久美子, 橋本史華, 田中譲太郎, 井上緑, 関原磨希, 西岡由紀子, 宮脇卓也

日本歯科麻酔学会雑誌 52 ( 抄録号 ) 121 - 121 2024.9

高速液体クロマトグラフィーを用いたレミマゾラム及び代謝物CNS7054の血中濃度測定法の確立

佐藤理子, 樋口仁, 西岡由紀子, 三宅沙紀, 宮脇卓也

日本歯科麻酔学会雑誌 52 ( 抄録号 ) 120 - 120 2024.9

当院歯科麻酔科に係わるインシデント事例の検討過去5年間のインシデントレポートの分析

西岡由紀子, 井上緑, 秦泉寺紋子, 花澤郁恵, 松田怜奈, 若杉優花, 丸濱美菜子, 齊田拓也, 平野彩加, 三宅康太, 田中譲太郎, 宇治田仁美, 三宅沙紀, 樋口仁, 宮脇卓也

日本歯科麻酔学会雑誌 52 ( 抄録号 ) 158 - 158 2024.9

高齢者におけるレミマゾラムを用いた全静脈麻酔後の術後せん妄発症に関する後ろ向き調査

宇治田仁美, 三宅沙紀, 樋口仁, 秦泉寺紋子, 三宅康太, 花澤郁恵, 石田久美子, 橋本史華, 田中譲太郎, 井上緑, 関原磨希, 西岡由紀子, 宮脇卓也

日本歯科麻酔学会雑誌 52 ( 抄録号 ) 121 - 121 2024.9

高速液体クロマトグラフィーを用いたレミマゾラム及び代謝物CNS7054の血中濃度測定法の確立

佐藤理子, 樋口仁, 西岡由紀子, 三宅沙紀, 宮脇卓也

日本歯科麻酔学会雑誌 52 ( 抄録号 ) 120 - 120 2024.9

Optimising the oral midazolam dose for premedication in people with intellectual disabilities and/or autism spectrum disorder. Reviewed International journal

Hitoshi Higuchi, Kota Miyake, Saki Miyake, Maki Fujimoto, Yukiko Nishioka, Shigeru Maeda, Takuya Miyawaki

Journal of applied research in intellectual disabilities : JARID 37 ( 4 ) e13265 2024.7

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

BACKGROUND: In people with intellectual disabilities and/or autism spectrum disorder, oral midazolam (OM) is very effective as premedication for facilitating medical treatment. In this retrospective study, we investigated the optimal dosage of OM for premedication. METHODS: Patients with intellectual disability and/or autism spectrum disorder who were given OM as a premedication were selected from anaesthesia records. The primary outcome variable was the dose of OM (mg/kg) required to produce an adequate sedation. RESULTS: The mean OM dose required was 0.32 ± 0.10 mg/kg. The required OM dose decreased significantly as age and weight increased, and age and weight were also shown to be significantly associated with the dose of OM in the multivariate linear regression analysis. CONCLUSION: The dosage of OM to achieve adequate sedation should decrease as the patient ages. Furthermore, adequate sedation can be achieved with even lower doses of OM in obese people.

DOI： 10.1111/jar.13265

歯科患者を対象とした歯科用局所麻酔剤アルチカイン塩酸塩・アドレナリン酒石酸水素塩注射剤(OKAD01)の臨床用量域の検討(アルチカイン塩酸塩第II相試験) Reviewed

樋口仁, 飯島毅彦, 北畑洋, 藤澤俊明, 角南次郎, 深山治久, 三宅実, 鮎瀬卓郎, 丹羽均, 渡辺禎久, 三島克章, 細井宏輝, 吉田道弘, 宮脇卓也

日本歯科麻酔学会雑誌 52 ( 1 ) 26 - 36 2024.1

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

われわれは本邦での歯科用局所麻酔剤アルチカイン塩酸塩・アドレナリン酒石酸水素塩注射剤(OKAD01)の第I相試験を実施し,日本人でのアルチカインの薬物動態と安全性を明らかにした.そこで第I相試験の結果に基づき,OKAD01の臨床用量域を,有効性および安全性の観点から検討するOKAD01の国内第II相試験を実施した.歯科治療を受ける20～80歳の日本人成人患者を対象とした.予定された施術内容を用法に基づき,「歯科治療患者を対象とした浸潤麻酔」および「口腔外科患者を対象とした局所麻酔」に分類した.そのうえで,各用法を「施術の侵襲の程度(軽度,中等度,重度)」で分類した.各施術の侵襲の程度に応じた投与目安を設け,用量範囲でOKAD01を口腔内に単回投与した.主要評価項目は,Visual Analogue Scale(VAS)(0～10cm)を用いた患者による歯科施術中の痛みとした.治験薬を投与された55例(Safety Data Set:SDS)のうち,治験薬用法違反および適格基準違反の各1例を除いた53例(Full Analysis Set:FAS)における歯科施術中のVASの平均値(両側95%CI)は0.65(0.27～1.02)であった.また用法別では,「歯科治療患者を対象とした浸潤麻酔」(24例)で0.31(-0.04～0.67),「口腔外科患者を対象とした局所麻酔」(29例)で0.92(0.30～1.55)であった.またSDSにおいて因果関係が否定できない有害事象として「舌のしびれ」を1例認めた.本治験により本治験で規定および目安とした用法・用量で,日本人成人におけるOKAD01の有効性および安全性が確認された.(著者抄録)

慢性口腔顎顔面痛患者の初診時の痛み強度と多角的な非器質的要因との関連について

川瀬明子, 藤本磨希, 西岡由紀子, 三宅沙紀, 樋口仁, 宮脇卓也

岡山歯学会雑誌 42 ( 2 ) 74 - 74 2023.12

Use of MICRO MIST Nebulizer for Local Anesthesia of the Upper Airway during Awake Fiberoptic Intubation : a Case Report Reviewed

SATO Riko, HIGUCHI Hitoshi, NISHIOKA Yukiko, FUJIMOTO Maki, MIYAKE Saki, MIYAWAKI Takuya

Journal of Japanese Dental Society of Anesthesiology 51 ( 4 ) 123 - 126 2023.10

Language：Japanese Publisher：The Japanese Dental Society of Anesthesiology

Local anesthesia of the upper airway during awake intubation is very important to alleviate pain and facilitate the procedure. In this case report, we used a MICRO MIST Nebulizer to allow a patient to inhale lidocaine for local anesthesia of the upper airway, enabling a smooth and safe awake nasal fiberoptic intubation in a patient with severe obesity and cervical abscess. The patient was a 66-year-old male with a height of 168 cm, a weight of 108 kg, and a BMI of 38 kg/m². Cervical abscess incision and debridement under general anesthesia were scheduled for the treatment of acute cervical abscess. Because of severe neck swelling and obesity, anesthesia induction was predicted to be difficult ; we therefore selected full awake nasal fiberoptic intubation with local anesthesia of the upper airway.

The patient was instructed to inhale a 4% lidocaine mist using a MICRO MIST nebulizer while receiving 8 L/min oxygen. After inhaling the lidocaine, awake fiberoptic nasal intubation was performed. No sedatives were used during the intubation. The oxygen saturation did not decrease during the fiberoptic intubation, and the intubation was performed smoothly with minimal gagging reflex, coughing reflex, swallowing reflex, or body movement. This case report suggests that local anesthesia of the upper airway using a MICRO MIST nebulizer is a useful and safe method for performing awake fiberoptic intubation in patients predicted to have a difficult airway.

DOI： 10.24569/jjdsa.51.4_123

知的能力障害を有する成人歯科患者に対してデクスメデトミジン経鼻投与による麻酔前投薬を試みた1症例 Reviewed

田中譲太郎, 三宅沙紀, 藤本磨希, 西岡由紀子, 樋口仁, 宮脇卓也

日本歯科麻酔学会雑誌 51 ( 3 ) 69 - 71 2023.7

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

麻酔前投薬としてミダゾラム(MDZ)は小児患者に広く用いられており、知的能力障害を有する成人歯科患者にも用いられることがある。本邦ではMDZの経口製剤は市販されていないためMDZ注射液を代用しているが、MDZ注射液は苦味が非常に強い。そのため甘い飲料水などに混ぜて内服させることが多いが、味覚過敏を有する知的能力障害者などでは投与が困難な場合がある。近年、小児における麻酔前投薬としてデクスメデトミジン(DEX)経鼻投与の有用性が報告されているが、成人の知的能力障害者に対する有用性を報告したものは見受けられない。今回我々は、MDZの経口投与が困難となった知的能力障害を有する成人歯科患者に対し、診療室や手術室にスムーズに入室でき診療台に臥位になれることを目標にDEX経鼻投与を試み、円滑に麻酔導入を行うことができたので報告した。

Evaluation of Sedation Levels Using SedLine During Intravenous Sedation for Dental Procedures: A Case-Series Study. Invited Reviewed International journal

Kota Miyake, Hitoshi Higuchi, Saki Miyake, Yukiko Nishioka, Maki Fujimoto, Erika Kurita, Akiko Kawase, Yuka Wakasugi, Takuya Miyawaki

Anesthesia progress 70 ( 2 ) 85 - 87 2023.6

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

The Patient State Index (PSI) is the numerical value of anesthesia depth as measured using a SedLine Sedation Monitor (Masimo Corporation). In this pilot study, we evaluated PSI values captured during intravenous (IV) moderate sedation for dental treatment. During the dental treatment, a dental anesthesiologist maintained the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score at 3 to 4 by adjusting the administration of midazolam and propofol while PSI values were recorded. The mean (SD) and median (25th percentile, 75th percentile) PSI values during dental treatment under IV moderate sedation were 72.7 (13.6) and 75 (65, 85), respectively.

DOI： 10.2344/anpr-70-01-01

Anesthetic Management Using Remimazolam in a Hemodialysis Patient. Reviewed International journal

Yukiko Nishioka, Saki Miyake, Midori Hamaoka, Kota Miyake, Maki Fujimoto, Hitoshi Higuchi, Takuya Miyawaki

Anesthesia progress 70 ( 2 ) 65 - 69 2023.6

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

岡山大学病院歯科外来における過去10年間の歯科麻酔管理症例の臨床統計的観察 Reviewed

三宅沙紀, 西岡由紀子, 藤本磨希, 栗田恵理佳, 濱岡緑, 宇治田仁美, 三宅康太, 佐藤理子, 田中譲太郎, 樋口仁, 宮脇卓也

岡山歯学会雑誌 41 ( 2 ) 15 - 20 2022.12

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。

The clinical advantage of nasal high-flow in respiratory management during procedural sedation: A scoping review on the application of nasal high-flow during dental procedures with sedation. Reviewed International journal

Shinji Kurata, Takuro Sanuki, Hitoshi Higuchi, Takuya Miyawaki, Seiji Watanabe, Shigeru Maeda, Shuntaro Sato, Max Pinkham, Stanislav Tatkov, Takao Ayuse

The Japanese dental science review 58 179 - 182 2022.11

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

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

Capsaicin May Improve Swallowing Impairment in Patients with Amyotrophic Lateral Sclerosis: A Randomized Controlled Trial. Reviewed

Tomoko Higashi, Naomichi Murata, Maki Fujimoto, Saki Miyake, Masahiko Egusa, Hitoshi Higuchi, Shigeru Maeda, Takuya Miyawaki

Acta medica Okayama 76 ( 2 ) 179 - 186 2022.4

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

Reply Invited International journal

Hitoshi Higuchi, Kumiko Takaya-Ishida, Saki Miyake, Maki Fujimoto, Yukiko Nishioka, Shigeru Maeda, Takuya Miyawaki

Journal of Oral and Maxillofacial Surgery 79 ( 11 ) 2181 - 2182 2021.11

知的障害者の安全な麻酔管理を目指して Invited Reviewed

樋口仁

日本歯科麻酔学会雑誌 49 ( 4 ) 158 - 157 2021.10

Patient satisfaction with deep versus light/moderate sedation for non-surgical procedures Reviewed International journal

Hiroshi Hoshijima, Hitoshi Higuchi, Aiji Sato (Boku), Makiko Shibuya, Yoshinari Morimoto, Toshiaki Fujisawa, Kentaro Mizuta

Medicine 100 ( 36 ) e27176 - e27176 2021.9

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

Comparison of Oxygen Saturation Between Nasal High-Flow Oxygen and Conventional Nasal Cannula in Obese Patients Undergoing Dental Procedures With Deep Sedation: A Randomized Crossover Trial Reviewed International journal

Hitoshi Higuchi, Kumiko Takaya-Ishida, Saki Miyake, Maki Fujimoto, Yukiko Nishioka, Shigeru Maeda, Takuya Miyawaki

Journal of Oral and Maxillofacial Surgery 79 ( 9 ) 1842 - 1850 2021.9

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

Evaluation of the Safety and Pharmacokinetics of Articaine Hydrochloride and Adrenaline Bitartrate (OKAD01) for Local Anesthesia in Dentistry : A Phase Ⅰ, Single Center, Non-blinded Study Reviewed

HIGUCHI Hitoshi, HONDA-WAKASUGI Yuka, YABUKI-KAWASE Akiko, MAEDA Shigeru, MIYAWAKI Takuya

Journal of Japanese Dental Society of Anesthesiology 49 ( 3 ) 81 - 96 2021.7

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

A Case of Delayed Emergence from General Anesthesia with Propofol in an Outpatient Receiving Multi-drug Therapy for Epilepsy Reviewed

HONDA-WAKASUGI Yuka, YABUKI-KAWASE Akiko, UJITA Hitomi, HAMAOKA Midori, HIGUCHI Hitoshi, MAEDA Shigeru, MIYAWAKI Takuya

Journal of Japanese Dental Society of Anesthesiology 49 ( 1 ) 1571 - 3 2021.1

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

Pulmonary Aspiration During Induction of General Anesthesia Reviewed International journal

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

Anesthesia Progress 67 ( 4 ) 214 - 218 2020.12

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

Dexmedetomidine inhibits LPS-induced inflammatory responses through peroxisome proliferator-activated receptor gamma (PPARγ) activation following binding to α2 adrenoceptors Reviewed

Maki Fujimoto, Hitoshi Higuchi, Yuka Honda-Wakasugi, Saki Miyake, Yukiko Nishioka, Akiko Yabuki-Kawase, Shigeru Maeda, Takuya Miyawaki

European Journal of Pharmacology 892 173733 2020.11

Metabolic alterations caused by the mutation and overexpression of the Tmem135 gene Reviewed

Wei-Hua Lee, Vijesh J Bhute, Hitoshi Higuchi, Sakae Ikeda, Sean P Palecek, Akihiro Ikeda

Experimental Biology and Medicine 245 ( 17 ) 1571 - 1583 2020.11

知的障害を伴ったGlenn術後患者の静脈内鎮静法の経験 Reviewed

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 2020.10

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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Assessing the Effectiveness of Combined Analgesics for Bilateral Ramus Osteotomies Reviewed

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

Anesthesia Progress 67 ( 3 ) 140 - 145 2020.9

Assessing the Effectiveness of Combined Analgesics for Bilateral Ramus Osteotomies

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

Anesthesia progress 67 ( 3 ) 140 - 145 2020.9

Language：English Publishing type：Research paper (scientific journal) Publisher：NLM (Medline)

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 &lt
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 Reviewed

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 2020.4

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。

Multi-drug therapy for epilepsy influenced bispectral index after a bolus propofol administration without affecting propofol's pharmacokinetics: a prospective cohort study. Reviewed International journal

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

Scientific reports 10 ( 1 ) 1578 - 1578 2020.1

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

歯科麻酔専門医・認定医における深鎮静の現状認識調査報告 Reviewed

渋谷真希子, 佐藤會士[朴], 樋口仁, 星島宏, 森本佳成, 藤澤俊明, 日本歯科麻酔学会歯科麻酔医のための深鎮静ガイドライン策定小部会

日本歯科麻酔学会雑誌 48 ( 1 ) 22 - 29 2020.1

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。

歯科麻酔医の深鎮静に関する施設実態調査報告 Reviewed

渋谷真希子, 佐藤會士[朴], 樋口仁, 星島宏, 森本佳成, 藤澤俊明, 日本歯科麻酔学会歯科麻酔医のための深鎮静ガイドライン策定小部会

日本歯科麻酔学会雑誌 47 ( 4 ) 158 - 164 2019.10

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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Locally injected ivabradine inhibits carrageenan-induced pain and inflammatory responses via hyperpolarization-activated cyclic nucleotide-gated (HCN) channels. Reviewed International journal

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

PloS one 14 ( 5 ) e0217209 2019.5

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

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

Marshall-Smith症候群患児の全身麻酔経験 Reviewed

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 2019.4

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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Hyperoxia reduces salivary secretion by inducing oxidative stress in mice. Reviewed International journal

Ayako Tajiri, Hitoshi Higuchi, Takuya Miyawaki

Archives of oral biology 98 38 - 46 2019.2

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

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.

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

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

Journal of Anesthesia 32 ( 5 ) 731 - 739 2018.8

The effect of Tmem135 overexpression on the mouse heart. Reviewed

Lewis SA, Takimoto T, Mehrvar S, Higuchi H, Doebley AL, Stokes G, Sheibani N, Ikeda S, Ranji M, Ikeda A.

PLoS One 13 ( 8 ) e0201986 2018.8

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

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

Journal of Anesthesia 32 ( 5 ) 688 - 693 2018.7

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

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

Journal of Intellectual Disability Research 62 ( 3 ) 217 - 224 2017.11

Capnography prevents hypoxia during sedation for dental treatment: A randomized controlled trial Reviewed

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

JDR Clinical and Translational Research 2 ( 2 ) 158 - 167 2017.4

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

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

Clinical Analysis of Analgesics and Steroids Use for Extraction of Teeth in Patients with Intellectual Disability Under General Anesthesia. Reviewed International journal

Shigeru Maeda, Yuka Honda, Hiroshi Tanimura, Yumiko Tomoyasu, Hitoshi Higuchi, Naomichi Murata, Masahiko Egusa, Takuya Miyawaki

The open dentistry journal 11 181 - 186 2017.3

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

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

Effect of Intravenous Patient-controlled Analgesia (IV-PCA) on Postoperative Pain in Patients Undergoing Surgery for Oral and Maxillofacial Tumors Reviewed

日本歯科麻酔学会雑誌 45 ( 1 ) 17 - 22 2017.1

Anesthetic management of a child with diamond-Blackfan Anemia and cyanotic congenital heart disease undergoing cleft lip repair

Yukiko Nishioka, Hiroshi Tanimura, Rieko Onishi, Yuka Honda-Wakasugi, Akiko Yabuki-Kawase, Hitoshi Higuchi, Shigeru Maeda, Takuya Miyawaki

Journal of Japanese Dental Society of Anesthesiology 45 ( 5 ) 669 - 671 2017

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

Diamond-Blackfan anemia (DBA) is a rare congenital form of pure red cell aplasia that is often complicated by congenital anomalies such as craniofacial anomalies and heart disease. We report a case of cleft lip repair performed under general anesthesia in a child with DBA. The patient was a male aged 12 years old, 95.8cm in height, and 12.8 kg in body weight He had anemia, a double-outlet right ventricle (DORV), and coarctation of the aorta (CoA). He had been treated with the administration of prednisolone and red blood cell transfusion for the anemia. Because steroid therapy increases the risk of infection, he was unable to undergo a radical operation for DORV. He exhibited cyanosis with an SpO2 of 75% under 2//min oxygen, and we considered tracheal intubation to be difficult because of the craniofacial anomaly. Before the induction of anesthesia, his SpO2 was 76%. Anesthesia was induced with thiopental. Because tracheal intubation was difficult, we performed oral intubation using a video laryngoscope. Anesthesia was maintained with oxygen, air, sevoflurane, and fentanyL To prevent infective endocarditis (IE), we administered ampicillin just before the operation, and 2% lidocaine with 1/240, 000 adrenalin was used for local anesthesia Under mechanical ventilation with the pressure mode, the FIO2 was kept at 0.5 to maintain the SpO2 at around 75%. In the present case, we needed to manage respiration and circulation because of cyanotic congenital heart disease, to take measures because of a difficult tracheal intubation, to prevent IE, and to prepare for red blood cell transfusion for anemia As a result, we were able to manage the general condition of a child with Diamond-Blackfan anemia and cyanotic congenital heart disease during general anesthesia safely without any complications.

Mouse Tmem135 mutation reveals a mechanism involving mitochondrial dynamics that leads to age-dependent retinal pathologies Reviewed

Wei-Hua Lee, Hitoshi Higuchi, Sakae Ikeda, Erica L Macke, Tetsuya Takimoto, Bikash R Pattnaik, Che Liu, Li-Fang Chu, Sandra M Siepka, Kathleen J Krentz, C Dustin Rubinstein, Robert F Kalejta, James A Thomson, Robert F Mullins, Joseph S Takahashi, Lawrence H Pinto, Akihiro Ikeda

eLife 5 e19264 2016.11

Female Patients Require a Higher Propofol Infusion Rate for Sedation. Reviewed International journal

Shigeru Maeda, Yumiko Tomoyasu, Hitoshi Higuchi, Yuka Honda, Minako Ishii-Maruhama, Takuya Miyawaki

Anesthesia progress 63 ( 2 ) 67 - 70 2016.8

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

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

Effect of a low dose of midazolam on high blood pressure in dental patients: A randomised, double-blind, placebo-controlled, two-centre study

Yoshihisa Watanabe, Hitoshi Higuchi, Minako Ishii-Maruhama, Yuka Honda, Akiko Yabuki-Kawase, Ayaka Yamane-Hirano, Yumiko Tomoyasu, Shigeru Maeda, Takuya Miyawaki

British Journal of Oral and Maxillofacial Surgery 54 ( 4 ) 443 - 448 2016.5

Language：English Publishing type：Research paper (international conference proceedings) Publisher：Churchill Livingstone

Some patients have transient hypertension before dental treatment as a result of anxiety and stress. Midazolam is an anxiolytic, and thought to be effective for the management of this sort of transient hypertension. We have evaluated in a randomised, controlled trial whether a low dose of midazolam can lower blood pressure in dental patients to an acceptable level without excessive sedation. Suitable patients were randomised to be given midazolam (trial group) or physiological saline (control group) intravenously. Blood pressure, heart rate, degree of anxiety, and amount of sedation were measured before and after injection. After injection, blood pressure in the trial group significantly decreased to clinically acceptable levels compared with controls. The degree of anxiety in the trial group was also significantly less than that in the control group, but there were no significant differences in sedation. These results suggest that injection of a low dose of midazolam stabilises the blood pressure of dental patients with transient hypertension.

DOI： 10.1016/j.bjoms.2016.02.006

知的障害を有する肥満患者の静脈内鎮静法下歯科治療における経鼻高流量酸素供給システム (Optiflow) の使用経験 Reviewed

大西梨恵子, 樋口仁, 川瀬明子, 丸濱美菜子, 本田優花, 前田茂, 宮脇卓也

日本歯科麻酔学会雑誌 44 ( 2 ) 207 - 209 2016.4

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。

Effect of a low dose of midazolam on high blood pressure indental patients: a randomised, double-blind,placebo-controlled, two-centre study Reviewed

Yoshihisa Watanabe, Hitoshi Higuchi, Minako Ishii-Maruhama, Yuka Honda, Akiko Yabuki-Kawase, Ayaka Yamane-Hirano, Yumiko Tomoyasu, Shigeru Maeda,Takuya Miyawaki

British Journal of Oral and Maxillofacial Surgery 54 ( 4 ) 443 - 448 2016.3

Effect of carbamazepine or phenytoin therapy on blood level of intravenously administered midazolam : a prospective cohort study Reviewed

Journal of anesthesia 30 ( 1 ) 166 - 169 2016.2

Airway management using a nasal high flow system (Optiflow™) during intravenous sedation for dental treatment in an obese patient with intellectual disability

Rieko Onishi, Hitoshi Higuchi, Akiko Kawase, Minako Maruhama, Yuka Honda, Shigeru Maeda, Takuya Miyawaki

Journal of Japanese Dental Society of Anesthesiology 44 ( 2 ) 207 - 209 2016

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

Intravenous sedation (IVS) is useful for the dental treatment of patients with intellectual disability (ID). However, in obese patients, difficulties in airway management can easily lead to oxygen desaturation. Nasal high-flow systems (NHFS) are a new type of device that can supply oxygen at a high flow rate. Several recent studies have shown that the use of an NHFS is very effective for preventing oxygen desaturation, and we have used an NHFS for airway management during IVS for a dental procedure in a patient with severe obesity and ID. Use of the NHFS was approved by the institutional review board of Okayama University Hospital, and written informed consent was obtained from the patient's parents. The dental treatment was planned for a 40-year-old male patient (height: 170 cm
body weight : 92.1 kg
body mass index : 31.8) with ID. He had experienced several oxygen desaturation episodes during previous dental sedations because of difficulties encountered during airway management. At this time, the NHFS (Optiflow™) was used for airway management during IVS. Fifty-minutes after the oral administration of 25 mg of midazolam, propofol was continuously infused at a dose of 1.0 μg/ml of the target effect site concentration. The sedation level was maintained at a bispectral index value of 50-70 by adjusting the target concentration of propofol. Initially, 40% oxygen was administered at a rate of 20 l/min via the NHFS. The flow volume was gradually increased up to 50 l/min, and high-flow oxygen was supplied throughout the dental treatment. Neither airway obstruction nor oxygen desaturation was observed during the dental treatment, resulting in no complications such as airway injury. This case suggests that NHFS enabled easy airway management during IVS for dental treatment in an obese patient.

The inhibitory effect of locally injected dexmedetomidine on carrageenan-induced nociception in rats Reviewed

Yuka Honda, Hitoshi Higuchi, Yoshikazu Matsuoka, Akiko Yabuki-Kawase, Minako Ishii-Maruhama, Yumiko Tomoyasu, Shigeru Maeda, Hiroshi Morimatsu, Takuya Miyawaki

European Journal of Pharmacology 764 215 - 219 2015.10

Effect of dexmedetomidine injected into the oral mucosa in combination with lidocaine on local anesthetic potency in humans: a crossover double-blind study. Reviewed International journal

Ayaka Yamane, Hitoshi Higuchi, Yumiko Tomoyasu, Minako Ishii-Maruhama, Shigeru Maeda, Takuya Miyawaki

Journal of oral and maxillofacial surgery 73 ( 4 ) 616 - 621 2015.4

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

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

Independent factors affecting recovery time after sedation in patients with intellectual disabilities. Reviewed International journal

Shigeru Maeda, Yumiko Tomayasu, Hitoshi Higuchi, Minako Ishii-Maruhama, Ayaka Yamane, Akiko Yabuki, Yuka Honda, Masahiko Egusa, Takuya Miyawaki

The open dentistry journal 31 146 - 149 2015.3

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

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

Independent predictors of delay in emergence from general anesthesia Reviewed

Shigeru Maeda, Yumiko Tomoyasu, Hitoshi Higuchi, Minako Ishii-Maruhama, Masahiko Egusa, Takuya Miyawaki

Anesthesia Progress 62 ( 1 ) 8 - 13 2015.3

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

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

Genetic basis of agedependent synaptic abnormalities in the retina Reviewed

Hitoshi Higuchi , Erica L. Macke, Wei-Hua Lee, Sam A. Miller, James C. Xu, Sakae Ikeda, Akihiro Ikeda

Mammalian Genome 26 ( 1 ) 21 - 32 2015.2

骨形成不全症患児の全身麻酔下歯科治療の周術期にデクスメデトミジン塩酸塩を用いた１例 Reviewed

谷村博史, 樋口仁, 高谷久美子, 平野彩加, 前田茂, 友安弓子, 宮脇卓也

日本歯科麻酔学会雑誌 43 ( 1 ) 51 - 53 2015.1

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。

Perioperative management using dexmedetomidine for a pediatric patient with osteogenesis imperfecta undergoing dental treatment under general anesthesia

Hiroshi Tanimura, Hitoshi Higuchi, Kumiko Takaya, Ayaka Hirano, Shigeru Maeda, Yumiko Tomoyasu, Takuya Miyawaki

Journal of Japanese Dental Society of Anesthesiology 43 ( 1 ) 51 - 53 2015

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

Osteogenesis imperfecta (OS) is an autosomal recessive disease that results in a congenital vulnerability to external forces, easily leading to bone fractures. We performed dental treatment under general anesthesia in a pediatric patient with OS to prevent bone fractures induced by restraint during dental treatment, and the continuous infusion of dexmedetomidine was useful for controlling agitation after the general anesthesia. The patient was a 5-year-old male who had already experienced more than 10 bone fractures
he had been treated with intravenous injections of bisphosphonate every 45 days. General anesthesia for dental treatment was suggested by his parents and was performed twice for dental treatment and teeth extraction. The first and second general anesthesia procedures were performed using the same procedure: premedication with oral midazolam
induction with sevoflurane, remifentanil, and rocuronium
and maintenance with the continuous infusion of propofol and remifentanil. During the middle of the dental treatment procedure, a continuous infusion of 0.4 μg/kg/h of dexmedetomidine was started and continued until 30 minutes after the removal of the tracheal tube. The durations for the infusion of dexmedetomidine were 114 and 170 minutes in the first and second general anesthesia procedures, respectively. Abnormal respiratory and circulatory suppression related to the use of dexmedetomidine was not observed throughout the management period. An adequate level of sedation was obtained after emergence, with a Richmond Agitation-Sedation scale of 2 or less. Thus, the continuous infusion of dexmedetomidine was considered to be useful for preventing agitation after general anesthesia in a pediatric patient In the present case, this management procedure was useful for preventing bone fractures during the perioperative period in a patient with OS.

知覚痛覚定量装置 (Pain Vision?) を応用した口腔内局所麻酔時の電流識別閾値評価 Reviewed

平野彩加, 本田優花, 川瀬明子, 丸濱美菜子, 友安弓子, 樋口仁, 前田茂, 宮脇卓也

岡山歯学会雑誌 33 ( 2 ) 19 - 21 2014.12

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。

岡山大学病院歯科麻酔科における過去10年間の麻酔管理症例の臨床統計

高谷久美子, 大西梨恵子, 兒玉茉莉, 谷村博史, 森恵, 本田優花, 平野彩加, 川瀬明子, 丸濱美菜子, 友安弓子, 樋口仁, 前田茂, 宮脇卓也

岡山歯学会雑誌 33 ( 2 ) 42 - 42 2014.12

Chronic Orofacial Pain in Dental Patients: Retrospective Investigation over 12 years Reviewed

Tomoyasu Yumiko, Higuchi Hitoshi, Mori Megumi, Takaya Kumiko, Honda Yuka, Yamane Ayaka, Yabuki Akiko, Hayashi Tomoko, Ishii-Maruhama Minako, Jinzenji Ayako, Maeda Shigeru, Kohjitani Atsushi, Shimada Masahiko, Miyawaki Takuya

Acta Medica Okayama 68 ( 5 ) 267 - 275 2014.10

歯科治療を受ける知的障害者に対してデクスメデトミジン塩酸塩経口投与による麻酔前投薬を行った１症例 Reviewed

平野彩加, 樋口仁, 兒玉茉莉, 友安弓子, 前田茂, 宮脇卓也

日本歯科麻酔学会雑誌 42 ( 5 ) 640 - 641 2014.10

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。

Hemodynamic changes by drug interaction of adrenaline with chlorpromazine. Reviewed International journal

Hitoshi Higuchi, Akiko Yabuki, Minako Ishii-Maruhama, Yumiko Tomoyasu, Shigeru Maeda, Takuya Miyawaki

Anesthesia progress 61 ( 4 ) 150 - 154 2014.9

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

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

抗凝固療法の再開に伴い術後出血を呈した深部静脈血栓症の既往を有する口腔外科患者の１症例 Reviewed

兒玉茉莉, 樋口仁, 山根彩加, 友安弓子, 丸濱美菜子, 矢吹明子, 本田優花, 前田茂, 宮脇卓也

日本歯科麻酔学会雑誌 42 ( 3 ) 299 - 300 2014.7

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。

ゴールデンハー症候群３症例の口腔外科手術における挿管困難因子の検討 Reviewed

高谷久美子, 山根彩加, 林知子, 丸濱美菜子, 新井由起子, 友安弓子, 樋口仁, 前田茂, 宮脇卓也

日本歯科麻酔学会雑誌 42 ( 3 ) 301 - 302 2014.7

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。

Locally injected dexmedetomidine induces vasoconstriction via peripheral α-2A adrenoceptor subtype in Guinea pigs Reviewed

Akiko Yabuki, Hitoshi, Higuchi, Tatsushi Yoshitomi, Yumiko Tomoyasu, Minako Ishii-Maruhama, Shigeru Maeda, Takuya Miyawaki

Regional Anesthesia and Pain Medicine 39 ( 2 ) 133 - 136 2014.4

歯科治療恐怖症患者に対してNoise-cancelling headphone(ノイズキャンセリングヘッドフォン)を併用した静脈内鎮静法を施行した1症例 Reviewed

丸濱美菜子, 樋口仁, 友安弓子, 高谷久美子, 森恵, 本田優花, 矢吹明子, 山根彩加, 前田茂, 宮脇卓也

日本歯科麻酔学会雑誌 42 ( 2 ) 218 - 219 2014.4

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。

Locally injected dexmedetomidine inhibits carrageenin-induced inflammatory responses in the injected region Reviewed

Shintaro Sukegawa, Hitoshi Higuchi, Miho Inoue, Hitoshi Nagatsuka, Shigeru Maeda, Takuya Miyawaki

Anesthesia and Analgesia 118 ( 2 ) 473 - 480 2014.2

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

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

A case of anesthetic premedication with oral dexmedetomidine to the dental patient with intellectual disability

Ayaka Hirano, Hitoshi Higuchi, Matsuri Kodama, Yumiko Tomoyasu, Shigeru Maeda, Takuya Miyawaki

Journal of Japanese Dental Society of Anesthesiology 42 ( 5 ) 640 - 641 2014

A case of the intravenous sedation with the noise-cancelling headphone for the patient with fear of dental treatments

Minako Maruhama, Hitoshi Higuchi, Yumiko Tomoyasu, Kumiko Takaya, Megumi Mori, Yuka Honda, Akiko Yabuki, Ayaka Yamane, Shigeru Maeda, Takuya Miyawaki

Journal of Japanese Dental Society of Anesthesiology 42 ( 2 ) 218 - 219 2014

The possible factors of difficult intubation in three cases with Goldenhar syndrome undergoing oral and maxillofacial surgery

Kumiko Takaya, Ayaka Yamane, Tomoko Hayashi, Minako Maruhama, Yukiko Arai, Yumiko Tomoyasu, Hitoshi Higuchi, Shigeru Maeda, Takuya Miyawaki

Journal of Japanese Dental Society of Anesthesiology 42 ( 3 ) 301 - 302 2014

A case of uncontrolled postoperative bleeding after oral surgery in a patient with deep venous thrombosis

Matsuri Kodama, Hitoshi Higuchi, Ayaka Yamane, Yumiko Tomoyasu, Minako Maruhama, Akiko Yabuki, Yuka Honda, Shigeru Maeda, Takuya Miyawaki

Journal of Japanese Dental Society of Anesthesiology 42 ( 3 ) 299 - 300 2014

A report of preoperative respiratory rehabilitation to patient with COPD undergoing oral and maxillofacial surgery

Megumi Mori, Hitoshi Higuchi, Yumiko Tomoyasu, Akiko Yabuki, Shigeru Maeda, Takuya Miyawaki

Journal of Japanese Dental Society of Anesthesiology 41 ( 5 ) 607 - 608 2013

A retrospective study on the risk factors for emergence agitation following general anesthesia

Yuka Honda, Shigeru Maeda, Hitoshi Higuchi, Yumiko Tomoyasu, Minako Ishii, Tomoko Hayashi, Kazuo Mukae, Ayaka Yamane, Akiko Yabuki, Takuya Miyawaki

Journal of Japanese Dental Society of Anesthesiology 41 ( 1 ) 21 - 25 2013

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

We performed a retrospective study on the risk factors for emergence agitation following general anesthesia in patients undergoing oral surgery in Okayama University Hospital between June 2011 and March 2012. This study was performed after approval by the Ethics Committee of the Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences. One hundred and eighty one patients aged more than 16 years old were enrolled. We used the Richmond Agitation and Sedation Scale (RASS, Table 1), which was developed to assess the level of agitation and sedation following general anesthesia The patients were divided into two groups : non-agitated patients (RASS score : -5 to 0) and agitated patients (RASS score : 1 to 4). The results were statistically analyzed using JMP 9.0.0 (SAS Institute, Cary, USA). In the univariate analysis, Fisher's exact test and the χ2 test were used to compare groups. A multivariable analysis was performed using stepwise logistic regression to separately determine risk factors of agitation. Of the 181 patients, emergence agitation occurred in 30 patients (16.6%). Agitation of level 1, 2, 3 or 4 of excitement according to the RASS was observed in 25, 4, 1, and 0 patients, respectively. Table 2 shows the risk factors of emergence agitation using univariate analysis. Emergence agitation was not correlated with age, BMI, duration of operation, postoperative pain, amount of opioid during the operation, or kind of postoperative analgesics, but was more common in males than females (p = 0.039) and also in patients who received general anesthesia than patients who received total intravenous anesthesia (p = 0.011). Table 3 shows the risk factors of emergence agitation using multivariate analysis by stepwise logistic regression. One variable was associated with emergence agitation. Inhalational anesthesia was the highest risk factor (odds ratio [OR] = 3.24
95% confidence interval [CI] = 1.23-10.17
p = 0.015). In conclusion, the results suggest that inhalational anesthesia was the highest risk factor of emergence agitation.

Midazolam is associated with delay in recovery and agitation after ambulatory general anesthesia for dental treatment in patients with disabilities: a retrospective cohort study. International journal

Shigeru Maeda, Yumiko Tomoyasu, Hitoshi Higuchi, Takayuki Mori, Masahiko Egusa, Takuya Miyawaki

Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 70 ( 6 ) 1315 - 20 2012.6

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

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

Partial laryngospasms during general anesthesia with a laryngeal mask airway for dental treatment: A report of 5 cases

Ayako Jinzenji, Shigeru Maeda, Hitoshi Higuchi, Keita Yoshida, Takayuki Mori, Masahiko Egusa, Takuya Miyawaki

Journal of Oral and Maxillofacial Surgery 68 ( 10 ) 2554 - 2557 2010.10

Partial laryngospasms during general anesthesia with a laryngeal mask airway for dental treatment: a report of 5 cases. International journal

Ayako Jinzenji, Shigeru Maeda, Hitoshi Higuchi, Keita Yoshida, Takayuki Mori, Masahiko Egusa, Takuya Miyawaki

Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 68 ( 10 ) 2554 - 7 2010.10

Sudden cardiac arrest in head and neck surgery: a case report Reviewed

Hitoshi Higuchi, Minako Ishii, Hideki Nakatsuka, Shigeru Maeda, Kiyoshi Morita, Takuya Miyawaki

JOURNAL OF ANESTHESIA 24 ( 1 ) 146 - 147 2010.2

Oral midazolam for sedation in minor oral operations in children: A retrospective study

Atsushi Kohjitani, Hitoshi Higuchi, Masahiko Shimada, Takuya Miyawaki

British Journal of Oral and Maxillofacial Surgery 46 ( 4 ) 330 - 331 2008.6

Publishing type：Research paper (scientific journal)

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

口腔外科手術におけるレミフェンタニルを用いた全身麻酔経験?セボフルラン・プロポフォール麻酔との併用?． Reviewed

秦泉寺紋子,前田茂,樋口仁,坂口舞,渡辺禎久,林由起子,友安弓子,吉田啓太,宮脇卓也

日本歯科麻酔学会雑誌 36 49-50 2008.4

知的障害者の全身麻酔下歯科治療における術前血液検査スクリーニングの必要性について. Reviewed

秦泉寺紋子, 前田茂, 吉田啓太, 樋口仁, 有岡享子, 北ふみ, 森貴幸, 石田瞭, 江草正彦, 宮脇卓也

障害者歯科 29 146-151 2008.4

歯科・口腔外科手術における精密鎮静法の有用性の検討． Reviewed

林由起子, 樋口仁, 前田茂, 吉田啓太, 秦泉寺紋子, 友安弓子, 渡辺禎久, 坂口舞, 吉冨達志, 宮脇卓也

岡山歯学会雑誌 27 19-22 2008.4

岡山大学病院歯科麻酔科における静脈内鎮静法に関するアンケート調査の検討． Reviewed

吉田啓太, 石井美菜子,林知子,坂口舞,林由起子, 渡辺禎久, 友安弓子, 秦泉寺紋子, 樋口仁, 前田茂, 宮脇卓也

岡山歯学会雑誌 27 89-92 2008.4

頸部CTにより発見された喉頭蓋嚢胞を有する患者の全身麻酔経験.

坂口舞,樋口仁,吉田啓太,林由起子,秦泉寺紋子,友安弓子,渡辺禎久,吉冨達志, 北ふみ, 前田茂,宮脇卓也

日本歯科麻酔学会雑誌 36 575-576 2008.4

Heme oxygenase-I induction in the brain during lipopolysaccharide-induced acute inflammation Reviewed

Shigeru Maeda, Ichiro Nakatsuka, Yukiko Hayashi, Hitoshi Higuchi, Masahiko Shimada, Takuya Miyawaki

Neuropsychiatric Disease and Treatment 4 ( 3 ) 663-667 - 667 2008.4

Publishing type：Research paper (scientific journal)

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

Dexmedetomidine enhances the local anesthetic action of lidocaine via an α-2A adrenoceptor Reviewed

YOSHITOMI T

Anesth Analg. 107 96-101 - 101 2008.4

知的障害者歯科治療時の静脈内鎮静法におけるプロポフォールの用手投与とTarget Controlled Infusion投与の比較 Reviewed

*樋口仁,前田茂,吉田啓太,糀谷淳,北ふみ,森貴幸,石田瞭,江草正彦,嶋田昌彦,宮脇卓也

障害者歯科 28 ( 4 ) 607 - 610 2007.4

岡山大学医学部・歯学部附属病院歯科麻酔科における過去10年間の麻酔中および麻酔後の合併症の臨床統計的検討

吉田啓太,前田茂,坂口舞,林由起子,渡辺禎久,秦泉寺紋子,友安弓子,*樋口仁,宮脇卓也:

岡山歯学会雑誌 26 ( 2 ) 83 - 86 2007.4

筋緊張性ジストロフィー患者に対し術前にCICR(Ca-induced Ca release)速度測定を行った全身麻酔症例

渡辺禎久、吉田啓太、林由起子、*樋口仁、糀谷淳、前田茂、宮脇卓也、嶋田昌彦

日本歯科麻酔学会雑誌 35(1),70-71 2007.4

口腔外科手術後の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との比較

友安弓子、*樋口仁、吉田啓太、渡辺禎久、林由起子、糀谷淳、前田茂、宮脇卓也、嶋田昌彦

日本歯科麻酔学会雑誌 35(2),197-201 ( 2 ) 197 - 201 2007.4

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)

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

口腔外科手術患者の術後鎮静における塩酸デクスメデトミジンをベースとしたプロポフォールによるPatient-Controlled Sedation Reviewed

*樋口仁,前田茂,吉田啓太,林由起子,友安弓子,坂口舞,秦泉寺紋子,渡辺禎久,宮脇卓也

日本歯科麻酔学会雑誌 35 ( 5 ) 693 - 694 2007.4

Dental management of a patient with takotsubo cardiomyopathy : a case report

HIGUCHI H

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103 e26-e29 ( 3 ) e26 - e29 2007.4

レミフェンタニル?本邦での臨床使用に際して最近の話題? Reviewed

11. 溝渕知司,佐藤健治,花?元彦,中塚秀輝, 渡辺禎久,*樋口仁

臨床麻酔 31 ( 1 ) 93 - 100 2007.1

岡山大学医学部・歯学部附属病院における静脈内鎮静下におけるインプラント治療の検討

吉田啓太、渡辺禎久、林由起子、秦泉寺紋子、友安弓子、樋口仁、糀谷淳、前田茂、宮脇卓也

岡山歯学会雑誌 2006.4

The Influence of Antiepileptic Drugs on Intravenous Sedation with Midazolam and Propofol for Dental Treatments in Patients with Intellectual Disabilities

NISHI Chikako, YOSHIDA Keita, TOMOYASU Yumiko, HIGUCHI Hitoshi, KOHJITANI Atsushi, MAEDA Shigeru, MIYAWAKI Takuya, SHIMADA Masahiko

34 ( 2 ) 169 - 172 2006.4

知的障害者歯科治療における精密鎮静法の試み -Bispectral Index(BIS)およびTarget Controlled Infusion（TCI）の応用-

*樋口仁、前田茂、糀谷淳、吉田啓太、秦泉寺紋子、林由起子、友安弓子、渡辺禎久、宮脇卓也

岡山歯学会雑誌 25 ( 2 ) 53 - 57 2006.4

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。

本院における自己血輸血準備および実地の状況について

吉田啓太、前田茂、友安弓子、西周子、樋口仁、糀谷淳、宮脇拓也、嶋田昌彦

日本歯科麻酔学会雑誌 2005.4

岡山大学歯学部附属病院（現：岡山大学医学部・歯学部附属病院）における同種血輸血準備および実施の現状について

吉田啓太、前田茂、友安弓子、西周子、*樋口仁、糀谷淳、宮脇拓也、嶋田昌彦

日本歯科麻酔学会雑誌 33 ( 2 ) 234 - 238 2005.4

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

Analysis of homologous blood transfusion at the Okayama University Dental Hospital (Okayama University Medical and Dental Hospital)

Keita Yoshida, Shigeru Maeda, Yumiko Tomoyasu, Chikako Nishi, Hitoshi Higuchi, Atsushi Kohjitani, Takuya Miyawaki, Masahiko Shimada

Journal of Japanese Dental Society of Anesthesiology 33 ( 2 ) 234 - 238 2005

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.

Analysis of autologous blood transfusion at the Okayama University Medical and Dental Hospital

Keita Yoshida, Shigeru Maeda, Yumiko Tomoyasu, Chikako Nishi, Hitoshi Higuchi, Atsushi Kohjitani, Takuya Miyawaki, Masahiko Shimada

Journal of Japanese Dental Society of Anesthesiology 33 ( 3 ) 428 - 432 2005

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

Autologous transfusion is widely used in many surgical procedues because of its safety. It allows avoidance of infectious disease mediated by blood. At Okayama University Dental Hospital, cases of autologous transfusion has increased in the last several years. However, autologous transfsusion depends on the subjective judgement of the physician in charge of the patient. Therefore, we assessed the autologous transfusion in scheduled surgery performed in the last five years at our hospital. We investigated 198 cases. Most of the cases were repositioning of the mandible, the maxilla or both. The number of instances of each procedure were 93, 10 and 91, respectively. The mean values of blood loss were 169.9 ml, 232.5 ml and 330.2 ml, respectively (Fig. 1). The rates of cases in which blood loss was more than 600 ml were 4.3%, 0% and 11%, respectively (Fig. 2). The averages of amounts of autologous blood prepared were 409.6 ml, 382.2 ml and 448.3 ml, respectively (Fig. 3). For repositioning of both mandible and maxilla, a preserved autologous transfusion was prepared in 80.2% of the cases. For repositioning of the mandible, a dilutional autologous transfusion was prepared in 67.7% of the cases (Fig. 4). The preserved autologous transfusion was carried out in 9.5% of the cases involving repositioning of both mandible and maxilla, and in none of other repositioning surgeries (Fig. 5). Mean values of hemoglobin before surgeries in patients whose preserved autologous blood had been taken a couple of weeks prior to surgery were within normal range (Fig. 6). Since no homologous transfusion was necessary in any of the cases, we believe that one of the goals of autologous transfusion was achieved. However, preparing autologous transfusion may be done excessively for these procedures. Furthermore, since a small amount of dilutional autologous transfusion in our facility may not be effective, the preparation of autologous blood for the repositioning of the mandible should be re-assessed carefully.

岡山大学歯学部附属病院における５年間の院内救急症例の検討

友安弓子,吉田啓太, 西周子, 北ふみ, *樋口仁, 糀谷淳, 前田茂, 宮脇拓也, 嶋田昌彦

日本歯科麻酔学会雑誌 2004.4

Effects of Isoflurane-Induced and Prostaglandin E1-Induced Hypotension on Cytokine Responses to Oral and Maxillofacial Surgery

Takuya Miyawaki, Atsushi Kohjitani, Shigeru Maeda, *Hitoshi Higuchi, Masahiko Shimada

Journal of Clinical Anesthesia 2004.4

Prevalence of blood Pressure levels and hypertension-related diseases in Japanese dental patients

Takuya Miyawaki, Fusanori Nishimura, Atsushi Kohjitani, Shigeru Maeda, *Hitoshi Higuchi, Fumi Kita and Masahiko Shimada

Community Dental Health 2004.4

Serum cortisol level and depth of propofol-induced sedation

T. Miyawaki, A. Kohjitani, S. Maeda, F. Kita, *H. Higuchi, M. Shimada

Acta Anaesthesiol Scand 2004.4

Intravenous sedation for dental patients with intellectual disability

MIYAWAKI T.

J. Intellect. Disabil. Res. 48 764 - 768 2004.4

Serum cortisol level and depth of propofol-induced sedation [1]

Takuya Miyawaki, A. Kohjitani, S. Maeda, F. Kita, H. Higuchi, M. Shimada

Acta Anaesthesiologica Scandinavica 48 ( 3 ) 384 - 385 2004.3

Medical emergencies at Okayama University Dental Hospital during the recent 5-year period

Yumiko Tomoyasu, Keita Yoshida, Chikako Nishi, Fumi Kita, Hitoshi Higuchi, Atsushi Kohjitani, Shigeru Maeda, Takuya Miyawaki, Masahiko Shimada

Journal of Japanese Dental Society of Anesthesiology 32 ( 5 ) 624 - 625 2004

Suppression of the hyperpolarization-activated inward current contributes to the inhibitory actions of propofol on rat CA1 and CA3 pyramidal neurons

HIGUCHI Hitoshi, FUNAHASHI Makoto, MIYAWAKI Takuya, MITOH Yoshihiro, KOHJITANI Atsushi, SHIMADA Masahiko, MATSUO Ryuji

Neuroscience Research 45 ( 4 ) 459 - 472 2003.4

Ketamine and Midazolam Differentially Inhibit Nonadrenergic Noncholinergic Lower Esophageal Sphincter Relaxation in Rabbits: Role of Superoxide Anion and Nitric Oxide Synthase

Atsushi Kohjitani, Takuya Miyawaki, Makoto Funahashi, *Hitoshi Higuchi, Ryuji Matsuo and Masahiko Shimada :

Anesthesiology 2003.4

A report of a damaged endotracheal tube during oral surgery

Fumi Kita, Takuya Miyawaki, Atsushi Kohjitani, Shigeru Maeda, Hitoshi Higuchi, Keita Yoshida, Masahiko Shimada

Journal of Japanese Dental Society of Anesthesiology 31 ( 1 ) 39 - 40 2003

Propofol suppresses a hyperpolarization-activated inward current in rat hippocampal CA1 neurons

Makoto Funahashi, Hitoshi Higuchi, Takuya Miyawaki, Masahiko Shimada, Ryuji Matsuo

Neurosci. Lett. 311 177 - 180 2001.4

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