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

32歳、妊娠26週。カルバマゼピン内服により10年以上てんかん発作なく経過していたが、てんかん発作を疑う意識消失により転倒して受傷し、下顎正中部骨折および両側下顎骨関節突起部骨折の診断で3日後に全身麻酔下で観血的整復固定術を予定した。術前の産婦人科による対診で胎児の異常所見は認めなかった。カルバマゼピン内服を継続し、手術日朝のカルバマゼピン血中濃度は4.38μg/mLであった。麻酔導入はフェンタニル・プロポフォール・ロクロニウムで行い、デスフルランとレミフェンタニルで麻酔維持し、麻酔時間は2時間39分、手術時間は1時間41分であった。術中胎児心拍数は135～139回/分で推移し、翌日以降も胎児の健常性が確認され、経過良好で術後34日に退院した。妊娠39週4日に正常分娩で出生し、新生児に明らかな形態的・機能的な異常は認めなかった。

Language：Japanese   Publisher：The Japanese Dental Society of Anesthesiology  

<p>  Methylmalonic acidemia (MMA) is an autosomal recessive disorder and a metabolic disorder of organic acids in which the accumulation of methylmalonic acids causes various symptoms. MMA has several features related to acidosis, and the prevention of acidosis through nutritional management is necessary.</p><p>  We performed the anesthetic management of a 7-year-old girl with MMA. She was diagnosed as having MMA during newborn screening, and she exhibited mental retardation and malnutrition. She was able to take nutrition orally, but she gradually became unable to eat because of vomiting ; she underwent a gastrostomy at the age of 2 years and 9 months old. Her kidney function gradually worsened, and a kidney transplantation was scheduled. Her oral hygiene was poor, and several calculus deposits were visible. Because the patient was noncooperative, periodontal treatment under general anesthesia was scheduled before the kidney transplantation.</p><p>  Our anesthetic goal was to maintain her metabolism : in particular, we sought to minimize her required fasting time, and we gave her sugar, as appropriate, to prevent an increase in catabolism. The anesthesia was induced with sevoflurane, midazolam, propofol, fentanyl and rocuronium and was maintained with desflurane and remifentanil. We performed a blood analysis twice using samples collected from the right femoral artery before and after the operation ; the results showed that her metabolism remained under control during the operation. The operation was completed uneventfully ; because her respiration was good after extubation, she was transferred to the pediatric ward. She has since received a kidney transplantation using an organ from her father, as planned. This case shows that importance of managing a patient’s nutrition before and after operation.</p>

DOI： 10.24569/jjdsa.50.1_11

CiNii Research

Language：Japanese   Publisher：The Japanese Dental Society of Anesthesiology  

<p>  Radical brachiocephalic artery transection is often performed for the treatment of tracheo-innominate artery fistula. Postoperatively, the blood flow to the right upper extremity is supplied through the left carotid artery, the Willis arterial ring, and the right subclavian artery. Therefore, brain circulation may decrease when blood flow to the right upper extremity is increased.</p><p>  We performed anesthesia for dental treatment in a 14-year-old girl with a history of radical brachiocephalic artery transection. She was 138 cm in height and 17.2 kg in weight, and she had undergone radical brachiocephalic artery transection and tracheal plasty for the treatment of tracheal stenosis at the age of 13 years.</p><p>  A pulse oximeter was applied to her right finger to evaluate oxygen saturation and blood flow to her right upper extremity continuously. A probe for the noninvasive monitoring of regional oxygen saturation (rS<span style="font-variant: small-caps;">o</span>₂) was also placed on her forehead to evaluate cerebral blood flow continuously. Anesthesia was induced with intravenous midazolam, propofol, atropine, remifentanil and rocuronium, and the patient was intubated using a spiral tube (ID, 5.0 mm) nasally. The anesthesia was maintained using 1%-1.5% isoflurane. The rS<span style="font-variant: small-caps;">o</span>₂ transiently decreased from 70% to 53% on the right side during the induction of anesthesia, but it recovered quickly and was maintained at around 70%-90% during the operation. The pulse wave in the right finger was continuously detected during anesthesia, and the Sp<span style="font-variant: small-caps;">o</span>₂ was maintained at 97%-100%. The dental procedure was completed uneventfully. After emergence from the anesthesia, the movement of her right upper extremity was the same as before surgery.</p><p>  In the present case, isoflurane was used to prevent an epilepsy seizure. The noninvasive monitoring of regional oxygen saturation (rS<span style="font-variant: small-caps;">o</span>₂) was helpful for evaluating cerebral blood flow during anesthesia.</p>

DOI： 10.24569/jjdsa.50.1_8

CiNii Research

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

症例は14歳女児。生後13日に脳室周囲白質軟化症と診断され、生後3ヵ月で点頭てんかんを発症し、内服薬でコントロールされていた。12歳時の胸部CTにて気管分岐部直上の気管狭窄、縦隔の扁平化が指摘された。胸骨と腕頭動脈による気管の圧迫があり、13歳時に腕頭動脈離断術と気管吊り上げ術を受けた。今回、かかりつけ医で全顎にわたるう蝕を指摘され、全身麻酔下での歯科治療目的に紹介受診となった。その麻酔経過を報告した。右示指にパルスオキシメーターを装着し、さらに経時的脳血流量測定のため両側前額部に局所脳酸素飽和度(rSo2)センサーのプローブを貼付した。う蝕治療21歯と抜歯1本で、治療時間は3時間11分、術中のSpO2は97～100%、rSO2は右側69～88%、左側75～95%で推移した。

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

症例は7歳1ヵ月の女児。先天性代謝異常症スクリーニングでメチルマロン酸血症(MMA)と診断された。経時的に腎機能障害が進行し、腎移植の方針となった。移植前の周術期口腔管理の際に歯周病を指摘され、全身麻酔下で歯科治療および歯周治療を施行した。その麻酔経過を報告した。MMA患者の麻酔管理では、急性代謝不全の発症を防ぐことが重要であり、術前絶食時間を極力短くすることに配慮し、入室4時間30分前まで胃瘻からの栄養投与を継続し、術直後は速やかに栄養投与を再開した。また、肝代謝の負担を考慮し、導入時のみプロポフォールを使用し、他の薬剤も短時間作用性で腎代謝の少ないものを選択した。麻酔時間は3時間33分、覚醒は良好で呼吸も安定していた。2ヵ月後、実父からの腎移植を受け、現在経過観察中である。

Event date： 2023.11

Language：Japanese  

Venue：出島メッセ⻑崎   Country：Japan  

Event date： 2022.6

Language：Japanese  

Country：Japan  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

症例は77歳女性で、左側舌下腺悪性腫瘍の診断で、口腔底部分切除術、下顎骨辺縁切除術、左顎下部郭清術を全身麻酔下に施行した。手術開始前から術翌日の離床まで弾性ストッキングを着用し、間欠的空気圧迫装置を装着した。全身麻酔は、酸素、フェンタニル、レミフェンタニル、プロポフォール、ロクロニウムで急速導入を行い、酸素、空気、デスフルラン、レミフェンタニルで維持した。経過良好であり特に異常を認めなかったが、術後2日目の午前中に歩行の際に意識消失して転倒した。すぐに意識は回復したが、軽度の呼吸苦、全身発汗、嘔気を認めた。造影コンピュータ断層撮影(CT)検査では、右側優位に前肺底動脈の中枢から末梢にわたり血栓を認めた。肺血栓塞栓症(PTE)と診断し治療を開始した。リザーバー付き酸素マスクで酸素投与とヘパリンの持続投与を開始した。APTTの延長不十分であったため、発症翌日からは抗凝固薬のアピキサバン内服を開始した。術後11日目に造影CT、肺血流シンチグラフィーで両側前肺底動脈に血栓の残存を認めたが、血栓は画像上縮小し、Dダイマーは改善した。術後34日に軽快退院し、以後良好に経過している。