歯科口腔外科手術における高齢患者の麻酔方法と術前合併疾患に関する検討

歯科口腔外科手術における高齢患者の麻酔方法と術前合併疾患に関する検討


Pronounced QTc Prolongation During General Anesthesia in a Child with Left Ventricular Non-Compaction Cardiomyopathy

We report the case of an 8-year-old boy with left ventricular noncompaction cardiomyopathy (LVNC) and QT prolongation who experienced further prolongation of the QTc during general anesthesia for extraction of a maxillary mesiodens. Pronounced prolongation of the QTc was observed after induction of general anesthesia with thiamylal and during emergence. No notable fluctuations in blood pressure, heart rate, and estimated continuous cardiac output were observed. We considered it likely that the QT prolongation was triggered by thiamylal and increased sympathetic nervous system activity. During general anesthesia for children with LVNC and QT prolongation, it is necessary to monitor intraoperative hemodynamic fluctuations and prepare for the possible occurrence of arrhythmias.


機器紹介 インターサージカル個人防護用呼吸マスク「i-Proマスク」

機器紹介 インターサージカル個人防護用呼吸マスク「i-Proマスク」


下咽頭梨状窩瘻に対しトリクロル酢酸で化学的焼灼術を施行した1症例

下咽頭梨状窩瘻に対しトリクロル酢酸で化学的焼灼術を施行した1症例

下咽頭梨状窩瘻の治療方法は通常，外科的に前頸部を切開して瘻管摘出術が行われるが，前頸部切開創跡による美容上の問題は無視できず，より低侵襲な治療法が求められている．当院小児科ではトリクロル酢酸を用いて口側から瘻管を化学的に焼灼する方法を考案した．今回，本法を5歳男児例に施行し，良好な結果が得られたので報告した．本法は外科的摘出術を回避できるため有用性は高いが，経鼻挿管が必要であり，上体を挙上した特殊な体位で行うため，呼吸・循環動態の変動に注意を要し，口腔内の内視鏡操作による気管チューブ閉塞や事故抜管が起こらないよう細心の注意を払う必要がある．


複数回の再手術を要し血友病Bと判明した舌裂傷の1症例

複数回の再手術を要し血友病Bと判明した舌裂傷の1症例


Total Intravenous Anesthesia Using Remimazolam and Continuous Cardiac Output Monitoring for Dental Anesthesia in a Patient With Takayasus Arteritis: A Case Report

Takayasu's arteritis is a persistent chronic progressive inflammation of the large- and medium-caliber arteries. Controlling cardiovascular variability during anesthesia and overcoming difficulties of cardiovascular monitoring due to the impaired vessels are important in patients with Takayasu's arteritis. Remimazolam is a novel short-acting benzodiazepine with mild effects on hemodynamics. We report the case of a patient with Takayasu's arteritis who underwent oral surgery under general anesthesia. This report highlights the use of remimazolam and remifentanil to reduce hemodynamic perturbations using estimated continuous cardiac output monitoring.


Successful Anesthesia Management of a First-trimester Pregnant Patient Requiring Oral Malignancy Ablative Surgery Using Intravenous Sedation and a Lingual Nerve Block : A Case Report

静脈内鎮静法と舌神経ブロックで管理した 妊娠初期患者の舌腫瘍切除術の 1 例

Journal of Japanese Dental Society of Anesthesiology


Comparison of Four Types of Airway Management Simulator in Tracheal Intubation

心肺蘇生教育に用いる気道管理シミュレータ4種類の気管挿管手技における比較

The Journal of Japanese Dental Education Association

日本歯科医学教育学会雑誌


Pronounced QTc Prolongation during Induction of and Awakening from General Anesthesia in a Child with Left Ventricular Non-compaction Cardiomyopathy : A Case Report

全身麻酔導入および覚醒時に顕著なQTc延長を認めた左室心筋緻密化障害患児の1例


Management of a patient with tracheal stenosis after previous tracheotomy

Tracheal stenosis after tracheotomy can cause difficult airway management and respiratory complications. It is difficult to predict tracheal stenosis after tracheotomy based on a patient's symptoms as the symptoms of tracheal stenosis appear only after they become severe. In patients with a history of previous tracheotomy, it is important to consider the risk factors for tracheal stenosis. Detailed preoperative evaluation of patients with a history of previous tracheotomy is essential and should include 3-dimensional assessment of the airway. We report the preoperative assessment and perioperative management of an 83-year-old woman at high risk for tracheal stenosis due to a previous emergency tracheotomy who was scheduled to undergo general anesthesia for a right maxillectomy for squamous cell carcinoma. Preoperative anteroposterior chest radiograph revealed findings indicative of tracheal stenosis. Additional detailed examinations of the stenotic area were conducted with computed tomography imaging and bronchofiberscopy. General anesthesia with nasotracheal intubation was performed, and although there were no adverse intraoperative events, stridor after extubation was observed. Nebulized epinephrine was administered via an ultrasound nebulizer and effectively improved the patient's postoperative transient dyspnea.


A Retrospective Case Series of Anesthetic Patients With Epiglottic Cysts

Previously undiagnosed or asymptomatic epiglottic cysts may be coincidentally detected during intubation. This retrospective case series identified undiagnosed epiglottic cysts that were discovered during intubation in 4 patients who underwent oral surgery under general anesthesia at our hospital during a 6-year period. Including 2 additional cases, 1 previously diagnosed and 1 detected during preoperative imaging, epiglottic cysts were observed in 6 of 1112 cases (0.54%) total. Among the undiagnosed epiglottic cyst cases, mild dyspnea on effort or snoring was reported in 2 patients, but all others were asymptomatic. Upon discovering previously undiagnosed epiglottic cysts during intubation, it is essential to proceed cautiously, remain alert for potential airway management difficulties, and avoid injuring or rupturing the cysts. In addition, any available preoperative imaging should be reviewed as information pertinent to the airway and any abnormalities may be useful. This report discusses the anesthetic care of 6 patients with epiglottic cysts that were previously known or initially discovered during intubation.


Clinically relevant concentration of propofol and benzodiazepines did not affect in vitro angiogenesis.

Angiogenesis, one of regenerative medicine, is essential in the process of wound healing. The detailed effects of intravenous anesthetics and sedatives used during perioperative period have not yet been clarified. We investigated the effects of benzodiazepines and propofol on in vitro capillary tube formation. The effects of midazolam, diazepam and propofol (1, 10, 50 M each) on proliferation of human umbilical vein endothelial cells (HUVEC) and normal human diploid fibroblasts (NHDF) were determined. Quantitation of migration was achieved by measuring the fluorescence of migrating HUVEC using angiogenesis system. The effects of midazolam, diazepam and propofol on in vitro angiogenesis were investigated in co-cultured HUVEC and NHDF incubated. The effects of midazolam on activation of p38 mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinases were examined by Western blot analysis using phospho-specific antibodies. Parametric data were analyzed with one-way repeated measures analysis of variance followed by the Scheff test. A value of P < 0.05 was considered statistically significant. Fifty M of midazolam significantly impaired endothelial cell proliferation, migration, and in vitro capillary tube formation. Propofol, diazepam or lower dose midazolam did not show any enhancing or suppressive effects on in vitro angiogenesis. Fifty M of midazolam remarkably activated ERK, but not p38 MAPK in HUVEC. Propofol and benzodiazepines except high-dose midazolam did not affect in vitro angiogenesis. High-dose midazolam may impair in vitro capillary tube formation due to by suppressing proliferation and migration of endothelial cells via activation of ERK.


Human Vascular Smooth Muscle Function and Oxidative Stress Induced by NADPH Oxidase with the Clinical Implications

<jats:p>Among reactive oxygen species, superoxide mediates the critical vascular redox signaling, resulting in the regulation of the human cardiovascular system. The reduced form of nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase, NOX) is the source of superoxide and relates to the crucial intracellular pathology and physiology of vascular smooth muscle cells, including contraction, proliferation, apoptosis, and inflammatory response. Human vascular smooth muscle cells express NOX1, 2, 4, and 5 in physiological and pathological conditions, and those enzymes play roles in most cardiovascular disorders caused by hypertension, diabetes, inflammation, and arteriosclerosis. Various physiologically active substances, including angiotensin II, stimulate NOX via the cytosolic subunits' translocation toward the vascular smooth muscle cell membrane. As we have shown, some pathological stimuli such as high glucose augment the enzymatic activity mediated by the phosphatidylinositol 3-kinase-Akt pathway, resulting in the membrane translocation of cytosolic subunits of NOXs. This review highlights and details the roles of human vascular smooth muscle NOXs in the pathophysiology and clinical aspects. The regulation of the enzyme expressed in the vascular smooth muscle cells may lead to the prevention and treatment of human cardiovascular diseases.</jats:p>


Cytoskeleton-disrupting agent cytochalasin B reduces oxidative stress caused by high glucose in the human arterial smooth muscle

The role of cytoskeleton dynamics in the oxidative stress toward human vasculature has been unclear. The current study examined whether the cytoskeleton-disrupting agent cytochalasin B reduces oxidative stress caused by high glucose in the human arterial smooth muscle. All experiments in the human omental arteries without endothelium or the cultured human coronary artery smooth muscle cells were performed in d-glucose (5.5 mmol/L). The exposure toward d-glucose (20 mmol/L) for 60 min reduced the relaxation or hyperpolarization to an ATP sensitive K channel (KATP) opener levcromakalim (10 to 3 × 10 mol/L and 3 × 10 mol/L, respectively). Cytochalasin B and a superoxide inhibitor Tiron, restored them similarly. Cytochalasin B reduced the NADPH oxidase activity, leading to a decrease in superoxide levels of the arteries treated with high d-glucose. Also, cytochalasin B impaired the F-actin constitution and the membrane translocation of an NADPH oxidase subunit p47phox in artery smooth muscle cells treated with high d-glucose. A clinical concentration of cytochalasin B prevented human vascular smooth muscle malfunction via the oxidative stress caused by high glucose. Regulation of the cytoskeleton may be essential to keep the normal vascular function in patients with hyperglycemia.


Pathophysiology and complications during extracorporeal circulation

The Journal of Medical Investigation : JMI


Inferior alveolar nerve paresthesia caused by the extrusion of calcium hydroxide-based paste into themandibular canal: A case report.

Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology


Electrons released from both flavins of NADPH-P450 reductase contribute to the reductive mobilization of iron from ferritin.

Ferritin, an iron storage protein, plays an important role in iron homeostasis. The mechanism of reductive mobilization of iron from ferritin has not been clarified yet despite many studies. The aim of this study was to assess the mechanisms of the mobilization of iron from ferritin by NADPH P-450 reductase. Nucleotide-dependent flavoenzymes generated significant mobilization of iron from ferritin. The possibility of reductive mobilization of iron from ferritin by electrons released from flavin sites or heme site of two flavoenzymes was investigated to elucidate the mediator-independent mechanisms of such reductive mobilization. The mobilization by NADPH-P450 reductase in the presence of ferricyanide increased threefold, while in the presence of cytochrome C increased thirteen-fold. These results indicate that electrons released from both flavins of NADPH-P450 reductase contribute to the reductive mobilization of iron from ferritin. The mechanism of the mobilization of iron from ferritin is discussed. J. Med. Invest. 66 : 230-232, August, 2019.


Continuous blood glucose monitoring during pediatric cardiopulmonary bypass.


Accuracy and reliability of continuous blood glucose monitoring during pediatric cardiopulmonary bypass.

The purpose of this study was to assess the accuracy and reliability of a continuous blood glucose monitoring system (artificial endocrine pancreas; STG-55, Nikkiso, Tokyo, Japan) during pediatric cardiopulmonary bypass surgery. Twenty-five pediatric patients scheduled to undergo cardiovascular surgery with cardiopulmonary bypass (age 4 months to 11 years; body weight 5.6-59.7 kg) were enrolled. The glucose sensor line of the artificial endocrine pancreas was connected to the venous side of the cardiopulmonary bypass circuit and used for continuous blood glucose monitoring. We obtained 192 samples for blood gas assessment from the cardiopulmonary bypass circuit, and i-STAT (Abbott, East Windsor, NJ, USA) was used for conventional blood glucose assessment. The accuracies of continuous glucose measurements (STG-55) and conventional intermittent glucose measurements (i-STAT) during cardiopulmonary bypass were compared by means of Clarke error grid analysis. The results were divided into five zones, A, B, C, D, and E, and 78.6% of paired measurements were in zone A, while 21.4% were in zone B. We confirmed that the results of this continuous blood glucose monitoring system for cardiopulmonary bypass during pediatric cardiovascular surgery were highly reliable. An artificial endocrine pancreas may facilitate the safe use of intensive insulin therapy during pediatric cardiovascular surgery.


Ultrasound-guided Peripheral Nerve Block and General Anesthesia for Hepatectomy in a Patient with Chronic Inflammatory Demyelinating Polyneuropathy

慢性炎症性脱髄性多発根ニューロパチー患者に対する肝切除術の麻酔経験


Peripartum Cardiomyopathy after Cesarean Section in a Patient with Myotonic Dystrophy

帝王切開後に産褥性心筋症を発症し心不全に陥った筋緊張性ジストロフィー妊婦の麻酔経験


Intraoperative Change in QTc in a Patient with a Prolonged QTc Interval

QTc延長患者における全身麻酔中のQTc変動

 Long QT syndrome is characterized by a prolongation of the QT interval and a morphological change in the T wave on an electrocardiogram. Prolongation of the QT interval is associated with serious arrhythmia and may cause syncope and sudden death. A 13-year-old male with a prolonged corrected QT interval (QTc) on a preoperative electrocardiogram was scheduled to undergo the extractation of a supernumerary tooth under general anesthesia.

 Although he had no remarkable past medical history, his QTc was prolonged to 514 ms on a 12-lead electrocardiogram. There was no history of syncope or sudden death in his family. The QTc at the time of his entrance into the operation room was 483 ms. During surgery, his QTc was continuously monitored in addition to the usual intraoperative monitoring. After the rapid introduction of anesthesia with remifentanil and propofol, the anesthesia was maintained with remifentanil and sevoflurane in oxygen and air. No significant change in the QTc was observed at the time of tracheal intubation accompanied by sympathetic stimulation. There was also no significant change in the QTc after the administration of atropine for bradycardia. However, when 2% lidocaine containing adrenaline was used for local anesthesia, the QTc gradually became prolonged reaching a maximum of 507 ms. In patients with a prolonged QT interval on a preoperative electrocardiogram, careful attention may be needed during the use of local anesthetics containing adrenaline. In addition, continuous monitoring of the QTc during surgery may be useful for the prevention of serious arrhythmias.

Journal of Japanese Dental Society of Anesthesiology


The unique action of nicorandil on cerebral circulation.


Nasotracheal intubation through pharyngeal flap after pharyngeal flap construction.


閉塞型睡眠時無呼吸症候群を伴った成人スティル病患者の嚢胞摘出術における静脈内鎮静法下患者管理の経験


Stevens-Johnson症候群の既往がある難治性てんかん患者の全身麻酔経験


Successful treatment of mixed (mainly cancer) pain by tramadol preparations

The patient, a 70-year-old Japanese woman diagnosed with parotid gland cancer, underwent wide excision and reconstruction (facial nerve ablation, nerve transposition). At 1 month after the surgery, she was brought to our hospital's pain medicine department because her postoperative pain and cancer-related pain were poorly controlled. She had already been prescribed a tramadol (37.5 mg)/acetaminophen (325 mg) combination tablet (5 tablets/day). However, in addition to the continuous pain in her face and lower limbs, she was troubled by a trigeminal neuralgia-like prominence ache. Because this pain could not be controlled by an increase to eight combination tablets per day, we switched her medication to a tramadol capsule. At 11 months post-surgery, we then switched her medication to an orally disintegrating tramadol tablet to improve medication adherence of the drug. From 14 months post-surgery, the patient also used a sustained-release tramadol preparation, and she was then able to sleep well. Her current regimen is an orally disintegrating sustained-release tablet combination (total 300 mg tramadol) per day, and she achieved sufficient pain relief. Because tramadol is not classified as a medical narcotic drug, it widely available and was shown here to be extremely useful for the treatment of our patient's mixed (mainly cancer) pain. J. Med. Invest. 64: 311-312, August, 2017.

The Journal of Medical Investigation : JMI


Strict blood glucose control by an artificial endocrine pancreas during hepatectomy may prevent postoperative acute kidney injury

The aim of the present study was to evaluate the usefulness of a closed-loop system (STG-55; Nikkiso, Tokyo, Japan), a type of artificial endocrine pancreas for the continuous monitoring and control of intraoperative blood glucose, for preventing postoperative acute kidney injury (AKI) in patients undergoing hepatectomy. Thirty-eight patients were enrolled in this study. Glucose concentrations were controlled with either a manual injection of insulin based on a commonly used sliding scale (manual insulin group, n = 19) or the programmed infusion of insulin determined by the control algorithm of the artificial endocrine pancreas (programmed insulin group, n = 19). After the induction of anesthesia, a 20-G intravenous catheter was inserted into the peripheral forearm vein of patients in the programmed insulin group and connected to an artificial endocrine pancreas (STG-55). The target range for glucose concentrations was set to 100-150 mg/dL. The mean serum creatinine concentrations of preoperative, postoperative 24 and 48 h were 0.72, 0.78, and 0.79 mg/dL in the programmed insulin group, and 0.81, 0.95, and 1.03 mg/dL in the manual insulin group, respectively. Elevations in serum creatinine concentrations postoperative 48 h were significantly suppressed in the programmed insulin group. The STG-55 closed-loop system was effective for maintaining strict blood glucose control during hepatectomy with minimal variability in blood glucose concentrations and for suppressing elevations in serum creatinine concentrations. Strict blood glucose control by an artificial endocrine pancreas during hepatectomy may prevent postoperative AKI.


Anesthetic management of a patient with unruptured sinus of valsalva aneurysm with right ventricular outflow tract obstruction.


Role of transesophageal echocardiography during biventricular pacemaker implantation in children


特発性間質性肺炎を合併した患者に対する口腔外科長時間手術の全身麻酔経験

特発性間質性肺炎を合併した患者に対する口腔外科長時間手術の全身麻酔経験


静脈穿刺により発症した血管迷走神経性失神時に心拍変動解析を行った1例

静脈穿刺により発症した血管迷走神経性失神時に心拍変動解析を行った1例


Impact of newly developed, next-generation artificial endocrine pancreas

Recent studies have shown that strict perioperative blood glucose management may reduce mortality and morbidity in critically ill adult patients. The purpose of this study was to assess the accuracy and efficacy of the intraoperative application of a newly developed, next-generation artificial endocrine pancreas (STG-55, Nikkiso Co., Ltd., Tokyo, Japan). Twenty patients scheduled to undergo surgery were enrolled in this study. The STG-55 is designed to be more user-friendly than its conventional counterpart (STG-22) while maintaining the latter's fundamental functions, such as a closed-loop system using algorithms for insulin and glucose infusion. After anesthetic induction, a 20G intravenous catheter was inserted into a peripheral forearm vein and connected to a continuous blood glucose monitor. The resultant 105 scores for paired blood glucose values were compared by Bland-Altman analysis. Stable blood glucose values were maintained automatically, and there were no complications related to use of the STG-55. A close correlation (r=0.96) was observed between continuous glucose measurements using the STG-55 and conventional intermittent glucose measurements. The difficulty of manipulation using this system was decreased by improved preparation procedures. The glycemic control system using the STG-55 could provide an alternative way to achieve effective and safe perioperative glycemic control.

The Journal of Medical Investigation : JMI


Cuffed oropharyngeal airway for difficult airway management.

Abstract Difficulties with airway management are often caused by anatomic abnormalities due to previous oral surgery. We performed general anesthesia for a patient who had undergone several operations such as hemisection of the mandible and reconstructive surgery with a deltopectoralis flap, resulting in severe maxillofacial deformation. This made it impossible to ventilate with a face mask and to intubate in the normal way. An attempt at oral awake intubation using fiberoptic bronchoscopy was unsuccessful because of severe anatomical abnormality of the neck. We therefore decided to perform retrograde intubation and selected the cuffed oropharyngeal airway (COPA) for airway management. We inserted the COPA, not through the patient's mouth but through the abnormal oropharyngeal space. Retrograde nasal intubation was accomplished with controlled ventilation through the COPA, which proved to be very useful for this difficult airway management during tracheal intubation even though the method was unusual.


Propofol-induced relaxation of rat aorta is altered by aging.

Propofol causes vasodilation via endothelium-dependent and -independent mechanisms. Because endothelial function is impaired with aging, the effects of propofol on endothelium-dependent vasodilation might be altered by aging. The aim of this study was thus to determine the effects of aging on vascular responses to propofol. Young (4-6 weeks old) or adult (16-25 weeks old) rats were anesthetized with sevoflurane. The thoracic aorta was dissected and cut into pieces 3-4 mm in length. In some rings, the endothelium was deliberately removed. The ring segment of the aorta was mounted for isometric force recording at a resting tension of 0.5-1.0 g in a 2 ml organ bath, containing Krebs-Ringer bicarbonate buffer. Arteries were precontracted with phenylephrine, and the function of endothelium was confirmed with acetylcholine. Then, we studied the concentration-dependent effects of propofol in endothelium-intact (control group) and -denuded aortic rings (denuded group), as well as those treated with N()-nitro-L-arginine methylester (L-NAME group). Relaxation due to propofol was observed in the control groups of both young and adult rats in a concentration-dependent manner, but the magnitude of relaxation was significantly greater in young rats. In addition, in young rats, relaxation due to propofol was significantly and equally reduced in both L-NAME and denuded groups at all propofol concentrations that we studied (10(-6)-10(-3) M). In adult rats, relaxation due to propofol was quite similar between control and L-NAME groups at all propofol concentrations, whereas it was significantly reduced in the denuded group. These results suggest that endothelium-derived nitric oxide plays an important role in propofol-induced vasodilation in young rats, but not in adult rats. J. Med. Invest. 61: 278-284, August, 2014.


Usefulness of artificial endocrine pancreas during resection of insulinoma.

A 71-year-old woman had an episode of syncope due to hypoglycemia of 27 mg/dl. She was diagnosed with insulinoma and scheduled for laparoscopic enucleation along with the use of an artificial endocrine pancreas (STG-22, Nikkiso Co., Ltd., Tokyo, Japan). Anesthesia was maintained with sevoflurane and remifentanil. Her blood glucose level was controlled using the artificial endocrine pancreas, which enabled continuous blood glucose monitoring and computer-operated glucose and insulin infusion to maintain the blood glucose level at a steady state. The target concentration of blood glucose was set at 80-120 mg/dl during surgery. Until removal of the tumor, the blood glucose level was kept at around 80-100 mg/dl. After removal of the tumor, the blood glucose level gradually increased, but it was kept in the normal range by the artificial endocrine pancreas. The artificial endocrine pancreas was useful to monitor and maintain blood glucose levels during and after the removal of insulinoma, without any hyper- or hypoglycemia. J. Med. Invest. 61: 421-425, August, 2014.


Role of an intraoperative single-plane transesophageal echocardiography probe for infants with congenital heart disease


いわゆる病病連携による障害者歯科医療連携が奏功した集学的歯科治療について

いわゆる病病連携による障害者歯科医療連携が奏功した集学的歯科治療について


Increase in prominence of electrocardiographic J waves after a single dose of propofol in a patient with early ventricular repolarisation.

J waves appear on an electrocardiogram as an elevation of the J point in the terminal portion of the QRS complex. J waves are often benign, but may be associated with malignant ventricular arrhythmias. In some cases, such problems appear to have been precipitated by propofol infusions. We observed a sudden increase in J waves and profound hypotension following a single intravenous dose of propofol in an 84-year-old woman with early repolarisation in the inferior ventricular wall. When early repolarisation (as shown by electrocardiographic J waves) is observed in the inferior ventricular wall pre-operatively, patients should be carefully monitored. Myocardial ischaemia and the use of drugs that might worsen J waves should be avoided.


Local anesthetics inhibit nitric oxide production and l-arginine uptake in cultured bovine aortic endothelial cells.

Previous studies have shown that local anesthetics have various effects on nitric oxide (NO) production, but the mechanisms remain unclear. The purpose of this study was to evaluate the effects of local anesthetics on NO production and 2-amino-5-guanidinopentanoic acid (l-arginine) uptake in one cell line. Cultured bovine aortic endothelial cells (BAEC) were stimulated with bradykinin and/or acetylcholine to activate endothelial NO synthase (NOS). BAEC were also incubated with interleukin-1β and lipopolysaccharide to stimulate inducible NOS. NO production was measured with the rapid spectrophotometric method, and l-arginine uptake was measured with high performance liquid chromatography. To assess the effects of local anesthetics, NO production and l-arginine uptake were measured in the presence or absence of procaine or lidocaine. NO was produced in BAEC stimulated with bradykinin and acetylcholine or interleukin-1β and lipopolysaccharide, but NO production was not affected by the addition of superoxide dismutase. In the cells stimulated with bradykinin and acetylcholine, 10 μM each of procaine and lidocaine significantly inhibited NO production by 35% and 20%, respectively. In the cells incubated with interleukin-1ß and lipopolysaccharide, the same quantities of procaine and lidocaine significantly inhibited NO production by 15% and 10%, respectively. Both procaine and lidocaine significantly suppressed l-arginine uptake in BAEC stimulated with either bradykinin/acetylcholine or interleukin-1β/lipopolysaccharide. It is suggested that inhibitory effects of procaine and lidocaine on NO production are partially due to suppression of l-arginine uptake.


Recent less-invasive circulatory monitoring during renal transplantation.

For anesthetic management during renal transplantation, it is necessary to maintain the blood flow and function of the transplanted kidney by performing massive fluid management and stabilizing blood pressure. We report anesthetic management for renal transplantation with a less-invasive circulatory monitoring system (Edwards Life Sciences Co., Ltd., Irvine, California, U.S.A.). In November 2010, renal transplantation was started in our hospital, and performed in 6 patients. In the first patient, fluid/circulatory management was conducted by connecting a standard arterial line and a standard central venous (CV) line. In the second patient, a FloTrac(TM) system and a standard CV line were used. In the third patient, a standard arterial line and a PreSep(TM) CV Oximetry Catheter were used. In the fourth and fifth patients, a FloTrac(TM) and a PreSep(TM) were used. In the latest patient, FloTrac(TM) and PreSep(TM) were connected to an EV1000(TM) Clinical Platform for fluid/circulatory management. The establishment of high-visibility monitors was useful for evaluating the condition and confirming the effects. As there are marked changes in hemodynamics, the CV pressure, which has been used as a parameter of fluid management, is not reliable in renal failure patients with a high incidence of cardiovascular complications. Advances in noninvasive circulatory monitoring with dynamic indices may improve the safety of anesthetic management during renal transplantation.

The Journal of Medical Investigation : JMI


Anesthetic Management for Buccal Mucosa Tumor Resection in a Patient with Pemphigus Vulgaris

尋常性天疱瘡患者における頬粘膜腫瘍切除術の全身麻酔経験

Journal of Japanese Dental Society of Anesthesiology


Molecular mechanisms of the inhibitory effects of clonidine on vascular adenosine triphosphate-sensitive potassium channels.

We investigated the effects of the imidazoline-derived α2-adrenoceptor agonist clonidine on vascular adenosine triphosphate-sensitive potassium (K(ATP)) channel activity in rat vascular smooth muscle cells and recombinant vascular K(ATP) channels transiently expressed in COS-7 cells. Using the patch-clamp method, we investigated the effects of clonidine on the following: (1) native vascular K(ATP) channels; (2) recombinant K(ATP) channels with different combinations of various types of inwardly rectifying potassium channel (Kir6.0 family: Kir6.1, 6.2) and sulfonylurea receptor (SUR1, 2A, 2B) subunits; (3) SUR-deficient channels derived from a truncated isoform of the Kir6.2 subunit (Kir6.2ΔC36 channels); and (4) mutant Kir6.2ΔC36 channels with diminished sensitivity to ATP (Kir6.2ΔC36-K185Q channels). Clonidine (≥3 × 10(-8) M) inhibited native K(ATP) channel activity in cell-attached configurations with a half-maximal inhibitory concentration value of 1.21 × 10(-6) M and in inside-out configurations with a half-maximal inhibitory concentration value of 0.89 × 10(-6) M. With similar potency, clonidine (10(-6) or 10(-3) M) also inhibited the activities of various recombinant SUR/Kir6.0 K(ATP) channels, the Kir6.2ΔC36 channel, and the Kir6.2ΔC36-K185Q channel. Clinically relevant concentrations of clonidine inhibit K(ATP) channel activity in vascular smooth muscle cells. This inhibition seems to be the result of its effect on the Kir6.0 subunit and not on the SUR subunit.


A retrospective survey of conscious sedation used in children undergoing oral surgery or dental treatment during e ten-year period at the Tokushima University Hospital

小児患者の精神鎮静法に関する過去10年間の検討


Intravenous Sedation of Persons with Disabilities during Dental Treatment in Dental Clinics

当歯科診療所における障害者歯科治療時の鎮静法の実態と有用性

Journal of the Japanese Society for Disability and Oral Health


The Effects of General Anesthetics on Aquaporin 5 Expressed in Xenopus Oocytes

アフリカツメガエル卵母細胞に発現したアクアポリン5に対する全身麻酔薬の作用


ガム噛みがストレス反応に与える影響

ガム噛みがストレス反応に与える影響


口腔外科手術時の静脈内鎮静法におけるデクスメデトミジンとプロポフォールの比較

口腔外科手術時の静脈内鎮静法におけるデクスメデトミジンとプロポフォールの比較


抜管直後に喘鳴を呈した1症例

抜管直後に喘鳴を呈した1症例


熱中症と悪性症候群の既往をもつ知的障害者の全身麻酔経験

熱中症と悪性症候群の既往をもつ知的障害者の全身麻酔経験


全身麻酔中に短時間の停電に遭遇した経験

全身麻酔中に短時間の停電に遭遇した経験


歯学部学生と卒直後歯科医師に対する救急蘇生教育後の知識およびアンケート調査

歯学部学生と卒直後歯科医師に対する救急蘇生教育後の知識およびアンケート調査


[Anesthetic management of a teenage athlete who developed arrhythmia during general anesthesia].

全身麻酔時に不整脈を呈した高校生スポーツ選手の麻酔経験

A 17-year-old man with fracture of the mandible underwent open fixation under general anesthesia. He was an athlete of the rugby suffering the fracture in a match. His preoperative physical examinations were normal except for I degrees atrioventricular block on electrocardiogram (ECG). During anesthesia, atrioventricular dissociation and frequent premature ventricular contractions were induced by the stimulation of nasotracheal intubation and the administration of atropine for the reversal of muscle relaxation. We thought the cause of the arrhythmia is the athlete's heart which may be vagotonic and may induce vagal reflex or fatal arrhythmia. This case demonstrates that it is necessary to pay attention to chronotropic action associated with the intubation of nasopharynx, the handling of laryngoscope and the usage of drugs for the anesthetic management of the athlete.


Anesthetic Management of the Patient with Ataxia Telangiectasia

毛細血管拡張性運動失調症患者の全身麻酔経験


低カリウム血症により心電図異常を認めた糖尿病患者の1例

低カリウム血症により心電図異常を認めた糖尿病患者の1例


Acceleration of Calcium-induced Calcium Release Rate in a Japanese Family

家族性にCICR速度亢進を認めた症例


Anaesthetic Study for the Management of Body Fluid and the Efficiency of Preoperative Blood Preparation in Orthognathic Surgery During 10 Years

過去10年間の外科的矯正手術における体液管理と輸血準備の効率化についての検討


Clinico-statistical Observations of Outpatients for Dental Treatment at the Anesthetic Clinic in the Hospital of Tokushima University during a 17-year Period

徳島大学歯学部付属病院歯科麻酔科外来における過去17年間の臨床統計的観察


徳島大学歯学部附属病院歯科麻酔外来における過去17年間の臨床統計的観察

徳島大学歯学部附属病院歯科麻酔外来における過去17年間の臨床統計的観察


肝肺症候群患者の抜歯時の全身管理経験

肝肺症候群患者の抜歯時の全身管理経験


Anesthetic Management for a Patient with Aplastic Anemia

再生不良性貧血を合併する上顎骨亜全摘術の麻酔経験


Assessment on the sedative effects using bispectral index

鎮静状態の新しい判定方法を使用した経験


Sturge-Weber 症候群患者の精神鎮静法経験

Sturge-Weber 症候群患者の精神鎮静法経験


Usefulness of NAZORCAP(TM) during intravenous sedation with propofol in dentistry

歯科治療時の静脈内鎮静法における呼気ガスサンプリングチューブNAZORCAPTM の有用性


異常絞扼反射に鎮静量以下の低濃度プロポフォールが有効だった症例

異常絞扼反射に鎮静量以下の低濃度プロポフォールが有効だった症例


悪性高熱症患者2例の遺伝子解析ーナトリウムチャネルαサブユニットエキソン22の関与についてー

Journal of Japanese Dental Society of Anesthesiology


局所麻酔薬が血管内皮細胞へのアルギニン輸送に与える影響

局所麻酔薬が血管内皮細胞へのアルギニン輸送に与える影響


局所麻酔薬が動脈内皮細胞での一酸化窒素に与える影響

局所麻酔薬が動脈内皮細胞での一酸化窒素に与える影響


Propofol Is Effective in Chemotherapy-Induced Nausea and Vomiting:A Case Report with Quantitative Analysis

the International Anesthesia Research Society


徳島大学歯学部附属病院歯科麻酔科における過去13年間の全身麻酔症例の検討

徳島大学歯学部附属病院歯科麻酔科における過去13年間の全身麻酔症例の検討


エホバの証人に対する閉鎖循環型自己血輸血回路

エホバの証人に対する閉鎖循環型自己血輸血回路


レミマゾラムを使用した全静脈麻酔と文献的考察

レミマゾラムを使用した全静脈麻酔と文献的考察