グルコース-6-リン酸脱水素酵素欠損症患者の静脈内鎮静管理経験

抄録

  We report the use of intravenous sedation for dental treatment in a patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency, a condition that induces acute hemolysis and methemoglobinemia under surgical stress, during infection, or subsequent to the administration of oxidant drugs. Intravenous sedation for dental treatment in patients with G6PD deficiency has not been previously reported.

  G6PD deficiency occurs frequently in Kurdish Jewish and African-American populations ; it occurs less frequently in the Japanese population, with the asymptomatic variant having an incidence of less than 0.1%. Here, we report the case of a 20-year-old man (height, 157 cm ; weight, 51 kg) with G6PD deficiency who underwent intravenous sedation prior to dental treatment, which involved a pulpectomy and root canal treatment. The patient was sedated using an intravenous infusion of midazolam. Amide-type local anesthesia is known to cause methemoglobinemia. However, the required dental treatment was considered to be difficult to perform using an ester-type local anesthetic agent ; hence, an amide-type local anesthetic agent was used. Acute hemolysis occurring 2 to 3 days after the oxidative stress with anemia and jaundice accompanied by hemoglobinuria are usually observed.

  In the present case, the dental treatment was safely and successfully concluded with due attention to the general anesthesia procedure.