【要約】 McGRATH^® MACのX blade^TMは挿管困難症例に対する有用性が高い．今回われわれは，挿管経験が少ない者がどの程度トレーニングを積めば挿管困難症例に対してX blade^TMを用いて短時間で良好な視野が得られるようになるのかを検証した．気管挿管経験数20症例以上100症例未満の者（L群）7名および100症例以上200症例未満の者（H群）10名の計17名を対象とし，開口量20mm，頭部後屈不能に設定したシミュレータを用いて検証を行った．なお，本シミュレータは上顎前歯に強い力が加わると，歯が脱落する仕様になっていた．参加者が順番に1回ずつ交代しながらおのおのの合計が10回になるまでX blade^TMで喉頭展開を行った．あらかじめ左右の声帯ヒダの中央に印した線がビデオ喉頭鏡の画面上で確認できた時点で喉頭展開成功とした．喉頭展開開始後30秒以内に線を確認できなかった場合や，上顎前歯が脱落した場合は失敗とした．検討項目は，喉頭展開の成功率および成功した場合の展開時間とした．1回目は4名（L群2名，H群2名）が失敗したが，9回目以降は全員が成功した．喉頭展開時間は1回目と比較して7回目以降で短縮を認めた．本研究の結果から，挿管経験に乏しい者でも最低9回トレーニングすることで喉頭展開の成功率が100%となり，確実な喉頭展開が可能になることが示された．加えて，喉頭展開時間が短縮され，迅速な喉頭展開が可能となることも示された．

  We report the case of a 61-year-old woman whose severe neuropathic pain, caused by the extraction of the right maxillary lateral incisor, temporarily disappeared for seven months because of the development of tongue cancer. The patient’s right maxillary lateral incisor had been extracted because of a suspected tooth fracture 5 months prior to her first visit. After the extraction, she began to feel a tingling pain in the area of the tooth extraction site. Although the extraction site had healed well, she visited several dentists because of the pain but a cause could not be identified. Diclofenac sodium and over-the-counter analgesics were completely ineffective, and carbamazepine, which was prescribed for suspected trigeminal neuralgia, was ineffective.

  At the time of the patient’s first visit to our hospital, her Visual Analogue Scale (VAS) result was 72/100 mm, and she complained of a tingling pain that lasted all day. No macroscopic abnormalities of the mucosa were visible, but allodynia was observed.

  The patient was diagnosed with neuropathic pain following tooth extraction. Stellate ganglion blocks (SGB), adenosine 5-triphosphate (ATP) infusion, and oral pregabalin were ineffective. Fortunately, topical capsaicin therapy and oral tramadol (300 mg/day) almost eliminated the pain.

  Seven years and seven months after the first visit, the patient suddenly developed tongue cancer near the right lateral incisor ; at this time, the neuropathic pain in the right maxillary lateral incisor disappeared.

  The onset of the cancer might have caused conditioned pain modulation (CPM), which is a diffuse noxious inhibitory controls (DNIC)-like phenomenon.

  The tongue cancer was resected, and the neuropathic pain in the maxillary gingiva remained absent for 7 months from the onset of the tongue cancer, but gradually reappeared thereafter. At present, the patient’s pain is being controlled using oral tramadol (300 mg/day) and oral pregabalin (150 mg/day).

  We report a patient with Ramsay Hunt syndrome in whom the infusion of adenosine triphosphate (ATP) significantly alleviated neuropathic pain developing as a result of herpes zoster in the trigeminal nerve region.

  The patient was a 74-year-old man who complained of severe pain in the third branch region of the left trigeminal nerve and auricle at the time of his first visit and who exhibited edematous erythema and blisters. Since peripheral facial nerve paralysis appeared 6 days after the initial diagnosis, the administration of a stellate ganglion block (SGB), near-infrared therapy, prednisolone (30 mg/day, gradually decreasing), and mecobalamin (1.5 mg/day) was initiated. Two weeks later, neuropathic pain appeared, so pregabalin (50 mg/day, gradually increasing to 450 mg/day) and amitriptyline (10 mg/day, gradually increasing to 60 mg/day) were additionally administered. After repeated SGB and near-infrared therapy, the facial nerve paralysis nearly disappeared, but the improvement in the neuropathic pain was insufficient.

  Therefore, the intravenous administration of magnesium sulfate hydrate and lidocaine hydrochloride was performed. Since the pain relief was temporary, ATP infusion (100 μg/kg/min) was subsequently performed. The ATP infusion resulted in continuous pain relief ; thereafter, a total of 4 ATP infusions were performed. The pain gradually decreased and ultimately disappeared completely.

  A patient with takotsubo cardiomyopathy (TCM) underwent an open reduction and internal fixation under general anesthesia for a mandibular fracture. The patient had no history of cardiac disease, and TCM was thought to have been triggered by a fracture of the articular process of the mandible. Although the exact causes of TCM are not fully elucidated, it is known to be a stress-induced cardiomyopathy. The prevalence of TCM is high among postmenopausal women. The patient presented with no characteristic chest symptoms on admission to the hospital. However, she was diagnosed as having TCM according to the Mayo Clinic criteria. Since no specific treatment for TCM exists, it is important to avoid stress to prevent deteriorating symptoms. During surgery, her heart rate was controlled to avoid tachycardia and adequate intravascular volume was maintained using the FloTrac System, which enables the evaluation of stroke volume variations and invasive arterial blood pressure measurements. The use of sevoflurane and remifentanil hydrochloride, both of which have low cardiac depression effects and are easily adjustable, ensured good anesthetic management. The patient was carefully monitored and managed during the perioperative period to avoid the recurrence of TCM.