Journal of Japanese Dental Society of Anesthesiology
Online ISSN : 2433-4480
Current issue
Displaying 1-4 of 4 articles from this issue
Clinical Report
  • Mayuka UEDA, Hiroharu MAEGAWA, Chiho KUDO, Rena OKAHASHI, Yuka HAMABE, ...
    2024 Volume 52 Issue 4 Pages 181-184
    Published: October 15, 2024
    Released on J-STAGE: October 15, 2024
    JOURNAL FREE ACCESS

      Pyruvate produced from glucose in the glycolytic system is converted to acetyl CoA by the pyruvate dehydrogenase complex (PDHC) and transferred to the tricarboxylic acid cycle. In PDHC deficiency, excess pyruvate is converted to lactate, resulting in lactic acidosis. Here, we report the use of general anesthesia in an outpatient with PDHC deficiency.

      The patient was a 21-year-old woman with a body weight of 38.1 kg and a height of 140 cm. The patient was diagnosed as having PDHC deficiency after the observation of high lactate and pyruvate levels. After premedication with midazolam, anesthesia was induced using thiamylal sodium. Rocuronium was administered during anesthesia induction only, and a muscle relaxation monitor was used. The anesthesia was maintained using 1.0 vol% sevoflurane and 0.05–0.1 μg/kg/min of intravenous remifentanil infusion. Acetate Ringer’s solution was administered as an intravenous fluid. No significant changes in vital signs

    were observed, and the lactate level was normal during an arterial blood gas analysis that was performed during the surgery. Sugammadex sodium was administered at the end of the treatment. During general anesthesia in patients with PDHC deficiency, conditions such as hypothermia, hypoxemia, hypocarbia, and postoperative stress can cause an increase in lactate levels ; consequently, appropriate care and management is required. No complications were observed after the anesthesia in the presently reported outpatient.

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  • Kaori SEKIGUCHI, Nozomi YASHIMA, Kaneyuki KAWAMAE
    2024 Volume 52 Issue 4 Pages 185-189
    Published: October 15, 2024
    Released on J-STAGE: October 15, 2024
    JOURNAL FREE ACCESS

      Total anomalous pulmonary venous connection (TAPVC) was once a common congenital heart disease associated with high morbidity and mortality rates in infancy. However, currently, the prognosis for surgical treatment is better, with an early mortality rate of 2%–15% and a 10-year survival rate of approximately 90%. We report the general anesthetic management of a pediatric patient with developmental delay and pulmonary arterial hypertension after surgery for TAPVC.

      A 7-year-old boy (weight, 18 kg ; height, 111 cm) was diagnosed with TAPVC at 14 days of age owing to hypoxemia and underwent radical TAPVC surgery at 16 days of age. Postoperatively, he developed pulmonary arterial hypertension and cerebellar infarction, and continued to receive treatment, thereafter. Long-term warfarin was administered for cerebral infarction, and as his progress was good, we decided to discontinue this medication. At that time, we planned to perform dental treatment under general anesthesia.

      Considering the patient’s respiratory reserve and degree of mental developmental delay, slow anesthetic induction was performed without the use of sedatives. We also prepared circulatory agents to address perioperative hypotension and nitric oxide inhalational therapy in the case of increased pulmonary vascular resistance.

      When anesthetizing a child after radical surgery for TAPVC, anesthesiologists should determine the appropriate time for surgery after assessing the postoperative risks and the patient’s preoperative general condition. Additionally, anesthesiologists should consider the induction method in light of the child’s level of mental development and circulatory changes, and prepare adequately for emergency situations.

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  • Kazuhiro HANO, Momoko KAWANO, Urara KUBOTA, Yu OSHIMA, Takashi HITOSUG ...
    2024 Volume 52 Issue 4 Pages 190-193
    Published: October 15, 2024
    Released on J-STAGE: October 15, 2024
    JOURNAL FREE ACCESS

      In non-obstetric surgeries on pregnant women, the health of the fetus must be evaluated and managed in addition to ensuring maternal safety. Controlling seizures is of particular importance for pregnant patients with epilepsy, as seizures could suppress respiration and lead the fetus experiencing hypoxia.

      We performed general anesthesia in a 32-year-old woman with epilepsy ; at the time, the patient was in her 26th week of pregnancy. An obstetrician confirmed the health of the pregnant woman and the fetus. A neurologist suggested that the patient’s serum level of carbamazepine might be reduced because of fatigue and emotional stress, which could lead to an epileptic seizure. Consequently, the patient’s serum level of carbamazepine was measured on the morning of the surgery. Anesthesia was rapidly induced using fentanyl, propofol, and rocuronium. The patient was intubated using a fiberscope, as she had a restricted mouth opening. Anesthesia was maintained with desflurane and remifentanil. The fetal heartbeat was periodically checked intraoperatively using fetal ultrasound cardiography. The fetal heart rate was stable at 135–139 beats per minute, and no bradycardia was noted. The operation was completed without any problems, and the patient had a good respiratory condition after extubation. Both the mother and the fetus subsequently progressed uneventfully, and the baby was born by normal vaginal delivery ; no morphological or functional abnormalities were found. When performing general anesthesia during pregnancies complicated by epilepsy, preventing seizures by collaborating with a neurologist is important.

      Working in collaboration with the obstetrician/gynecologist to perform appropriate fetal monitoring appropriate for the number of weeks of pregnancy is also important.

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Special Article
  • Takuya NAGANAWA
    2024 Volume 52 Issue 4 Pages 194-199
    Published: October 15, 2024
    Released on J-STAGE: October 15, 2024
    JOURNAL FREE ACCESS

      Dental telemedicine is a service that allows patients to receive treatment while communicating with a dentist online from their home or workplace. The benefits of telemedicine are that it saves the time and effort of going to a hospital, and it is also highly convenient for people who are busy or live in remote areas. On the other hand, telemedicine is not a panacea, as it may not be applicable in some cases, such as when emergency treatment is required. However, telemedicine can be used as a supplement to in-person medical treatment. In dental telemedicine, sharing accurate information and regular follow-up care are important to provide appropriate treatment while building a relationship of trust between dentists and patients. Dental telemedicine is expected to become more popular as technology advances and legal systems are improved, contributing to an improved convenience for patients and an improved quality of medical care.

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