After more than 40 years as a member of the Japanese Dental Society of Anesthesiology (JDSA) and 17 years as a board member, the author has recognized the importance of not only daily educational, research, and clinical activities, but also activities outside the JDSA (such as those involving the Japanese Association for Dental Science and the government) so as to increase the JDSA’s contribution to the dental community and the public. Consequently, the author has worked to promote several issues related to the Ministry of Health, Labor and Welfare. In other words, the author decided to go beyond “contributing to the progress of dentistry and dental health care through the results of academic activities” to “bringing about valuable changes in dental health care in Japan through the results of academic activities” as his own goal. In all of these tasks, the knowledge and experiences that the author has gained through JDSA activities have played major roles. Based on these experiences, the author would like to ask not only the current board members and committee chairs and members, but also young dental anesthesiologists who will become active as key JDSA members in the future to take an interest in social contribution in the context of the JDSA’s activities and to work actively and strategically to further enhance the JDSA’s presence.

  Older patients with dementia often exhibit poor cooperation during dental treatment, necessitating intravenous sedation or general anesthesia. Evaluating sedation depth in patients with dementia is challenging, and deep sedation is often required to suppress body movement, posing a risk of oversedation. This report provides details of intravenous propofol sedation in a patient with Lewy body dementia.

  A 105-year-old woman (weight : 48 kg) required tooth extraction and oral cleaning owing to apical periodontitis. Considering her poor cooperation and communication difficulties, intravenous propofol sedation was selected. As the sedation effect was difficult to predict because of her advanced age, careful titration of propofol in small increments based on body movement was proposed. Sedation depth was assessed using the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) and electroencephalogram monitoring via SedLine^®.

  Sedation was initiated with 7 mg of propofol, followed by additional single-bolus doses based on the Patient State Index and MOAA/S scores (total propofol : 18 mg). The procedure was completed without complications, and the patient recovered from sedation to 60 min after the final dose.

  In this extremely older patient, propofol sedation was selected because of its rapid onset and recovery characteristics. SedLine^® allowed for continuous monitoring of brain activity, facilitating the prevention of oversedation. Despite using low-dose propofol, delayed recovery was observed, likely due to age-related changes in drug metabolism.

  Although only a minimal amount of propofol was used, sufficient sedation and prolonged effects were observed. Further research is warranted to optimize sedation management in this growing population of older patients with dementia.

  Hypertensive encephalopathy is a life-threatening condition caused by a sudden rise in blood pressure, leading to the failure of cerebral autoregulation and vasogenic edema. Proper preoperative blood pressure management is essential for the prevention of perioperative complications, yet the inadequate control of hypertension remains a major cause of surgery cancellations. We report a 63-year-old man with a history of hypertension and poor medication adherence who was scheduled to undergo an elective tumor resection under general anesthesia. Despite presenting with severe hypertension (203/106 mmHg) on the day before surgery, a decision to proceed with the surgery was made under the assumption that intraoperative blood pressure control would be sufficient. Upon entering the operating room, however, the patient developed dizziness, tremors, and impaired consciousness, and a hypertensive crisis (277/131 mmHg) occurred. The surgery was canceled, and he was transferred to the ICU for blood pressure stabilization. A neurological evaluation confirmed hypertensive encephalopathy, and MRI findings suggested a high risk of cerebral hemorrhage. After aggressive antihypertensive therapy, his condition stabilized ; he was scheduled to undergo surgery three months later. This case underscores the importance of early therapeutic intervention in hypertensive patients undergoing elective surgery. An over-reliance on intraoperative blood pressure control can lead to severe complications. Strict adherence to antihypertensive therapy, a comprehensive preoperative evaluation, and interdisciplinary communication are crucial for preventing similar incidents and for ensuring patient safety.

  Examining the anesthesia machine prior to administering general anesthesia is an essential procedure. Newer electronic machines have a computerized safety check that allows for the detection of most defects prior to use. However, breaks in the breathing circuit that go undetected during a leak test can lead to unexpected ventilation failures. In cases of ventilation failure during anesthesia, the respiratory circuit is usually replaced. Such requirements can expose the patient to life-threatening hypoxemia during the exchange of the circuit system. This report presents a case in which a leak test did not detect a defect in the breathing circuit, highlighting the need for vigilance and for additional safety measures in anesthesia practice.

  Intravenous indwelling needles are widely used in intravenous sedation and perioperative management for general anesthesia. We report two cases in which cracks were observed near the hub of indwelling needles. The first patient was a 47-year-old woman with dental phobia who was scheduled to receive dental treatment under intravenous sedation. Peripheral intravenous access was secured using the BD Insyte^TM Autoguard^TM BC Pro 24G, manufactured by Becton, Dickinson and Company. Immediately after initiating the infusion, fluid leakage was observed near the connection between the intravenous needle and the IV circuit. The intravenous needle was removed, and another intravenous needle was used to resecure the venous access. The second patient was a 39-year-old woman who was scheduled to undergo an intramaxillary foreign body removal after sagittal splitting of the mandibular ramus under intravenous sedation. An intravenous line was established using the above-mentioned product from the same company and an infusion was initiated ; immediately afterwards, however, the infusion began to leak from the indwelling needle. In both cases, the intravenous access was resecured, and intravenous sedation was performed without any subsequent problems. When the removed indwelling needles were examined, cracks were found near the hub of the indwelling needles in both cases. Safety inspections are necessary before using medical devices, but unexpected problems can occur. In such cases, both early problem recognition and appropriate responses are necessary.

  Head and neck photoimmunotherapy is a novel treatment for the local control of head and neck carcinoma that utilizes cetuximab sarotalocan-sodium (Akalux^®) and a laser system to target tumor cells selectively. Photoimmunotherapy has been associated with severe pain during laser irradiation and during the postoperative period, along with tongue swelling and laryngeal edema following surgery. We attempted to manage postoperative pain and airway complications in a patient who underwent photoimmunotherapy for recurrent maxillary gingival cancer. Akalux^® was administered intravenously on the day before the surgery. Anesthesia was maintained with sevoflurane, intravenous remifentanil, and fentanyl. Following a tracheostomy, intravenous patient-controlled analgesia (IV-PCA) with fentanyl (20 μg/h, bolus dose of 10 μg, lockout time of 20 minutes) was initiated. Infiltration anesthesia with 1.5 mL of 2% lidocaine was applied, followed by a needle puncture for irradiation. During the surgery, the patient received 1,000 mg of acetaminophen and 50 mg of flurbiprofen axetil intravenously, followed by infiltration anesthesia with 4 mL of 0.75% ropivacaine. The NRS score upon ICU admission was 5, but the score decreased to 1 after six hours of IV-PCA. IV-PCA was discontinued on POD 1, and pain management was switched to flurbiprofen axetil and acetaminophen. Since the NRS score remained below 2, we considered this multimodal approach to analgesia to have been effective. Additionally, Akalux^® has been reported to cause significant tongue swelling and laryngeal edema postoperatively. In the presently reported case, a prophylactic tracheotomy successfully prevented airway complications after surgery. Multimodal pain management was effective for managing postoperative pain in a patient with oral cancer who underwent photoimmunotherapy.

  Microvascular angina (MVA) is caused by structural and functional abnormalities in microvascular coronary arteries smaller than 100 μm ; it is also known as coronary microvascular dysfunction (CMD). These abnormalities are difficult to visualize using coronary angiography, making the diagnosis of MVA challenging. We report a case of MVA that was diagnosed after the occurrence of chest pains during dental treatment under intravenous sedation. The patient was a 58-year-old man (height : 165 cm, weight : 60 kg, BMI : 22.0) with a history of a hyperactive gag reflex requiring intravenous sedation for dental treatment. Three years earlier, he had experienced chest pain during dental treatment, but a coronary spasm provocation test was negative and CMD was not evaluated. On the day of the presently reported treatment, the patient had stable vital signs. Propofol sedation and local anesthesia were administered. Shortly thereafter, he experienced nausea, convulsions, dizziness, and chest pain. The sedation was stopped, and the administration of sublingual nitroglycerin resolved his symptoms. He was transferred to the emergency room. A coronary angiography revealed no significant stenosis, and a coronary spasm was ruled out. An evaluation of coronary microvascular function showed a coronary flow reserve (CFR) of 2.3, an index of microvascular resistance (IMR) of 28, and a fractional flow reserve (FFR) of 0.91/0.91, leading to a diagnosis of MVA. This case highlights the need to consider MVA in patients with unexplained chest pain. Assessing coronary microvascular function is crucial for avoiding missed diagnoses and ensuring appropriate management.

  Multiple system atrophy (MSA) is a neural degenerative disease, mainly of the cerebellar-extrapyramidal tract-autonomic nervous system. Complications of perioperative management include cyclical fluctuations due to autonomic dysfunction, upper airway obstruction due to vocal cord paralysis, and prolonged effects of muscle relaxants. We encountered two cases of general anesthesia in patients with MSA with different clinical findings. Case 1 involved a 79-year-old man scheduled for implant removal. He had been diagnosed with MSA 6 years previously and had recurrent fainting spells due to orthostatic hypotension. During anesthesia induction, transient hypotension was observed ; however, no excessive hypotension due to the vasopressor was observed intraoperatively. After surgery, sugammadex was administered, and the patient was extubated.

  Case 2 involved a 65-year-old man who was scheduled for epulis resection and extraction. Preoperative otolaryngological examination revealed asymmetry in vocal fold movement. After the surgery, sugammadex was administered and sufficient spontaneous respiration was confirmed. The patient was extubated and it was confirmed that there was no limitation of vocal cord movement. Both two patients were discharged with no problems.

  It is estimated that approximately 12,000 individuals in Japan are affected by MSA, and it is anticipated that the disease will emerge as a clinical concern in the future.

  Patients with MSA have various symptoms that differ with individuals ; therefore, it is necessary to accurately assess a patient’s general condition through detailed interviews and anesthesia planning.

  Spinal muscular atrophy (SMA) is a progressive motor neuron disease characterized by the degeneration of anterior horn cells in the spinal cord. Anesthetic management in patients with SMA presents challenges such as respiratory muscle weakness and heightened sensitivity to muscle relaxants. This study reports a case of general anesthesia management in a patient with type Ⅱ SMA.

  A 22-year-old woman underwent wisdom tooth extraction under general anesthesia. Neuromuscular monitoring was performed at two sites : the ulnar nerve-abductor digiti minimi and the facial nerve-corrugator supercilii. Following administration of 10 mg rocuronium bromide, the train-of-four count (TOFc) was 0 at the abductor digiti minimi, while the corrugator supercilii maintained a TOFc of 4. However, sufficient muscle relaxation was achieved to allow successful nasal intubation. Postoperatively, the neuromuscular blockade was reversed with sugammadex sodium, and the patient recovered and was extubated without complications.

  In general anesthesia for SMA patients, the ulnar nerve-abductor digiti minimi demonstrates higher sensitivity to muscle relaxants compared to the facial nerve-corrugator supercilii. Monitoring the ulnar nerve-abductor digiti minimi may offer a more reliable assessment of the optimal timing for intubation. The reversal of neuromuscular blockade with sugammadex sodium is effective ; however, extubation should be carefully assessed using both neuromuscular monitoring and clinical indicators, such as adequate ventilation volume, to ensure a comprehensive evaluation.

  Nerve blocks involve the insertion of a needle into a peripheral nerve or nerve trunk to block nerve conduction using local anesthetics, neurolytic agents, or radiofrequency thermocoagulation and can have either temporary or long-term effects. This review covers stellate ganglion block (SGB), trigeminal nerve block (TNB), and trigger point injections (TPI), all of which are nerve block therapies frequently performed at the Department of Pain Clinic at Kyushu Dental University Hospital.

  SGB is used not only for painful conditions involving sympathetic nerve hyperactivity, but also for paralytic conditions such as trigeminal neuropathy and facial nerve palsy. SGB is also effective for treating neuroplastic pain. Importantly, SGB must be performed under ultrasound guidance to avoid complications.

  TNB is often performed when pain relief is not achieved even after microvascular decompression (MVD) or gamma knife surgery. A block needle is inserted into the nerve trunk, and nerve conduction is blocked using a neurolytic agent and radiofrequency thermocoagulation. The nerve foramen is clearly identified under ultrasound guidance and fluoroscopy.

  TPI is used to treatment myofascial pain and involves the injection of a local anesthetic into a trigger point to break vicious pain cycles and provide pain relief. If fascia involvement, in addition to myofascial pain, is recognized, myofascial release (MFR) is often used in combination with TPI. MFR releases the conglutination of fascia and the muscle body using an injection of saline or local anesthetics into stacking facia. Both procedures are performed under ultrasound guidance.

  Oral and maxillofacial surgeries are often associated with severe pain and complications postoperatively. Postoperative analgesia for highly invasive procedures commonly involves continuous intravenous opioid infusion. However, increased opioid dosage elevates the risk of life-threatening complications. Therefore, analgesic methods that reduce opioid dosage are desirable. In modern times, multimodal analgesia, including ultrasound-guided nerve blocks, is recommended to ensure safe and effective postoperative pain management in many surgical procedures. In oral and maxillofacial surgeries, ultrasound-guided maxillary and mandibular nerve blocks have recently attracted attention as effective analgesic methods. Some research indicates that these techniques effectively reduce postoperative pain scores and opioid consumption. This article will examine the technical aspects of ultrasound-guided nerve blocks and consider their potential as a foundation for multimodal analgesia, drawing on research evaluating the effective range of ultrasound-guided alveolar nerve blocks using cadavers in search of safer and more efficient methods.

  The “Act on Promotion of Dental and Oral Health,” enacted in August 2011, aims to comprehensively advance initiatives to maintain oral health through the prevention of dental diseases, thereby contributing to the improvement of public health. Following its enactment, local governments across Japan began establishing ordinances related to dental health, and Saitama City established its own ordinance in December 2012.

  The Act and ordinance specify that municipalities must implement measures to enable individuals with disabilities to access dental care ; as a result, Saitama City has decided to establish a “Saitama City Oral Health Center” (tentative name). Additionally, measures to prevent dental diseases during pregnancy and to maintain and improve oral functions in older adults were also specified, leading the city to launch new dental health checkups for pregnant women and elderly individuals aged 71 years and above.

  While various dental health initiatives, such as life stage-based dental checkups, have previously been implemented based on various legal grounds, the establishment of the basic Act on Dental and Oral Health and the corresponding ordinances following discussions in the National and Local Legislatures have strengthened dental and oral health measures led by local governments, improving the accessibility of these services to residents.