Holoprosencephaly (HPE) is a congenital brain malformation resulting from incomplete prosencephalic cleavage with an incidence of approximately 1 in 8,000 live births. Alobar HPE, the most severe form, is often associated with airway-related craniofacial anomalies such as a single nostril, absent columella, and nasal septal defects, which may complicate postoperative airway management. Here, we report two pediatric cases of alobar HPE with single nostril that presented difficult postoperative airway management after cheiloplasty.

  The first case involved a 22-month-old girl with a median cleft lip, a single nostril, and hypotelorism. She also had intractable epilepsy, central hypopituitarism, and thermoregulatory dysfunction and required home oxygen therapy. The anesthesia was uneventful. A nasopharyngeal airway (NPA) was inserted before extubation. Postoperatively, excessive secretion led to oxygen desaturation, which resolved after NPA removal. The remainder of the postoperative course was stable.

  The second case involved a 19-month-old boy who also had a median cleft lip, a single nostril, hypotelorism, and a history of epilepsy without respiratory disorders. The anesthesia was uneventful. After extubation, retractive breathing appeared, which was improved by NPA insertion. However, the patient experienced seizure-like episodes and respiratory deterioration the following day, resulting in difficult airway management.

  These cases suggest that in patients with alobar HPE and a single nostril, cheiloplasty may further narrow the nasal and oral airways, thereby increasing the risk of postoperative respiratory compromise. Careful postoperative airway evaluation, appropriate NPA positioning, and close monitoring are essential.

  Lateral periodontal cyst (LPC) is reported to be a rare condition with many unknown factors.

  The patient was a 47-year-old woman who experienced hypesthesia in the left inferior alveolar nerve area.

  Mechanical detection threshold (MDT) and mechanical pain threshold (MPT) measurements revealed increased tactile threshold on the left mental nerve innervated area. CT imaging suggested the presence of a dentigerous cyst involving the crown of a horizontally impacted tooth in the left lower 8th tooth, and it was believed that physical compression of the mandibular canal by the cyst was the cause of the hypesthesia.

  Tooth extraction and cystectomy were performed under intravenous sedation with midazolam. The dental anesthesiologist assisted during the cyst dissection and cystectomy to assess the burden and condition of the inferior alveolar nerve. Dissection of the cyst wall and the area of contact with the inferior alveolar nerve was straightforward, and no obvious injury was observed in the exposed inferior alveolar nerve area. The cyst that was removed was diagnosed as a LPC based on histopathological examination.

  MDT and MPT measurements taken after surgery showed no remaining left-right differences.

  In this case, the hypesthesia was caused by compression from the LPC.

  If the cyst is compressing or in contact with the inferior alveolar nerve, it is recommended that the dental anesthesiologist assess the difficulty of cyst dissection and the condition of the exposed inferior alveolar nerve to predict and manage the potential presence and severity of postoperative hypesthesia.

  Pediatric patients with micrognathia and restricted mouth opening are at increased risk of difficult mask ventilation and tracheal intubation due to craniofacial abnormalities ; therefore, an anesthetic plan anticipating a difficult airway is essential from the preoperative stage. In adults, awake intubation is a viable option ; however, in children, limited understanding and cooperation often necessitate tracheal intubation after induction of general anesthesia. Under such circumstances, upper airway obstruction and difficulty in ventilation may become apparent following induction, making it crucial to ensure adequate oxygenation strategies and to prepare alternative airway management options to prevent hypoxemia.

  Optiflow THRIVE^TM (Fisher & Paykel Healthcare, New Zealand) delivers heated and humidified high-flow oxygen via a nasal cannula and is used to maintain oxygenation and prolong safe apneic time during tracheal intubation. Although its utility in pediatric airway management has been reported, there are limited reports describing its use in combination with nasotracheal fiberoptic intubation in pediatric patients with anticipated difficult mask ventilation and intubation due to micrognathia and restricted mouth opening.

  We report a pediatric case with micrognathia and restricted mouth opening, in whom difficult airway management was anticipated, and in whom safe airway management was successfully achieved using nasotracheal fiberoptic intubation under Optiflow THRIVE^TM.

  Hypoplastic left heart syndrome (HLHS) refers to congenital conditions with hypoplasia of the left ventricle, ascending aorta and right-heart dominated circulation. We report a case of general anesthesia managed with propofol in a post-operative Fontan pediatric patient with HLHS. The patient was a 4-year-old boy undergoing dental treatment (caries restoration and extractions) under general anesthesia. Preoperative echocardiography demonstrated no significant intracardiac shunt and preserved right ventricular systolic function. Oral antithrombotic therapy was continued. Thirty minutes after oral administration of 10 mg midazolam, anesthesia was induced with sevoflurane. General anesthesia was maintained with continuous infusions of remifentanil and propofol, which was chosen for its antiemetic properties and to minimize emergence agitation. Mepivacaine hydrochloride was used during the dental treatment. Lidocaine hydrochloride was used at the time of tooth extraction. Since antithrombotic therapy was continued, lidocaine hydrochloride with 1/100,000 adrenaline was used at the extraction site, and no significant hemodynamic effect was observed. Intraoperative hemodynamics remained stable (blood pressure 60-85/30-50 mmHg ; heart rate 60-100 bpm ; SpO₂ 94-96％ at FiO₂ 0.3). Thirty minutes after the administration of sugammadex sodium, spontaneous respiration was observed and extubation was performed ; slight movement was noted, but no significant desaturation or respiratory depression occurred. The patient regained full consciousness within one hour after returning to the ward and could drink water. The patient was discharged on the next day without postoperative nausea and vomiting (PONV). Propofol-based anesthesia can maintain stable hemodynamics without PONV and agitation in a post-operative Fontan pediatric HLHS patient.

  There are few medical institutions that provide treatment and support for pediatric feeding and eating disorders (FED), making early intervention difficult. We report a case of FED that developed due to avoidant/restrictive food intake disorder (ARFID) after general anesthesia, in which the patient presented with hypoglycemia and ketoacidosis.

  The patient was a 9-year-old girl (height 131 cm, weight 23 kg ; Rohrer index 102.3). Because of difficulty in behavior management due to her dental anxiety, extraction of the impacted supernumerary tooth in the maxillary midline was performed under general anesthesia. She had no medical history and was not on any medications. Anesthesia was maintained with propofol and remifentanil hydrochloride, and 1％ glucose-acetated Ringer’s solution was administered as the infusion fluid.

  Three hours after returning home, she took a sip of fluid ; however, no further oral intake was observed. On the third postoperative day, due to ongoing poor oral intake, a decision was made―after consultation with a pediatrician―to admit her to a hospital with a pediatric ward for treatment. After admission, blood tests revealed a ketone body level of 7,996 μmol/L, indicating progression to ketoacidosis. On postoperative day 11, she was able to resume oral intake and blood glucose levels stabilized, allowing her to be discharged in good condition.

  FED requires early, comprehensive physical and psychological intervention, implying that dentists must fully understand it. For pediatric patients, appropriate preoperative preparation is vital to alleviate anxiety.

  Congenital adrenal hyperplasia (CAH) is a group of inherited disorders characterized by enzymatic defects in adrenal steroidogenesis, resulting in cortisol deficiency and compensatory adrenocorticotropic hormone (ACTH) overproduction. The most common form is 21-hydroxylase deficiency, and the salt-wasting type is associated with both glucocorticoid and mineralocorticoid deficiency, requiring careful perioperative management.

  We report the perioperative management of a 14-year-old boy with salt-wasting CAH who underwent oral surgery under general anesthesia. The patient had been treated with hydrocortisone, dexamethasone, and fludrocortisone, reflecting the need for combined glucocorticoid and mineralocorticoid replacement. In consultation with pediatric specialists, perioperative steroid coverage and electrolyte management were planned based on current guidelines.

  On the day of surgery, oral steroids were withheld and intravenous hydrocortisone was administered for stress coverage. General anesthesia was induced with propofol, rocuronium, and remifentanil and maintained with volatile anesthetics. Intraoperative monitoring included repeated measurements of electrolytes, glucose, ACTH, and cortisol levels. The surgery was completed uneventfully without signs of adrenal crisis.

  Postoperatively, intravenous hydrocortisone was gradually tapered, and oral steroid therapy was resumed. The patient was discharged without complications.

  In patients with CAH, perioperative care requires not only steroid coverage but also knowledge of glucocorticoid properties, electrolyte-focused fluid management, and readiness for adrenal crisis. Even dental procedures without general anesthesia can induce stress, and minimally invasive treatments may still trigger a stress response. Thus, individualized steroid coverage and perioperative management are essential.

 【要旨】 顎関節症は顎関節や咀嚼筋の疼痛，顎関節雑音，開口障害など多様な臨床症状を呈する．近年，国際的に標準化された顎関節症の診断基準であるDiagnostic Criteria for Temporomandibular Disorders（DC/TMD）が提唱され，臨床および研究に広く用いられている．また，顎関節症の治療は保存的で可逆的な治療が第一選択となり，運動療法は疼痛軽減および下顎可動域の改善に寄与することが報告されているが，その推奨度は必ずしも高くなく，運動処方の標準化が課題とされている．本稿では，有痛性顎関節症である咀嚼筋痛障害および顎関節痛障害に焦点を当て，その診断基準と保存的治療を中心とした多角的アプローチについて概説する．さらに，運動療法の分類や効果に関するエビデンスを整理し，EBMと個別化医療を融合した有痛性顎関節症のマネジメントの方向性について考察する．

 【要旨】 血液ガス分析は，ベッドサイドで迅速に行える簡便な検査の一つであり，患者の代謝や呼吸の異常，電解質異常，ヘモグロビンや血糖値のチェックなど，幅広く活用される．ただ，血液ガス分析を十分に理解し，活用することは案外難しい．血液ガス分析を効率よく学ぶには，呼吸生理と酸塩基平衡を理解し，分析に必要な公式を整理した後は，できるだけ多くの症例を通じて臨床に即した形で学習することが望ましい．血液ガス分析には，Boston法，Copenhagen法，Stewart法などの解析法があるが，それぞれの利点を統合した形で解析手順を整理しておくと便利である．また，各解析法の理論や複雑な酸塩基平衡異常をシンプルに理解するには，Stewart法のギャンブルグラムが大いに役に立つと思われる．一方で，血液ガス分析の限界を知ることも重要である．血液ガス分析は，あくまで患者の病態生理を解明する一手段であり，病歴や症候，他の検査なども参考に診断，治療に結び付けることが重要である．

 本稿では，血液ガス分析をわかりやすく解説し，ベッドサイドでの迅速な評価や診断に役立つ知識を整理することを目的とする．

 【要旨】 歯科診療時における全身的偶発症への対応および患者の安全性確保は，歯科麻酔科医の根幹的な責務である．近年のテクノロジーの進歩は，心肺蘇生（CPR）を取り巻く環境を劇的に変容させている．本稿では，2025年に発表されたCPR/ECCガイドラインの知見を交えながら，最新の救急デバイス，AIによる心停止予測，および市民救助者派遣システムについて概説する．主要なトピックとして，ビデオアシストCPRの臨床的意義，深層学習を用いた肥大型心筋症（HCM）のスクリーニング，およびウェアラブルデバイスによる不整脈検出について詳述する．さらに，救命の質を担保するCPRフィードバックデバイスの有用性や，操作エラーを最小化するオートショックAEDについても言及する．最後に，コネクテッドAEDやドローンなどのデジタル技術を統合した次世代の救急医療システムの展望を提示し，この進化し続ける分野において歯科麻酔科医が果たすべき役割を述べる．

 【要旨】 本邦の小児および障害児歯科診療は，身体抑制下での治療が一般的であったが，近年の倫理意識の変化や死亡事故の報告を受け，患者の心理的負担や精神発達に配慮した包括的な管理能力が歯科麻酔科医に強く求められている．行動調整においては，行動変容法，身体抑制法，精神鎮静法，全身麻酔の特性を理解し，患者の発達段階や社会的背景に応じて適切に選択・提示する必要があるが，患者の将来的な歯科受容性を考慮した「次につながる診療」の実践が不可欠である．また，解剖・生理的に気道閉塞リスクの高い小児への鎮静法や全身麻酔に関しては，安全性を最優先とした「撤退可能性」のある麻酔戦略の構築が重要となる．さらに，小児の急変には，心停止前の異常を早期に認識するPALS（小児二次救命処置）の体系的評価アプローチを術前評価や周術期管理に応用することで，多様な背景をもつ患者に対してより安全で質の高い全身管理が可能となる．