Hemostatic management for dental treatment in a patient of congenital deficiencies of factors V and VIII
Congenital deficiencies of factors V and VIII is rarer hereditary coagulation factor deficiency than hemophilia. Only about 30 cases have been few reports concerning hemostatic management for for dental treatment in patients with this disease. We performed scaling and teeth extraction in patient with congenital deficiencies of factors V for hemostasis, because the innate level was about 15%. As local hemostatic method, a stent and surgical pack were used at first and aterocollagen sponge was appropriate local hemostatic method was important for hemostasis after teeth extraction in patients with hemostatic disorders.

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Complete Left Bundle Branch Block (CLBBB) is a disturbance of the hearts' stimurational conduction. It is caused by hypertension, ischemic heart disease, and myocardiopathy.
In this case, we managed the patient, 87 years-Old female, with CLBBB.
In spite of transient incerasing of blood pressure, bradycaria, A-V blockoccured, with propofol in perioperative management.
The second day after Operation, there happened decreasing of oxygen partial pressure in arterial blood (PaO₂), and opacitial sthenia of chest X-P presumed aterectasis.
We used Continuous Positive Airway Pressure (CPAP) to improve PaO₂. Forth day after operation, PaO₂ was improved.
We concluded that general anesthesia management with propofol is useful for high aged patient with CLBBB.

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We reported the two cases of tooth extractions from the patients with hemorrhagic telangiectasia (Osler-Weber-Rendu disease). A fifty-four years old female was needed to receive blood transfusion prior to the tooth extraction, because she had had frequent recurrent breedings from the nasal and oral mucase. It was difficult to stop the bleeding from the tooth extracted cavity and the gingiva by using an electracautery. However, to give a systemical and topical coagulant, and to adapt a temporary attachment were effective methods in stopping the bleeding from oral mucosa and the cavity. In another case, it was not so severe case. Administration of topical coagulant to tooth extracted cavity seemed to have enough effect to stop th bleeding after the extraction.

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The case of a 55-year-old man in dental disorder with white coat hypertension is presented. Under general anesthesia removal of post operative cyst, tooth extractions, restorations and root canal treatments were performed. He took anxiolytic drugs before and after the treatment. The blood pressure and the pulse were stable.
In white coat hypertension blood pressures taken by clinic measurements are higher than those by ambulatory monitoring. The cause of white coat hypertension is supposed to be mental stress, alert reaction and defense reaction. Dental disorder cases refuse or avoid any dental treatment because of their strong fear of dental management.
The treatments were uneventful, but dental treatment of patients in dental disorder with white coat hypertension requires careful attention.

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We report three general anesthetic management cases dislocation of the mandible in two elderly patients with a history of cerebrovascular disease.
Case 1: An 86-year-old woman who complained of postprandial inability to close the mouth. At a general hospital, she was diagnosed as having bilateral dislocation of the mandible, and referred to our hospital. It was impossible to perform reposition by her pain.
Therefore, the procedure was performed under general anesthesia. Nasotracheal intubation was performed after induction with thiopental and vecuronium bromide (V. B.). The procedure required 2 minutes, and extubation was possible about 45 minutes later. During induction and procedure the hypertension were managed using calcium channel blocker (diltiazem).
About 8 months later the patient again experienced bilateral dislocation of the mandible. The same procedure was performed again under general anesthesia at our hospital.
Case 2: An 80-year-old woman who was unable to close the mouth as a result of falling when cerebral hemorrhage occurred.
However, the symptom was neglected as a sequela of the cerebral hemorrhage. After about 3 months, the patient was diagnosed as having bilateral dislocation of the mandible at a dental clinic, and referred to our hospital.
The reposition was performed under general anesthesia. Nasotracheal intubation was performed after induction with fentanyl and lidocaine, followed by thiopental and V. B..
The time required for the procedure was 30 minutes.
When patients have a history of cerebrovascular disease, they are at increased risk of recurrence due to sudden changes in blood pressure during the operation. In elderly patients this is most noticeable. For the cases reported here, the cardiovascular system was managed using a calcium channel blocker in Case 1, fentanyl and lidocaine in Case 2.

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