The selective serotonin reuptake inhibitor (SSRI) is a newer antidepressant in Japan, since its introduction in May 1999. We gave general anesthesia for teeth extraction to a 72-year-old woman having a depression, who was taking the SSRI (fluvoxamine). In this case, we directed the patient to suspend takirug the SSRI for two days preoperatively, and general anesthesia was given with nitrous oxide, oxygen, and sevoflurane. As a result of our management, no remarkable complications were seen throughout the perioperative period. For the general anesthetic management of patients taking the SSRI, it is thought to be important as follows; we should try to reduce the effects of the SSRI on the general anesthesia depending on withdrawal in the light of its half-life, and manage general anesthesia to cope with the inhibition of cytochrome P450 in the SSRI. The SSRI has less severe side effects, such as the anticholinergic effects reported in the tricyclic antidepressants. But the anesthetic implications of the SSRI particularly involve hyponatremia, platelet aggregation, and developing the serotonin syndrome associated with the serotomimetic drugs. Therefore, these drug interactions and altered physiological states should be cared.

View full abstract

We report general management of a patient with Noonan's syndrome and hypertrophic cardiomyopathy. A 29-year-old male needed to have a radicular cyst removed. He had been treated by a pediatrician because of cyanosis on crying and heart murmur after delivery. The diagnosis of Noonan's syndrome was made from his physical features. Cardiac catheterization revealed hypertrophic cardiomyopathy and drugs had been administered. He was also an epileptic and had been receiving valproate. In this division, dental anesthesiologists managed his dental treatment six times (general anesthesia three times, monitoring twice and intravenous sedation once). During operations under general anesthesia, premature ventricular contractions were observed but no severe complications occurred.
In the most recent operation, intravenous sedation was selected because the patient was cocperative for dental treatment. On the morning of the operation, an antibiotic was given because of aortic and mitral regurgitation. At the beginning of the operation, 5mg of midazolam was given intravenously and proper sedation was performed. Prilocaine with felypressin was given as a local anesthetic. Vital signs were stable and no events occurred during the operation.
It is important to choose appropriate management for dental treatment of a patient with Noonan's syndrome, considering the severity of the heart disease, co-operation of the patient and stress of dental treatment.

View full abstract

Glanzmanns thrombasthenia is a rare congenital platelet disorder characterized by prolonged bleeding time, qualitative platelet defect and severe hemorrhagic episods. we experienced 4 wisdom teeth extraction of the patient with Glanzmanns thrombasthenia. The patient was a 25-year-old female complained of pain at the lower left third molar region. The upper third molars were fully erupted but were inclined to the buccal side. The lower third molars were horizontally impacted. We first extracted the left lower and upper third molars simultaneously after platelet transfusion, and we observed no bleedings after the extraction. Next we extracted the right lower and upper third molars under the same conditions. Some authers reported that because platelet transfusion may have risks of causing hepatitis, HLA antigen products and graft versus host disease, platelet transfusion should be omitted for tooth extraction. However, in the cases expecting some surgical stress, enough pre-and post-operative platelet transfusion must be necessary to avoid post operative bleedings completely.

View full abstract

The medically compromised patients who underwent surgical procedure during the 10 year period from 1989 to 1998 in our department were analyzed. We obtained the following results. 1. The number of patients were 501 (281 men and 220 women) and their mean age was 48.3 years. 2. Among the disease in our area, 229 patients (45.7%) had malignant neoplasm. Advanced ages group as over 65 years, 115 patients (82.7%) had that one. 3. The patients who have medical diseases were 325 cases (64.9%) and the average number of diseases per patient was 1.6. Regarding to the underlying diseases, cardiovascular disease often observed (156 cases, 29.3%). Respiratory diseases, gastrointestinal diseases, diabetes melitus were then observed in 54 (10.1%) 49 (9.2%), and 47 (8.8%), r espectively. 4. The respiratory disease occured highly frequence than the other complications in postoperatively.

View full abstract