Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Neuroma formation at sites of injury can impair peripheral nerve regeneration. Although the involvement of semaphorin 3A has been suggested in neuroma formation, this detailed process after injury is not fully understood. This study was therefore undertaken to examine the effects of semaphorin 3A on peripheral nerve regeneration during the early stage after injury. Immunohistochemistry for semaphorin 3A and PGP9.5, a general neuronal marker, was carried out for clarify chronological changes in their expressions after transection of the mouse inferior alveolar nerve thorough postoperative days 1 to 7. At postoperative day 1, the proximal stump of the damaged IAN exhibited semaphorin 3A, while the distal stump lacked any immunoreactivity. From this day on, its expression lessened, ultimately disappearing completely in all regions of the transected inferior alveolar nerve. A local administration of an antibody to semaphorin 3A into the nerve transection site at postoperative day 3 inhibited axon sprouting at the injury site. This antibody injection increased the number of trigeminal ganglion neurons labeled with DiI (paired t-test, p < 0.05). Immunoreactivity of the semaphorin 3A receptor, neuropilin-1, was also detected at the proximal stump at postoperative day 1. These results suggest that nerve injury initiates semaphorin 3A production in ganglion neurons, which is then delivered through the nerve fibers to the proximal end, thereby contributes to the inhibition of axonal sprouting from the proximal region of injured nerves in the distal direction. To our knowledge, this is the first report to reveal the involvement of Sema3A in the nerve regeneration process at its early stage.

DOI： 10.1038/s41598-018-37819-6

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Activation of Shh signaling is known to be observed following injury of the peripheral nerves such as the sciatic nerve. However, the precise role of Shh signaling during peripheral nerve regeneration is not fully understood. The inferior alveolar nerve (IAN) is most commonly injured during oral surgery. Unlike the sciatic nerve, the IAN is isolated from other craniofacial tissues, as it resides in a long bony canal within the mandible. The IAN is thus an excellent experimental model for investigating peripheral nerve regeneration. In this study, the role of Shh signaling in peripheral nerve regeneration was investigated using the mouse IAN transection model. During regeneration, Shh signaling was activated within the entire distal region of the IAN and proximal stumps. Inhibition of Shh signaling by cyclopamine application at the transection site led to abnormal axon growth in random directions, a reduced number of macrophages, and an increase in myelin debris within the distal region. Shh signaling is thus involved in peripheral nerve regeneration via the regulation of myelin degradation.

DOI： 10.1016/j.neulet.2017.12.051

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Peripheral nerve injury has been suggested to up-regulate mRNA for the vascular endothelial growth factor (VEGF) which enhances nerve regeneration. VEGF is known to regulate angiogenesis by binding with a specific receptor, the vascular endothelial growth factor receptor (VEGFR). However, little is known about the involvement of VEGF-VEGFR signaling in the nerve regeneration at early stages though previous studies contained a lengthy observation. The present study examined that relationship between angiogenesis and peripheral nerve regeneration at the early stage after nerve transection by focusing on the chronological changes in the expression patterns of VEGF-VEGFR signaling. This study used our previously reported experimental model for nerve regeneration following the transection of the inferior alveolar nerve (IAN) in mice. In a double staining of PGP9.5 and CD31, respective markers for the nerve fibers and endothelial cells, CD31 immunoreactions first appeared in the injury site on postoperative (PO) day 2 when the transected nerve fibers had not been re-connected. The most intense immunoreaction for CD31 was found around the regenerating nerve fibers extending from the proximal stump on PO day 3, but it gradually lessened to disappear by PO day 7. The expression patterns of VEGFR1 and VEGFR2 showed similar chronological changes through the observation periods, with most intense immunoreaction found on PO day 3. Western blotting of total protein extracted from the injury site demonstrated the clear bands for VEGF-A and VEGF-B on PO day 2, indicating a time lag for the expression of ligands and receptors. A local administration of antibody to VEGF-A inhibited the elongation of the nerve fibers from the proximal stump. Furthermore, this administration of VEGF-A antibody inhibited the expression of CD31 in the gap between proximal and distal stumps. These results indicated that a nerve injury initiates productions in VEGF-A and VEFG-B, followed with the expression of VEGFR1 and VEGFR2 at early stages after the nerve injury. Taken these findings together, it is reasonable to postulate that immediate response of VEGF-VEGFR signaling to nerve injury plays a crucial role in local angiogenesis, resulting in a trigger for the regeneration of the nerve fibers in mouse IAN.

File： p287-294 1847 Yohei NISHIDA.pdf

DOI： 10.2220/biomedres.39.287

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

Background: The trigeminal subnucleus caudalis (Vc) plays a critical role in transmission and modulation of nociceptive afferent inputs, and exhibits a similar layer construction to the spinal dorsal horn. However, afferent inputs enter the brainstem and project to a separately located nucleus. It has previously been difficult to record responses of the Vc to afferent fiber activation in a brainstem slice preparation. The aim of the present study was to establish a novel brainstem slice preparation method to study trigeminal nociceptive transmission mechanisms.
New method: Thirty adult 6-7-week-old C57/BL6J male mice were included in the study. Obliquely sliced brainstem sections at a thickness of 600 mu m, which included the Vc and the root entry zone to the brainstem, were prepared. The Vc response to electrical stimulation of afferent fibers was observed as a change in intracellular calcium concentration by fluorescence intensity response.
Results: Electrical stimulation of afferent inputs to the trigeminal nerve increased fluorescent intensity in the Vc, which was completely diminished by tetrodotoxin and significantly suppressed by the AMPA/kainate antagonist CNQX (paired t-test, P&lt;0.001), although the non-competitive NMDA antagonist (+)-MK801 maleate resulted in no changes. These results suggested a glutamate receptor-mediated response.
Comparison with existing methods/conclusion: This brainstem slice preparation will be useful for investigating nociceptive transmission mechanisms of the trigeminal nerve. (C) 2017 The Authors. Published by Elsevier B.V.

DOI： 10.1016/j.jneumeth.2017.05.019

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Objective. Magnetic resonance neurography reveals abnormal morphologies of regenerated nerves and overgrown connective tissue in injured trigeminal nerves, suggesting neuroma formation. We hypothesized that such deformities and scar formation contribute to pain symptoms.
Study Design. High-contrast high-resolution magnetic resonance imaging was utilized to evaluate the inferior alveolar nerve and lingual nerve following traumatic injury in 19 patients. The relationship between the morphologic classification and severity of the sensory disorder was assessed.
Results. In all cases, 3-dimensional anisotropy contrast periodically rotated overlapping parallel lines with enhanced reconstruction (3DAC-PROPELLER) successfully revealed the inner structures within the lesion. The isolated type represented the normal course of the nerve isolated from scar-like tissue (8 cases), whereas the deformity type included the deformed nerve either within scar-like tissue or by itself, unassociated with surrounding scar-like tissue (9 cases). In the remaining 2 cases, the nerve tissue and scar-like tissue were incorporated. Patients with the deformity type exhibited significantly more severe pain symptoms compared with patients with the isolated type.
Conclusions. Overgrown connective tissue does not necessarily block regenerating nerves and itself may not cause pain. The morphologic findings on the 3DAC-PROPELLER were relevant to the severity of pain symptoms.

DOI： 10.1016/j.oooo.2017.02.017

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

Brain-derived neurotrophic factor (BDNF), which is released due to nerve injury, is known to promote the natural healing of injured nerves. It is often observed that damage of mandibular canal induces local sclerotic changes in alveolar bone. We reported that peripheral nerve injury promotes the local production of BDNF; therefore, it was possible to hypothesize that peripheral nerve injury affects sclerotic changes in the alveolar bone. This study aimed to evaluate the effect of BDNF on osteogenesis using in vitro osteoblast-lineage cell culture and an in vivo rat osteotomy model. MC3T3-E1 cells were cultured with BDNF and were examined for cell proliferative activity, chemotaxis and mRNA expression levels of osteoblast differentiation markers. For in vivo study, inferior alveolar nerve (IAN) injury experiments and mandibular cortical osteotomy were performed using a rat model. In the osteotomy model, exogenous BDNF was applied to bone surfaces after corticotomy of the mandible, and we morphologically analyzed the new bone formation. As a result, mRNA expression of osteoblast differentiation marker, osteocalcin, was significantly increased by BDNF, although cell proliferation and migration were not affected. In the in vivo study, osteopontin-positive new bone formation was significantly accelerated in the BDNF-grafted groups, and active bone remodeling, involving trkB-positive osteoblasts and osteocytes, continued after 28 days. In conclusion, BDNF stimulated the differentiation of MC3T3-E1 cells and it promoted new bone formation and maturation. These results suggested that local BDNF produced by peripheral nerve injury contributes to accelerating sclerotic changes in the alveolar bone.

DOI： 10.1371/journal.pone.0169201

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS  

Objective. Although surgery using a polyglycolic acid-collagen (PGA-c) tube is effective for peripheral nerve injury-induced chronic hand pain, it has not been applied to trigeminal nerve lesions because of the difficult approach. We used a PGA-c tube during surgery for trigeminal neuropathy and evaluated its prognosis based on the outcomes.
Design. Case report.
Setting and Patients. In the dental anesthesia division of a university hospital, 11 patients with severe dysesthesia underwent surgical repair of a damaged lingual nerve (LN) or inferior alveolar nerve (IAN). One patient was lost to follow-up. Changes in quantitative sensory testing (QST) and the presence of dysesthesia as a treatment outcome were compared preoperatively and postoperatively in 10 patients. Two surgical treatments, bridging or encircling peripheral nerves, were applied. Bridging of both stumps was selected when neurotmesis was detected or the nerve was lacerated during surgery (N=4). Otherwise, a longitudinal PGA-c tube was used to encircle the lesion (N56). Outcomes were evaluated 2 months to 8 years postoperatively.
Results. Both methods improved the patients' condition based on QST results (brush stroke perception, mechanical touch threshold, sensitivity to cold/hot stimuli). Preoperative allodynia or dysesthesia was resolved in six patients and greatly reduced in four. Two patients (one with inflammation-induced pain, one with implant-related pain) developed prolonged postoperative allodynia requiring pain-relief medication.
Conclusions. Use of a PGA-c tube for surgical treatment of intractable pain due to LN or IAN neuropathy helps alleviate sensory impairment. The possibility of new dysesthesias emerging postoperatively, however, should be noted.

DOI： 10.1093/pm/pnw088

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Language：Japanese   Publisher：新潟歯学会  

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Quintessence Publishing Co. Inc.  

Aims: To examine the effects of local brain-derived neurotrophic factor (BDNF) produced after nerve injury on the functional regeneration of the damaged nerve. Methods: The inferior alveolar nerve was transected in adult male rats and 1 μg or 10 μg of BDNF antibody was administered at the injury site
a third group of rats received saline and a fourth group underwent nerve ligation. BDNF mRNA was quantified in the transected tissue and trigeminal ganglion by using realtime polymerase chain reaction (PCR). Head withdrawal thresholds following mechanical (tactile) stimulation (with von Frey filaments) of the mental region were measured for 3 weeks postoperatively. Electromyographic activity of the jaw opening reflex (JOR) was recorded from the anterior belly of the digastric muscle. Results: Within 24 hours, transection induced significant elevation of BDNF mRNA expression in the injured tissue (unpaired t test, P &lt
.01). The head withdrawal threshold to mechanical stimulation increased at 1 day after transection and then decreased (two-way repeated measures analysis of variance [ANOVA], P &lt
.001). At 2 weeks after surgery, the head withdrawal threshold was higher than before surgery in the group that received a higher dose of BDNF antibody (ANOVA, P &lt
.001), but not in the group that received a smaller dose (ANOVA, P &gt
.05). No significant differences were observed in the latency or threshold of the JOR between saline- and antibody-treated rats (unpaired t test, P &gt
.05). Conclusion: These results suggest that locally administered BDNF antibody neutralizes nerve injury-induced BDNF at the injury site and thus influences sensorimotor recovery.

DOI： 10.11607/ofph.1651

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Language：Japanese   Publisher：日本末梢神経学会  

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

This study aimed to examine the contributions of brain-derived neurotrophic factor (BDNF) at the injury site toward neuroma formation and nerve regeneration after inferior alveolar nerve transection. Histological analysis confirmed neuroma formation at 2 weeks after complete transection of the inferior alveolar nerve. A local administration of an antibody to BDNF inhibited connective tissue proliferation at the injury site and promoted nerve fiber integrity. Fluorogold labeling showed a significantly higher number of labeled cells in the trigeminal ganglion in the anti-BDNFtreated group compared with the vehicle control group. In-situ hybridization histochemistry showed intense signals for tropomyosin receptor kinase B mRNA in the area of the injury site containing fibrous or granular tissue in the anti-BDNF-treated group. In contrast, these signals were close to the detection limit in the area of the perineurium in intact nerve trunks, indicating that the signals were expressed by fibroblasts within the connective tissue. These findings suggest that antagonization of endogenous BDNF induced by nerve injury reduces neuroma formation, without inhibiting damaged axon regeneration. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

DOI： 10.1097/WNR.0000000000000231

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Authorship：Corresponding author   Language：Japanese   Publisher：(一社)日本ペインクリニック学会  

【目的】今まで外科的顎矯正手術を受けた患者で術後に下歯槽神経の損傷によって生じたと考えられるオトガイ部の触覚閾値が上昇した患者の治癒について検討してきた。そこで本研究では抜歯などの一般的な歯科処置を含む外傷性三叉神経障害を対象として、術後経過の記録から同領域における感覚が自然治癒しにくいと予測できる触覚閾値を後ろ向きに検討した。【方法】顎顔面領域の手術や外傷でオトガイ部に感覚障害を生じた、受傷から初回の触覚閾値測定までの日数が7日から14日であり、受傷から2回目の触覚閾値測定までの日数が21日から56日であった69名を対象とし、初回に対して2回目の触覚閾値が悪化または治癒傾向となった感度、特異度、陽性予測度、陰性予測度を算出し、感覚の自然回復が困難であると予測できる診断効率を比較した。【結果】受傷から1〜2週間の触覚閾値が3.0gのときに感覚の自然回復が困難であると予測できる診断効率が最も高かった。【結論】顎顔面領域の感覚障害では、受傷から1〜2週間の触覚閾値が3.0g以上であると、その後3週間の感覚は自然回復しにくくなることが示唆された。(著者抄録)

DOI： 10.11321/jjspc.12-0002

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J03612&link_issn=&doc_id=20130716410004&doc_link_id=%2Fca0jjspc%2F2013%2F002002%2F004%2F0093-0097%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fca0jjspc%2F2013%2F002002%2F004%2F0093-0097%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Introduction. Lingual nerve injury is sometimes caused by dental treatment. Many kinds of treatment have been reported, but many have exhibited poor recovery. Here the authors report changes in somatosensory and chemosensory impairments during a long-term observation after lingual nerve repair. Case presentation. A 30-year-old Japanese woman claimed dysesthesia and difficulty eating. Quantitative sensory test results indicated complete loss of sensation in the right side of her tongue. She underwent a repair surgery involving complete resection of her lingual nerve using a polyglycolic acid tube containing collagen 9 months after the injury. A year after the operation, her mechanical touch threshold recovered, but no other sensations recovered. Long-term observation of her somatosensory and chemosensory function after the nerve repair suggested that recovery of taste sensation was greatly delayed compared with that of somatosensory function. Conclusion: This case shows characteristic changes in somatosensory and chemosensory recoveries during 7 postoperative years and suggests that taste and thermal sensations require a very long time to recover after repair surgery. © 2013 Seo et al.
licensee BioMed Central Ltd.

DOI： 10.1186/1752-1947-7-77

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

Increased expression of the transient receptor potential vanilloid 1 (TRPV1) channels, following nerve injury, may facilitate the entry of QX-314 into nociceptive neurons in order to achieve effective and selective pain relief. In this study we hypothesized that the level of QX-314/capsaicin (QX-CAP) - induced blockade of nocifensive behavior could be used as an indirect in-vivo measurement of functional expression of TRPV1 channels. We used the QX-CAP combination to monitor the functional expression of TRPV1 in regenerated neurons after inferior alveolar nerve (IAN) transection in rats. We evaluated the effect of this combination on pain threshold at different time points after IAN transection by analyzing the escape thresholds to mechanical stimulation of lateral mental skin. At 2 weeks after IAN transection, there was no QX-CAP mediated block of mechanical hyperalgesia, implying that there was no functional expression of TRPV1 channels. These results were confirmed immunohistochemically by staining of regenerated trigeminal ganglion (TG) neurons. This suggests that TRPV1 channel expression is an essential necessity for the QX-CAP mediated blockade. Furthermore, we show that 3 and 4 weeks after IAN transection, application of QX-CAP produced a gradual increase in escape threshold, which paralleled the increased levels of TRPV1 channels that were detected in regenerated TG neurons. Immunohistochemical analysis also revealed that non-myelinated neurons regenerated slowly compared to myelinated neurons following IAN transection. We also show that TRPV1 expression shifted towards myelinated neurons. Our findings suggest that nerve injury modulates the TRPV1 expression pattern in regenerated neurons and that the effectiveness of QX-CAP induced blockade depends on the availability of functional TRPV1 receptors in regenerated neurons. The results of this study also suggest that the QX-CAP based approach can be used as a new behavioral tool to detect dynamic changes in TRPV1 expression, in various pathological conditions.

DOI： 10.1371/journal.pone.0044023

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Authorship：Lead author,　Corresponding author   Language：English   Publisher：W B SAUNDERS CO-ELSEVIER INC  

DOI： 10.1016/j.joms.2011.10.004

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MOSBY-ELSEVIER  

Objective. The objective of this study was to evaluate the inferior alveolar nerve (IAN) morphologically in patients with symptomatic posttraumatic sensory disorders using magnetic resonance imaging (MRI) on a high-field system.
Study design. Sixteen patients who complained of persistent sensory disturbance attributed to unilateral IAN injury participated in the investigation. High-resolution 3-dimensional volume rendering magnetic resonance neurography was performed on a 3.0-T MRI system.
Results. In 15 (94%) of 16 patients, high-resolution 3-dimensional volume rendering magnetic resonance neurography demonstrated morphologic abnormalities of the IAN as well as connective tissue overgrowth. These findings were confirmed intraoperatively (6 patients) and histopathologically (5 patients). The duration of sensory disturbance correlated significantly with the pattern of morphologic deformity and connective tissue overgrowth.
Conclusions. The current study clearly demonstrated that appropriate application of clinical MRI techniques can significantly improve the diagnosis and potential treatment of patients with orofacial peripheral nerve disorders. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:95-102)

DOI： 10.1016/j.tripleo.2010.09.002

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER IRELAND LTD  

Potentiation of inhibitory gamma-aminobutyric acid subtype A (GABA(A)) receptor function is involved in the mechanisms of anesthetic action. The present study examined the immobilizing action of the volatile anesthetic isoflurane in mice with double knockout (DKO) of phospholipase C-related inactive protein (PRIP)-1 and -2. Both of these proteins play important roles in the expression of GABA(A) receptors containing the gamma 2 subunit on the neuronal cell surface. Immunohistochemistry for GABA(A) receptor subunits demonstrated reduced expression of gamma 2 subunits in the spinal cord of the DKO mice. Immunohistochemistry also revealed up-regulation of the alpha 1 and beta 3 subunits even though there were no apparent differences in the immunoreactivities for the beta 2 subunits between wild-type and DKO mice. The tail-clamp method was used to evaluate the anesthetic/immobilizing effect of isoflurane and the minimum alveolar concentration (MAC) was significantly lower in DKO mice compared with wild-type controls (1.07 +/- 0.01% versus 1.36 +/- 0.04% atm), indicating an increased sensitivity to isoflurane in DKO mice. These immunohistochemical and pharmacological findings suggest that reduced expression of the GABA(A) receptor gamma 2 subunit affects the composition and function of spinal GABA(A) receptors and potentiates the immobilizing action of isoflurane. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.neulet.2010.01.031

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

Dental treatments sometimes cause sensory impairment, especially in the region innervated by the third division of the trigeminal nerve. The most frequent symptoms are loss of sensation and abnormal sensation. Although most studies have addressed the neuropathic symptom "allodynia" using experimental animal models of the infraorbital nerve, there is little information regarding the sensory impairment that frequently occurs clinically. Therefore, different experimental models are required to clarify the mechanisms of the clinical effects, and previous experimental models have been limited to rats. Here, we report a sensory impairment model in mice whose mechanical touch threshold increased after tight ligation of the mental nerve. Habituation before surgery by mechanical touching of the face enabled us to observe the long-term chronological changes in sensation. The mechanical touch thresholds within the mental nerve region were measured for 70 postoperative (PC) days. Changes in the distribution of substance P (SP) were evaluated by immunohistochemistry to clarify the involvement of axonal flow in the sensory impairment and its recovery. The mechanical touch thresholds transiently increased by PO days 2-3, but decreased to the preoperative levels at around PO day 14. Apparent SP immunoreactivity was recognizable on the medial side to the ligation at PO days 2-3 and disappeared at PO day 7. These behavioural and immunohistochemical changes appeared to exhibit similar time courses, suggesting a possible relationship between them. Therefore, we suggest that our experimental mouse model could represent a new model for clarifying the mechanism of the sensory impairment caused by peripheral nerve injury. (C) 2009 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jneumeth.2009.04.020

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

DOI： 10.1016/j.joms.2007.08.029

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMEDICAL RESEARCH PRESS LTD  

The calcitonin-gene related peptide (CGRP) is a primary afferent neurotransmitter in the trigeminal system. Although a neonatal administration of capsaicin eliminates substance P (SP)-mediated nociceptive responses to induce a permanent functional reduction in C-fibers, little information is available regarding changes in CGRP-immunoreaction in mice undergoing neonatal capsaicin treatment (CP mice). This study examined postnatal changes in the distribution of CGRP-immunoreaction in the trigeminal subnucleus caudalis and trigeminal ganglion of CP mice by immunohistochemical technique and a quantitative analysis. Immunohistochemistry for CGRP in the subnucleus caudalis (Vc) demonstrated two dense distributions of neurons in the CP mice as well as naive mice: in the marginal layer and the region 400-600 mu m deep. The quantitative analysis revealed no significant difference in the density of CGRP immunoreaction between naive and CP mice 1-8 weeks of age. In the trigeminal ganglion of both groups, the size distribution of CGRP-positive neurons displayed a distribution pattern with one peak in 200-300 mu m(2) at week 1 and with two peaks in 200-300 mu m(2) and 600-700 mu m(2) at week 8 but no significant difference in neural density existed between these regions. When double staining in the naive mice with CGRP or SP and VR1, a capsaicin receptor, was done, many trigeminal ganglion neurons co-expressed SP- and VR1-immunoreactions, but rarely exhibited CGRP/VR1-co-localization. Taken together with previous data, these current observations suggest that CGRP containing afferent neurons possibly performs differing roles in nociceptive afferent input transmission within the Vc from SP-containing neurons in mice.

DOI： 10.2220/biomedres.29.33

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER IRELAND LTD  

To investigate plastic changes in nociceptive sensitivity of the dorsal horn, slow excitatory responses elicited by iteration of high-frequency stimulation were spatiotemporally observed in spinal cord slices of young-adult rats using membrane excitation imaging techniques. Single-pulse stimulation to the dorsal root elicited membrane excitation in lamina II, and high-frequency pulse-train stimulation evoked long-lasting excitation that expanded widely in the dorsal horn. Iteration of high-frequency stimulation enhanced the strength and extent of the excitatory responses, but such augmentation of the excitatory responses disappeared in the presence of an NMDA receptor antagonist (CPP) and was hindered by an NK1 receptor antagonist (L-703.606). The results suggest that activation of both NMDA and NK1 receptors is involved in the enhancement of slow excitatory responses evoked by iteration of high-frequency stimulation. (c) 2006 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.

DOI： 10.1016/j.neures.2006.11.011

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：INT SOC HISTOLOGY & CYTOLOGY  

The trigeminal subnucleus caudalis (Vc) is a critical relay site for processing nociceptive afferent input from the orofacial area in addition to its modulation by neuroplastic change. Although an administration of capsaicin in neonates induces a selective destruction of substance P (SP)-immunoreactive nerve fibers, little information is available regarding its detailed effects on the Vc, particularly during postnatal development. The present study examined postnatal changes in the distribution of SP in the Vc and trigeminal ganglion (TG) by immunohistochemical techniques in naive (NV) and neonatally capsaicin-treated (CP) mice, combined with a quantitative analysis. The neonatal mice received a single subcutaneous injection of capsaicin (50 mg/kg) at 48 hours after birth. The neural density of the SP-immunoreaction decreased to approximately a quarter of that in 1-week-old NV mice but increased to three-quarters of that in the NV in the superficial area after postnatal week 2. A double staining with SP and myelin basic protein confirmed the absence of any SP-immunoreaction in the myelinated nerve fibers in both NV and CP mice. The SP-immunoreaction never overlapped with non-peptidergic IB4-labeled neurons in the Vc and TG of either group. Neither the size distribution of SP-positive neurons nor their relative ratio in the TG differed between NV and CP mice at the ages of postnatal weeks 1 and 8. These findings indicate two putative origins for the emergent SP-immunoreaction in the superficial layer of the Vc of the CP mice: the surviving trigeminal neurons with SP against capsaicin treatment and/or intrinsic neurons/interneurons in the Vc without SP under normal conditions.

DOI： 10.1679/aohc.68.311

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER IRELAND LTD  

The postnatal development of nociceptive afferent activity expansion and its modulation features were examined in mice using an optical imaging technique. Developing mice (1-2 weeks old (N 1-2w), 3-4 weeks old (N3-4w), 5-6 weeks old (N5-6w) and 7-8 weeks old (N7-8w)) and neonatally capsaicin-treated mice were used. The propagation of neuronal excitation was measured by changes in fluorescent intensity in horizontal brain stem slices evoked by electrical stimulation to the trigeminal spinal tract. A single-pulse stimulation evoked excitation propagation in the trigeminal caudalis (Vc). The propagation area was larger in N1-2w than in N7-8w, and no differences were observed between capsaicin-treated and naive mice in the same age groups. Repetitive stimulation (100 Hz, 30 pulses) elicited long-lasting and widespread excitation propagation. The excitation propagation area was significantly larger in N7-8w than in N1-2w, N3-4w and N5-6w. This propagation was suppressed by 5 mu M L-703.606, an NK1-receptor antagonist, suggesting that the repetitive stimulation-elicited excitation may require substance-P releases. Morphological observations demonstrated that the neural network in the Vc had grown by postnatal week 5. These results suggest that nociceptive afferent activity co-operatively matures with development of the network structure in the Vc, and that a mechanism for prolonged increase in central excitability is established during a later postnatal period. (c) 2005 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.

DOI： 10.1016/j.neures.2005.03.005

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO  

Purpose: Paresthesia is a well known consequence of peripheral nerve injury. However, the neural mechanisms of the 2 recognized types, spontaneous and elicited, are currently unknown. This study aimed to investigate these 2 paresthesias and the possible mechanisms accompanying orthognathic surgery.
Patients and Methods: Mechanical-touch thresholds and current perception threshold were measured before and 7 days after surgery in 60 chin sites (mental nerve area) of 30 patients who underwent orthognathic surgery. Similar testing was conducted on healthy Volunteers (controls). All sites were classified by the presence or absence of each paresthesia: spontaneous paresthesia or no spontaneous paresthesia, and elicited paresthesia or no elicited paresthesia. Presence or absence analyses were followed-up for 6 weeks after surgery.
Results: Gender differences and maxillary surgery did not change the incidence of paresthesia during postoperative week 1 (chi-square test, P &gt; .05). A significantly higher mechanical-touch threshold was observed with spontaneous paresthesia compared with no spontaneous paresthesia (Mann-Whitney U-test; P &lt; .05), but not between no elicited paresthesia and elicited paxesthesia (Mann-Whitney U-test; P &gt; .05). A significant increase in postsurgery current perception thresholds values compared with presurgery values was observed at 2,000 Hz in spontaneous paresthesia, and at 2,000 and 5 Hz in elicited paresthesia (paired t test, P &lt; .05). The incidence of spontaneous paresthesia decreased more rapidly than elicited, while the latter tended to increase again during the 6-week postsurgical test period.
Conclusion: The results suggested that both spontaneous and elicited paresthesias are associated with damage and dysfunction in myelinated primary afferent fibers, but additional neural mechanisms are implicated during elicited paresthesia. (C) 2005 American Association of Oral and Maxillofacial Surgeons.

DOI： 10.1016/j.joms.2004.07.015

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

Nociceptive afferent signals from the orofacial area are transmitted to the trigeminal subnucleus caudalis (Vc) through the release of glutamate and/or substance P (SP). Although nociceptive transmission and/or modulating mechanisms are known to develop during the postnatal period, the specific developmental changes in nociception and/or modulation remain unclear. The present study examined postnatal changes in the spatial relationship between SP and its receptor, the NK1 receptor (NK1R), in the mouse Vc by immunohistochemistry and quantitative analysis. The medulla was removed from C57BL/6N mice (1, 2, 4, and 8 weeks of age) after perfusion and fixation, and cut horizontally at a thickness of 40 mu m. The relative densities of SP- and NK1R-immunoreactive areas and their changes with age were assessed statistically. One- and 2-week-old mice showed relatively high densities of SP-positive structures in the marginal layer (Mar) and the deep part of the magnocellular layer (Mag). The SP distribution in the superficial Vc remained unchanged, but the density in the deep Mag gradually decreased with age, resulting in a complete loss after postnatal week 4. The NK1R-irnmunoreactivity exhibited a similar distribution pattern to that of SP, but the pattern remained unchanged during the postnatal period.
Double-iinrnunofluorescence staining for SP and NK1 R demonstrated only moderate direct contact of SP-positive structures with NK1R in the superficial area. These separate distributions and the postnatal changes in SP and NK1R suggest the possibility of another nociceptive afferent transmission mechanists, that is, volume transmission, in the Vc other than synapse-mediated transmission. (c) 2005 Elsevier B.V All rights reserved.

DOI： 10.1016/j.devbrainres.2004.12.005

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO  

Purpose: Steroid hormones are therapeutic for motor and/or sensory dysfunctions caused by nerve injury. However, the timing for giving such medicine is unclear. This study aimed to estimate the efficacy of steroid treatment and determine an appropriate start time after sensory impairment.
Patients and Methods: Twenty-seven patients with sensory impairment who received orthognathic surgery were classified into groups called 1W (n = 6), 3W (n = 6), or 6W (n = 8) group on the basis of start time for steroid treatment, being 1 week, 3 weeks, or 6 weeks after surgery, respectively, and a no steroid treatment (NST) group (a control group) (n = 6) that did not receive treatment for 10 to 12 weeks after surgery. Sensory impairment was diagnosed if postoperative first week mechanical-touch threshold was over 4.0 as measured by Semmes aesthesiometer. Prednisolone treatment was administered orally to patients at 30 mg for 7 days, 15 mg for 4 days, and 5 mg for 3 days. Mechanical-touch threshold and thermal perceptions were compared before and after treatment.
Results: At 1 week postoperatively, there were no significant differences in mechanical-touch threshold among the 4 groups (analysis of variance, P &gt; .05). Changes in mechanical-touch threshold in the 1W group showed no significant improvement (analysis of variance, P &gt; .05), but in the 3W and 6W groups, there were significant differences compared with the NST group (Dunn's methods, P &lt; .05).
Conclusions: Steroid treatment for sensory impairment after orthognathic surgery has the potential to accelerate recovery and it appears desirable to start treatment later than 1 week postoperatively. (C) 2004 American Association of Oral and Maxillofacial Surgeons.

DOI： 10.1016/j.joms.2004.06.033

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

A high-speed optical imaging technique was employed for visualizing neuronal excitation propagation elicited by afferent stimulation in the mouse trigeminal caudalis (Vc) to clarify the central nociceptive modulation mechanism. Membrane depolarization evoked by a single-pulse stimulation to the spinal trigeminal tract (Tr) was propagated rostrally to the Vc, which was suppressed by CNQX This is consistent with our morphological observation that axons expand from the Tr into the Vc. A trained-pulse (tetanus) stimulation to the Tr evoked a broad, persistent excitation in the Vc, while MK-801 suppressed it. Neonatally capsaicin-treated mice maintained a single-pulse response but a lacked tetanus-evoked one. These indicated that prolonged depolarization elicited by repetitive stimulation is a prerequisite to C-fiber excitation for activating the NMDA receptors.

DOI： 10.1097/01.wnr.0000078544.07662.cc

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI IRELAND LTD  

The influence of testosterone on the postnatal development of reflex electromyographic (EMG) jaw muscle activity evoked by injection of mustard oil (MO) into the temporomandibular joint region and the later recurrence of this EMG activity after intravenous injection of naloxone, was studied in male rats. MO-evoked EMG activity in the contralateral digastric muscle and naloxone-induced recurrence of this EMG activity were fully developed in intact, 8-week-old rats. Castration at 4 weeks of age inhibited the development of the contralateral MO-evoked EMG activity, but did not influence the naloxone-induced recurrence. Contralateral MO-evoked responses were observed in 8-week-old castrated rats if they received testosterone replacement therapy beginning at 4 weeks of age. These data suggest that testosterone is required for the development of a contralateral nociceptive reflex in the digastric muscle of male rats. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

DOI： 10.1016/S0304-3940(02)01173-4

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

The effect of intrathecal administration of the 5-HT3 receptor agonist 2-methyl-5-hydroxytryptamine (2m-5HT) on jaw muscle activity evoked by mustard oil (MO) injection into the temporomandibular joint of anesthetized rats was examined. One microgram or 100 mug of 2m-5HT significantly enhanced or suppressed jaw muscle responses, respectively. Pre-administration of tropisetron, a 5-HT3 receptor antagonist, attenuated the effect of 2m-5HT. These results indicate that activation of 5-HT, receptors can modulate trigeminal nociceptive responses. (C) 2002 Elsevier Science B.V. All rights reserved.

DOI： 10.1016/S0006-8993(02)02367-3

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

The present study reports on a characteristic spatio-temporal propagation of differential fluorescent images in the rat, brain stem slice by a high-speed optical imaging technique. Coronal or sagittal slices were stained with a voltage-sensitive dye RH-414, and the superficial layer of the trigeminal caudalis (Vc) was then electrically stimulated. The marginal layer and substantia gelatinosa showed larger rostrocaudal excitation than coronal, despite a lack of tract stimulation expansion in either direction. A perfusion of 0.5 mu mol/l TTX, not 10 mu mol/l CNQX suppressed these propagations. These findings suggest that the superficial layer of Vc has spatial differences in neuronal excitation propagation, as evidenced by morphological observations that dendrites in the superficial layers extend in the rostrocaudal direction. NeuroReport 12:3985-3988 (C) 2001 Lippincott Williams & Wilkins.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

The injection of the small-fibre excitant and inflammatory irritant mustard oil (MO) into the temporomandibular joint (TMJ) region of rats evokes a sustained and reversible increase in electromyographic (EMG) activity of jaw muscles. The 'rekindling' of this nociceptive reflex by intrathecal (i.t.) administration of the opiate antagonist naloxone and mu, but not delta and kappa selective opioid antagonist, suggests that it may be modulated by endogenous opioid inhibitory mechanisms. (C) 2001 Elsevier Science B.V. All rights reserved.

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

The effect of intrathecal administration of the GABA(A) receptor antagonist bicuculline methylbromide on jaw muscle electromyographic (EMG) activity evoked by mustard oil injection into the rat temporomandibular joint was studied. Bicuculline given prior to mustard oil augmented the EMG activity evoked by mustard oil, and &apos;rekindling&apos; of EMG activity was induced by bicuculline given 30 min after mustard oil. These results suggest that central GABA(A) receptors modulate reflex responses to noxious craniofacial stimuli. (C) 2001 Elsevier Science B.V. All rights reserved.

DOI： 10.1016/S0006-8993(00)03283-2

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI IRELAND LTD  

Postnatal changes in the electromyographic (EMG) activity of jaw muscles evoked by mustard oil (MO) application into the rat temporomandibular joint region and the recurrence of increased jaw muscle activities after intravenous injection of naloxone were compared among 4,6 and 8-week-old rats. In all the groups, MO application increased EMG activity on the ipsilateral side, however, 4-week old rats showed only a small increase in EMG activity on the contralateral side. The EMG activity on the contralateral side increased in an age-dependent manner. The recurrence of increased jaw muscle activity was not induced in 4-week old rats. These results suggest that a neural circuit for generating contralateral responses and mechanisms for central excitation are not established until after 4 weeks postnatally. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.

DOI： 10.1016/S0304-3940(00)01215-5

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.7759/cureus.78708

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.heliyon.2024.e41602

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.7759/cureus.75522

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.7759/cureus.73784

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2344/anpr-63-16-65

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Publishing type：Research paper (scientific journal)   Publisher：American Dental Society of Anesthesiology (ADSA)  

Emerging evidence suggests that many conventional anticonvulsants, such as carbamazepine, phenytoin, and valproic acid, could cause cross-resistance to nondepolarizing muscle relaxants. However, there are few reports describing the interactions between levetiracetam and rocuronium. This case report describes the delayed onset of rocuronium in an adult patient with intractable epilepsy on long-term levetiracetam therapy. A 33-year-old man was scheduled for extraction of third molars and restorative dental treatment. His daily levetiracetam was continued preoperatively, and after a slow mask induction, rocuronium (20 mg; 0.66 mg/kg) was administered. Muscle relaxation was monitored by train-of-four (TOF) stimulation using the adductor muscle of the thumb. However, it took more than 9 minutes to finally obtain a TOF count of 0. This case report highlights that patients with intractable epilepsy taking levetiracetam may have resistance to rocuronium and should be carefully monitored to avoid harm triggered by prematurely initiated intubation maneuvers.

DOI： 10.2344/23-00018

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Other Link： https://anesthesiaprogress.kglmeridian.com/downloadpdf/journals/anpr/71/2/article-p76.xml

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.17245/jdapm.2024.24.2.137

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

Abstract

Introduction

As the population ages and more patients experience medical emergencies during dental treatments, dentists must competently and confidently manage these situations. We developed a simulation training course for medical emergencies in the dental setting using an inexpensive vital sign simulation app for smartphones/tablets without the need for an expensive simulator. However, the duration for which this effect is maintained is unclear. This study was performed to evaluate the long‐term educational effect at 3, 6, and 12 months after taking the course.

Materials and Methods

Thirty‐nine dental residents participated in this course. Scenarios included vasovagal syncope, anaphylaxis, hyperventilation syndrome, and acute coronary syndrome, each of which the participants had to diagnose and treat. The participants were evaluated using a checklist for anaphylaxis diagnosis and treatment skills immediately after and 3, 6, and 12 months after the course. The participants were also surveyed about their confidence in diagnosing and treating these conditions by questionnaire before, immediately after, and 3, 6, and 12 months after the course.

Results

The checklist scores for anaphylaxis were significantly lower at 3, 6, and 12 months after the course than immediately after the course. The percentage of participants who provided a correct diagnosis and appropriate treatment for vasovagal syncope, hyperventilation syndrome, and acute coronary syndrome was lower at all reassessments than immediately after the course.

Conclusion

Because medical emergency management skills and confidence declined within 3 months, it would be useful to introduce a refresher course approximately 3 months after the initial course to maintain skills and confidence.

DOI： 10.1111/eje.12996

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Language：Japanese   Publisher：日本慢性疼痛学会  

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Language：Japanese   Publisher：新潟歯学会  

新潟大学医歯学総合病院歯科麻酔科の最近の外来新患患者の動向を調査し,10年前の状況との比較および新型コロナウイルス感染症拡大前後の比較を行うことで今後の歯科麻酔に対する需要について検討した。外来新患患者数は2019年で129名,2020年で108名,2021年で101名,2022年で86名であった。2011年は117名であり,2019年の患者数は増加した。しかし,2020年と2022年に患者数の減少が認められた。2020年の減少は障害者および非協力児の全身麻酔依頼の患者数の減少が要因であった。これは新型コロナウイルス感染症の拡大で歯科治療が延期を余儀なくされたことが考えられた。また,2022年の減少は上記に加え,口腔外科から紹介される患者の減少が要因であり,特に術後の三叉神経障害とペイン(その他)の紹介が減少した。しかし,全体の三叉神経障害の症例数は減少しなかった。これは院外からの紹介が増加傾向にあることに起因すると考えられた。歯科麻酔に対する需要にも変化が生じ,障害者および非協力児の全身麻酔の需要が増加した。また,痛みや知覚障害の診察,治療に対しては院外からの紹介が増加していることから今後も需要は多いことが予想された。(著者抄録)

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Publishing type：Research paper (scientific journal)   Publisher：XMLink  

DOI： 10.17245/jdapm.2024.24.4.301

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Other Link： https://jdapm.org/DOIx.php?id=10.17245/jdapm.2024.24.4.301

Publishing type：Research paper (scientific journal)   Publisher：American Dental Society of Anesthesiology (ADSA)  

A tracheal bronchus is a congenital abnormality of the tracheobronchial tree in which a displaced or accessory bronchus arises from the trachea superior to its bifurcation. We herein report a case in which a tracheal bronchus was incidentally found after induction of general anesthesia, and we discuss the potential airway management problems that may have ensued. An 80-year-old man was scheduled for buccal mucosa resection and abdominal skin grafting for treatment of squamous cell carcinoma of the left buccal mucosa. Because of trismus and anticipated airway difficulty, an awake intubation was performed under sedation. A 3-branched structure was incidentally observed at the first branching site that was supposed to be the carina. The tip of the endotracheal tube was repositioned 3 cm above the tracheal trifurcation, and the rest of the procedure proceeded uneventfully. A flexible fiberoptic scope is not used in many anesthesia cases, making the identification of such tracheal or bronchial abnormalities more difficult. Therefore, it is important to carefully check the bronchial morphology on any available chest radiographs before surgery, listen to lung sounds after intubation, and assess thoracic lung compliance without neglecting routine safety checks.

DOI： 10.2344/anpr-70-02-09

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

In recent years, due to the aging of the population, the number of dental patients with comorbidities such as hypertension and diabetes has increased. Although it has been reported that these patients are increasingly developing medical emergencies during their dental treatments, many dental providers still do not possess the skills to manage medical emergencies appropriately. Simulation training is essential to improve this situation however, there is no report describing how to conduct an effective simulation in detail for dental office medical emergencies. The purpose of this review is to provide information on simulations that is effective and practical. The authors will highlight the key characteristics for providing effective simulation trainings, such as the selection of simulators, simulation locations, instructors, debriefings, methods for evaluating educational effectiveness, and the use of telesimulation as a method for simulation training due to the global COVID-19 pandemic. In addition, this review provides recommendations on tailoring an ideal simulation training course for those who wish to create one. The authors hope that this review will promote the spread of effective simulation training and in turn, contribute to improving the medical safety of dental patients.

DOI： 10.1016/j.jdsr.2023.02.004

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Language：Japanese   Publisher：日本慢性疼痛学会  

【目的】GAD-7を用いて口腔顔面痛初診患者の不安を調査するとともに,本病態における不安と身体症状との関連性について検討を行った。【対象および方法】事前に本調査の同意が得られた口腔顔面痛初診患者278名を対象として不安などの心理的特性,痛みなどの身体症状,および健康関連QOLを調査し比較検討を行った。【結果および考察】GAD-7の調査結果より,口腔顔面痛患者は比較的高い不安を有しており,不安と抑うつは有意に正の高い相関関係を示していた。さらに不安を有する患者は"痛み"などの身体症状を合併しており,さらに"身体化傾向"が有意に存在していることが示唆された。【結後】調査結果より,口腔顔面痛患者に対してGAD-7を用いて不安の評価を行うことは,本病態の"抑うつ状態","痛み","身体化傾向"など"不安"に伴って生じる心理的・身体的症状の合併を予測するための有用な評価ツールとなりうる可能性が示唆された。(著者抄録)

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s12663-023-01955-y

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Other Link： https://link.springer.com/article/10.1007/s12663-023-01955-y/fulltext.html

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

19歳女。中等度知的障害があり、通法下での歯科治療が困難であったため、全身麻酔下での歯科治療目的で当院に紹介された。治療は2回行い、1回目の全身麻酔の気管挿管において声門通過後に気管チューブ挿管困難を認め、気管狭窄であることが判明した。そこで2回目の全身麻酔では気管挿管の際、気管狭窄部の形態評価が可能なCT画像をもとに声門から狭窄部までの距離を計測し、狭窄部の上方でチューブ留置することで、気道管理を円滑に行うことができた。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01093&link_issn=&doc_id=20230703250002&doc_link_id=%2Feq9shika%2F2023%2F005102%2F002%2F0030-0032%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feq9shika%2F2023%2F005102%2F002%2F0030-0032%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本慢性疼痛学会  

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Publishing type：Research paper (scientific journal)   Publisher：Medknow  

DOI： 10.4103/jomr.jomr_2_23

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Language：Japanese   Publisher：(公社)日本障害者歯科学会  

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

症例は23歳女性で、顎変形症に対して上顎Le Fort I型骨切り術および両側下顎枝矢状分割術が予定された。手術室入室後、プロポフォールTCIで入眠を得たのち、レミフェンタニル塩酸塩、フェンタニルクエン酸塩を投与し、ロクロニウム臭化物にて筋弛緩を得た。右側鼻腔から内径7.0mmの気管チューブを挿入した。気管チューブを声門へ誘導することが困難であったため、マギル鉗子で気管チューブの先端を把持し、補助者にチューブを押してもらうことで声門へ誘導し、気管内へ挿入した。気管挿管から約10分後、気管チューブのパイロットバルーンを、自動カフ圧コントローラであるSmartCuffに接続し、カフ圧を28cmH2Oに設定したところ、カフ圧が21cmH2O以上に上昇せずアラームが鳴った。SmartCuffとパイロットバルーンの接続を解除したのち、手動カフ圧計を用いてカフ圧の調整を試みたが、カフ圧は10cmH2O程度までしか上昇しなかった。カフの損傷を疑って気管チューブを抜管し、別の同型の内径6.5mmの気管チューブを再度挿管した。その結果、リーク音は聴取されず、術中にカフ圧低下を示唆する所見は認められなかった。術後に最初に挿管した内径7.0mmの気管チューブを確認したところ、先端に近いカフ部分に約1mmの損傷が認められた。次にチューブ先端を水中に浸漬した状態でカフに空気を注入すると、カフの損傷部位から空気が排出される様子が観察された。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01093&link_issn=&doc_id=20220804470002&doc_link_id=10.24569%2Fjjdsa.50.3_122&url=https%3A%2F%2Fdoi.org%2F10.24569%2Fjjdsa.50.3_122&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：新潟歯学会  

今回、2007年4月から2020年3月までの13年間に新潟大学医歯学総合病院歯科外来において発生し、当科に出動要請のあった院内救急症例(全身的偶発症発生症例)および歯科外来における院内救急体制について後ろ向きに調査検討を行った。13年間に当科に出動要請のあった院内救急症例は全64例(発生率0.0034%)で、発生頻度は平均4.9例/年であった。症例の最低年齢は12歳、最高年齢は94歳、性別は男性31例(48.4%)、女性33例(51.6%)であった。年齢層は症例全体では20歳代が17例(26.6%)と最も多く、次いで60歳代が10例(15.6%)と多かった。全身的偶発症の診断は血管迷走神経反射が34例(53.1%)と多く、次いで過換気症候群が8例(12.5%)と多かった。また発生患者のうち循環器疾患など基礎疾患を有している患者は55例(85.9%)を占めていた。発生原因は局所麻酔によるものが最も多く、当科救急処置後に症状がほぼ全例で改善傾向がみられていたが、当科処置後に内科など医科を受診指示したものは37例(57.8%)であった。本病院では院内迅速対応システム(Rapid Response System(以下、RRS))が2020年8月に正式発足しているが、本システムは入院病棟における救急処置を主たる業務としていることから、歯科外来において発生する全身的偶発症の対応は原則含まない。従って、歯科麻酔医および口腔外科医が、救急処置の初期対応を迅速に行い、二次救命処置へとスムーズに移行させる役割を担っていくことが今後も重要であると考えられる。加えて、歯科医師、歯科衛生士、さらにはその他の歯科外来スタッフや学生などに対しての全身管理教育、医療安全教育、および院内救急の教育・啓蒙活動を行っていくことは歯科麻酔科の重要な責務であると考えられた。(著者抄録)

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Language：Japanese   Publisher：新潟歯学会  

末梢神経の構造的・機能的特徴の評価の一つにMRIの拡散強調画像(diffusion weighted image:DWI)が用いられてきた。一般に水分子の拡散性は、DWIの拡散に対する感度を変化させたDWIデータセットを指数関数モデルにあてはめて、見かけの拡散係数(apparent diffusion coefficient:ADC)を算出する。しかし生体内のADCは拡散・灌流成分が複雑に混合し、指数関数モデルに適合しない場合が知られている。そこで、特定のモデルに依存しないデータ探索的手法である多変量解析のk-meansクラスタ解析を応用し、正常被験者の下歯槽神経血管束組織内に異なる拡散特性を持つ部位のクラスタリングを試みた。その結果、空間分布が異なる三つのクラスタに分離された。このクラスタを従来のdouble exponentialモデルで解析し比較したところ、一つのクラスタは他の二つに比べ有意に速いADCを示した。遅いADC成分に関してはクラスタ間に有意差はなかった。一つのクラスタは速い流れを反映した灌流成分の豊富な分画とみられ、他の二つは指数関数モデルでは区別の困難な分画をより細分化して抽出したと考えられる。本研究はDWIデータの探索的な解析で、下歯槽神経血管束を組織学・機能的に意味のある分画に分離できうることを示した。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Allen Press Inc.  

We report a case of difficult endotracheal intubation in a patient with Treacher Collins syndrome. A sixteen-year-old female patient scheduled for general anesthesia had a displaced palatal tooth that interfered with laryngoscope insertion into the pharyngeal space. To address this problem, we successfully performed endotracheal intubation using a fiberscope while elevating the epiglottic vallecula using a King Visione video laryngoscope. A later operation was performed after tooth extraction without difficult laryngoscopy. Our experience stresses the importance of removing obstructions to laryngoscopic inspection prior to general anesthesia.

DOI： 10.2344/anpr-66-02-01

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Dental Society of Anesthesiology  

Preoperative pain management with a high-dose opioid sometimes makes it difficult to titrate opioids intraoperatively under general anesthesia. We present a case in which general anesthesia was difficult to maintain in a 54-year-old female with tongue cancer. The patient initially received general anesthesia for a primary lesion resection, bilateral neck dissections, and reconstruction using a pectoralis major myocutaneous flap. Continuous intravenous fentanyl and epidural morphine were utilized for postoperative pain control in the oral and chest regions simultaneously. The flap subsequently necrosed and the patient required high-dose morphine for pain control, resulting in a daily intravenous dose of 240 mg. Forty days after the first operation, a necrotomy was performed. Although general anesthesia was initiated without reducing the continuous dose of morphine, the patient's blood pressure tended to remain relatively low during the operation. Consequently, we reduced the continuously administered dosage of morphine to prevent the excessive suppression of circulation and additionally administered remifentanil, resulting in a stable circulatory condition. After awareness recovered from anesthesia, however, the patient claimed intolerable pain and an excessive increase in blood pressure occurred, suggesting insufficient analgesia. Consequently, we attempted to maintain the preoperative dosage of morphine by additionally administering a vasopressor drug during the next repair operation. This strategy resulted in a better circulatory condition and good pain relief over the perioperative period. The present case implies that the preoperative opioid dosage required for pain control should be maintained, in principle, even if compensation for opioid-induced circulatory suppression is required.

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

5歳9ヵ月女児。出生直後より呼吸不全のため気管挿管・持続陽圧呼吸療法を開始し、1歳時には気管切開術を施行した。2歳時には全身麻酔下に胃瘻形成術を施行し、胃瘻を介した栄養管理を行った。入院を5回繰り返し、入院中は人工呼吸管理下で心不全治療を行った。多数歯の動揺、周囲歯肉の腫脹・排膿に対して抜歯と歯肉整形術が必要であると判断した。心不全が改善して退院したことから、歯科治療を予定した。麻酔法は全身麻酔を選択した。治療終了後は開眼、呼吸状態、バイタルサインの安定、および口腔内の止血状態を確認して帰室させた。術後も特に異常経過はなく、治療4日後に退院した。

J-GLOBAL

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Dental Society of Anesthesiology  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Dental Society of Anesthesiology  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：CHROMA INC  

The diagnosis of orofacial pain associated with temporomandibular disorders after repeated temporomandibular joint (TMJ) surgeries can be quite difficult. This case report describes a 52-year-old woman who had previously undergone five TMJ surgeries and developed divergent pain caused by a trigger point in the left preauricular area. Computed tomography and magnetic resonance imaging could not be used to identify a lesion because of metallic artifacts from a TMJ prosthesis. However, sonography indicated the location of the suspected lesion. Moreover, a neurological examination performed with local anesthesia was clinically effective in ruling out other diagnoses of orofacial pain. Ultimately, a histopathological examination of a biopsy specimen from the painful site confirmed the lesion to be a traumatic neuroma. This case report suggests the value of including traumatic neuroma in the differential diagnosis of patients with a history of previous TMJ surgery who present with orofacial pain in the region of the TMJ.

DOI： 10.1179/crn.2012.028

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Language：Japanese   Publisher：(株)シービーアール  

17歳女。顎変形症のため上顎Le Fort I型骨切術、下顎枝矢状分割法を予定した。全身麻酔はレミフェンタニル、プロポフォールによるTIVAで行った。挿管は容易であったが、その直後より聴診上全肺野の著明な湿性ラ音と気道狭窄音を認めた。また、著しい気道抵抗の上昇を認めた。純酸素で換気を行いながら気管内吸引を行い、白色の粘稠な分泌物を多量に吸引した。気管支痙攣を疑い、麻酔回路にエアロチェンバーを取り付け、プロカテロールの吸入を行った。さらにアミノフィリンの持続投与をを開始し、気管内吸引を頻回に行ったところ、湿性ラ音は消失し、気道抵抗の低下とカプノグラムのプラトー部が水平に戻った。手術中止を決定した。発熱や咳嗽などは認めなかった。メサコリン吸入濃度は正常範囲より低値で、気道過敏性の亢進を認め、喘息に準じた治療を開始した。その後の異常経過はなく、ステロイド薬の吸入を継続した。

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

歯学部5年生を対象とした麻酔計画立案実習の教育効果を検討した。過去の麻酔管理症例の患者資料を基に、具体的な全身麻酔管理計画および局所麻酔計画を立案させ、グループ単位で患者の全身状態と全身麻酔もしくは局所麻酔・鎮静法管理における問題点とその対応を発表させた。学生の発表は、問題点の提起からその対策と麻酔計画に至るまで概ね良好な内容であり、合併症のある症例に対しても適切な麻酔管理法を立案できていた。また、登院前の5年生と登院後で臨床実習中の6年生に対して、本実習に関するアンケート調査を行った結果、多くの学生から臨床実習での手術室見学や患者の病態などの理解に役立ったという意見が得られた。本実習は患者管理法の理解に有効であることが示唆された。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J01093&link_issn=&doc_id=20120206340005&doc_link_id=%2Feq9shika%2F2012%2F004001%2F005%2F0031-0035%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feq9shika%2F2012%2F004001%2F005%2F0031-0035%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：CHURCHILL LIVINGSTONE  

Operations to the face and Skull can obscure the landmarks that are required to locate the position of the foramen ovale. We describe the use of three-dimensional computed tomography (3D-CT) to guide the approach to the foramen ovale to block the mandibular nerve in a patient with a mandibular deformity that had been caused by segmental mandiblectomy. Successful blockage of the mandibular nerve controlled the pain, contributed to the relief of physical and inertial stress, and avoided the side effects of analgesics and pain front inserting the blocking needle. (c) 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjoms.2008.09.013

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

18歳女。顎変形症の診断で下顎枝矢状分離術、Wassmund法およびKole法による形成術が予定された。維持は空気・酸素・セボフルランにレミフェンタニル持続投与で行ったが、手術開始後3時間から膀胱温と心拍数が上昇し始め、45分後には膀胱温39.1℃、心拍数150回/分以上、呼気終末炭酸ガス濃度は53mmHgに上昇し悪性高熱症が疑われた。直ちに手術を中断してプロポフォール・レミフェンタニルの全静脈麻酔に変更し、氷冷剤により体表冷却を行い、ダントロレンを急速点滴投与した。まもなく膀胱温・心拍数の急速な下降を認めたため、ダントロレン投与40分後に手術を再開し、術後は異常を認めなかった。手術後スキンドファイバー法を患者の両親に行った結果、母親が陽性であることが判明した。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2009&ichushi_jid=J01093&link_issn=&doc_id=20090424330025&doc_link_id=%2Feq9shika%2F2009%2F003702%2F026%2F0213-0214%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feq9shika%2F2009%2F003702%2F026%2F0213-0214%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

TCIによるプロポフォール静脈内鎮静法において、予測脳内濃度を目標に投与量を段階的に増加させることで鎮静レベルを変化させ、鎮静度、嚥下反射、呼吸・循環動態に与える影響について検討した。健康成人男性を対象に、カテーテルを中咽頭部に留置して安静にし、呼吸・循環動態(血圧、脈拍数、1回換気量、呼吸数、分時換気量、経皮的動脈血酸素飽和度)、鎮静度(BIS,OAA/S Scale)を測定した。その1分後、蒸留水0.3mlを3秒間で注入、嚥下開始時間を測定した。次に、TCIポンプを用い、目標血中濃度を0.5μg/mlに設定してプロポフォールを投与し、同様に測定、さらに目標血中濃度を0.5μg/mlずつ上昇させ、同様に測定し、以下の結果が得られた。1.予測脳内濃度の上昇に伴い、BIS,OAA/S Scaleは有意に低下した。2.予測脳内濃度の上昇に伴い、嚥下開始時間は有意に延長した。3.予測脳内濃度の上昇に伴い、呼吸・循環動態は抑制されたが、臨床的には許容範囲内であった。4.嚥下反射の抑制は呼吸抑制よりも浅い鎮静レベルで強く出現し、循環抑制よりも深い鎮静レベルで出現した。以上より、鎮静レベルが深くなるにつれ、嚥下反射は抑制されるため、口腔内の徹底した吸引対策が必要であること、また、嚥下反射の抑制は呼吸・循環抑制と発現時期にずれがあるため、呼吸・循環動態のモニタリングが必要であることが示唆された。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2007&ichushi_jid=J01093&link_issn=&doc_id=20070724330004&doc_link_id=%2Feq9shika%2F2007%2F003503%2F004%2F0354-0364%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feq9shika%2F2007%2F003503%2F004%2F0354-0364%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

目的:高齢者では日常の軽い動作においても起立性低血圧がしばしば認められ,転倒や失神の原因となるので注意が喚起されている.歯科治療は頻回に水平位と座位の体位変換が行われるため,高齢者では循環器系に大きく影響を与えることが予想される.そこで,歯科用治療椅子上で水平位から座位,座位から起立位の体位変換が循環器に及ぼす影響について検討した.研究方法:ボランティア(38名)を対象に,連続血圧測定装置フィナプレスを用いて,歯科用治療椅子による体位変換時の血圧および脈拍数を測定した.30歳未満を若年者群(14名),65歳以上(24名)を高齢者群とし,さらに高齢者群を降圧薬内服の有無で2群に分けて比較検討した.体位は血圧が安定した後,水平位から座位,座位から起立位へ変換した.結果および考察:高齢者群では,水平位から座位への体位変換により有意な一過性の血圧低下が認められた.また,座位から起立位への体位変換により低下した血圧がもとのレベルまで回復する時間は若年者群に比べ有意に延長した(p<0.05).以上のことから,高齢者では,歯科用治療椅子を水平位から座位へ変換すると著しい血圧低下が生じることが明らかになった.したがって,歯科治療時は急速な体位変換を避けることが望ましく,また,治療終了後に歯科用治療椅子から立ち上がる際には,起立性低血圧による立ちくらみ,ふらつき,転倒に十分な注意が必要であると考える(著者抄録)

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Language：Japanese   Publisher：新潟歯学会  

平成2年4月1日から平成14年3月31日迄に,新潟大学歯学部附属病院中央手術室で歯科麻酔科によって行われた全身管理4650症例とし,麻酔記録をもとに年齢分布,男女比,疾患別症例数,麻酔導入法,気道管理法,麻酔維持法,麻薬使用状況,精神鎮静法使用薬,麻酔時間,術前合併症,導入時・術中・術後合併症等について検討した.麻酔時間の短縮化傾向,使用薬剤の使用頻度に大きな変遷が認められた.患者の高齢化で術前合併症の頻度は増加し,一方,顕微鏡下での手術など多様で複雑な手術が行われる傾向にあり,麻酔管理法の困難性は増してきた

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2003&ichushi_jid=J00999&link_issn=&doc_id=20030730390006&doc_link_id=http%3A%2F%2Fhdl.handle.net%2F10191%2F23284&url=http%3A%2F%2Fhdl.handle.net%2F10191%2F23284&type=%90V%8A%83%91%E5%8Aw%81F%90V%8A%83%91%E5%8Aw%8Aw%8Fp%83%8A%83%7C%83W%83g%83%8A_Nuar&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80230_3.gif

Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Forty-three patients were monitored every week for a period of 6 weeks after orthognatic surgery to determine the incidence and severity of sensory impairment of the trigeminal nerve. The possibility of brush-stroke perception, the mechanical-touch threshold, the pin-touch pain threshold, and temperature perception at 0°C, 10°C, or 50°C, and 60°C were measured and compared. The patients who suffered nerve exposure in the operating field showed a significantly higher mechanical threshold (Mann-Whitney U-test, p &lt
0.05) (Fig. 1). Brush-stroke came to be recognized early after the operation, but many patients recognized an abnormal brush stroking sensation even after 6 postoperative weeks (Table 4 and Fig. 3). It was observed that there were two types of recovery after the fifth postoperative week
one was the recovery group, who showed significant improvement in the mechanical-touch threshold after the first postoperative week (Dunn's method, p &lt
0.05), and the other was the non-recovery group, who did show any improvement (Kruskal-Wallis one-way ANOVA, p &gt
0.05) (Fig. 4). Furthermore, the median of the recovery group expressed by mechanical-touch threshold was 0.09 gram in the mechanical-touch threshold and that of non-recovery group was 4.89 gram
these are significantly different (Mann-Whitney U-test, p &lt
0.05). The pin-touch pain threshold tended to show a recovery similar to that of the mechanical-touch threshold in many patients, but the changes in the pin-touch pain threshold seems steeper than those in the mechanical touch threshold (Fig. 3). Recognition of cold tended to recover earlier than that of heat (Table 6). In examining the interaction between sensitivity to heat or cold stimulations and mechanical threshold, we noted patients with higher mechanical threshold tended to have more difficulty in recognizing less extreme high and low temperatures (Fig. 2). Moreover, the patients with touch-sensation impaimment over 4.0 of gauge in Semmes Weinstein Aesthesiometer set at the postoperative 1st week tend not to be able recover within postoperative 6 weeks (Fig. 5). These results suggest that mechanical-touch threshold has similar directional, but different developing recovery changes when compared to other parameters such as pain and warm and cool perception. The mechanical-threshold at the first postoperative week may be good of the prognosis of recovery from sensory impairment.

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The effects of injection speed of propofol on blood pressure, heart rate, apnea, eyelash reflex, loss of consciousness, electrooculogram, pain with injection and recovery time have been studied during induction of general anesthesia in 16 patients who were scheduled for oral and maxillofacial surgery. Anesthesia was induced with propofol 2.5 mg/kg, at the speed of injection 4 mg/sec (9 patients in rapid injection group
RG) or 2 mg/sec (7 patients in slow injection group
SG). 1) At the end of injection of propofol, the systolic blood pressure decreased 22.3% in RG and 19.2% in SG. And the diastolic pressure decreased 28.3% in RG and 19.2% in SG. The largest decrease of systolic blood pressure after injection of propofol is 32.7 ± 7.0% in RG and 28.3 ± 7.5% in SG compared to that of before injection. The largest decrease of diastolic blood pressure after injection of propofol is 37.9 ± 9.8% in RG and 25.4 ± 8.6% in SG compared to that of before injection. 2) Heart rate did not change in either groups. 3) Rapid injection of propofol accelerated loss of consciousness and loss of eyelash reflex significantly, compared with slow injection. 4) Rapid injection of propofol did not increased the incidence of apnea at one minute after the end of injection of propofol, compared with slow injection. 5) Injection speed of propofol did not influence the incidence of apnea after induction. 6) Voluntary eye movements were suppressed after induction of anesthesia. 7) Only in one case, slight pain with injection was observed when 30 mg of lidocaine was administered in all patients before injection of propofol. 8) There was no case in which the propofol was suspected to delay the recovery time. It is suggested that propofol is useful in the induction for general anesthesia underwent oral and maxillofacial surgery. However, propofol should be administered at slow injection speed (&lt
4 mg/sec) to prevent large decrease of blood pressure.

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Lithium carbonate is a medication used for the management of various mental disorders. The present report describes a case of prolongation of rocuronium bromide in a patient concurrently taking lithium carbonate. A 64-year-old woman was scheduled to undergo cystectomy under general anesthesia. The patient took lithium carbonate (600 mg/d) for treatment of bipolar affective disorder. General anesthesia was induced with propofol, fentanyl, remifentanil, and sevoflurane. After loss of consciousness, rocuronium bromide (50 mg) was administered, and the trachea was intubated. Approximately 1 hour after the administration of rocuronium, the degree of residual muscle relaxant was evaluated using a nerve stimulation device. No muscle contraction occurred with train-of-four (TOF) stimulation. Following administration of sugammadex (200 mg) the TOF ratio increased to 95%. The ionic size of lithium is similar to that of sodium; therefore, lithium is transported into the cell with sodium. The resting membrane potential decreases, leading to a reduction in the height of the action potential. Thus, the effect of the remaining lithium may have been superimposed on the rocuronium neuromuscular blockade. Evaluation with a nerve stimulation device in patients taking lithium is crucial before extubation because of the risk of rocuronium potentiation.

DOI： 10.2344/anpr-66-04-04

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DOI： 10.1016/j.jds.2019.11.007

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患者は生下時にTreacher-Collins症候群および両側性唇顎口蓋裂を指摘され、1歳時に口唇形成術、2歳時に口蓋形成術が行われていた。16歳時、口蓋形成術後に生じた口蓋部骨欠損のため、全身麻酔下での腸骨移植術が予定された。日本麻酔科学会のガイドラインで術前予測危険クラスIIIであり、気道確保に注意しながら緩徐導入を行い、気管挿管補助器具を使用して気管挿管する方針とした。酸素・亜酸化窒素・セボフルランで緩徐導入を行い、入眠させたところ気道閉塞が生じ、経鼻エアウェイを使用し気道確保を行った。麻酔を深くしようとしたところ自発呼吸がすぐに消失したため、用手マスク換気を行った。ロクロニウム臭化物を投与し筋弛緩を得た後、エアウェイスコープの挿入を試みたが、イントロックが口蓋の転位歯に当たり挿入できなかった。薄型イントロックに変更したものの困難であり、ビデオ喉頭鏡KINGVISIONを使用したところ挿入可能であったが、可動域が制限されたため

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21歳女。下顎右側犬歯のう蝕に対し保存修復術が予定された。合併症としててんかん、パニック障害、自閉スペクトラム症を認めたが、以前から亜酸化窒素吸入鎮静法を用いててんかん発作を生ずることなく歯科治療を行っていたため同様に治療を行うこととなった。100%酸素の投与後亜酸化窒素濃度を投与したが、痙攣発作と意識消失を生じ、てんかん発作と考えフェニトイン、ジアゼパムを投与したが無効であった。アームドロップテスト陽性であったため心因性非てんかん発作(PNES)の可能性が考えられ、経過観察により徐々に呼びかけに反応し、会話もできるようになった。同日に再び痙攣と意識レベル低下を認めフェニトイン投与により軽快し、その後は問題なく経過し翌日に退院した。通常は治療前に行っていた会話が今回は全くなかったことから、PNESの原因として3ヵ月前のCT撮影中に生じた痙攣と意識消失に対する不安感が考えられた。

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DOI： 10.24569/jjdsa.46.2_102

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DOI： 10.24569/jjdsa.46.2_89

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Possible complications of nasotracheal intubation include injury to the nasal or pharyngeal mucosa. Dissection of the retropharyngeal tissue by the endotracheal tube is one of the rarer of the more severe complications. Previous studies have indicated that the Parker Flex-Tip (PFT) tracheal tube (Parker Medical, Highlands Ranch, Colo) reduces the incidence of mucosal injury. We experienced a case involving inadvertent retropharyngeal placement of a PFT tube in a 29-year-old patient during nasotracheal intubation under general anesthesia for elective dental treatment. Despite thermosoftening the PFT tube, expanding the nasal meatus, and ensuring gentle maneuvering, the tube intruded into the left retropharyngeal mucosa. However, the injury was not severe, and the only required treatment was the administration of antibiotics and corticosteroids. Even when a PFT tube is utilized, pharyngeal dissection is possible. When resistance is felt during passing of the PFT tube through the nasopharynx, an alternative method to overcome this resistance should be utilized.

DOI： 10.2344/anpr-64-03-05

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当院では障害者(児)の歯科治療が安全に行えるように薬物的行動調整法が選択された際に静脈内鎮静法と日帰り全身麻酔が実施されている。そこで、その選択基準の設定に向けて静脈内鎮静法と日帰り全身麻酔の選択の傾向を調査した。2010年4月から2015年3月までの5年間に当院で実施した障害者(児)の静脈内鎮静法のべ264例、日帰り全身麻酔のべ58例を対象とした。症例数は静脈内鎮静法で減少傾向にあったが、日帰り全身麻酔で徐々に増加傾向にあった。年齢(中央値)は静脈内鎮静法で25歳、日帰り全身麻酔で15歳であり、日帰り全身麻酔で有意に低かった。障害の分類は静脈内鎮静法および日帰り全身麻酔ともに知的能力障害、自閉スペクトラム症の順で多く、特筆すべき傾向はなかった。治療本数(中央値)は静脈内鎮静法で2本、日帰り全身麻酔で8本であり、日帰り全身麻酔で有意に多かった。処置時間(中央値)は静脈内鎮静法で55分、日帰り全身麻酔で158.5分であり、日帰り全身麻酔で有意に長かった。麻酔時間(中央値)は静脈内鎮静法で80分、日帰り全身麻酔で229.5分であり、日帰り全身麻酔で有意に長かった。以上より、本院では低年齢は患者本人の理解や協力および体動抑制に伴う心的外傷の点から、治療本数の多さや処置時間の長さは患者自身やその家族の負担軽減の点から日帰り全身麻酔を選択する傾向があり、それに合う基準が必要と考えられた。(著者抄録)

DOI： 10.14958/jjsdh.38.74

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症例は15歳男児で、11歳頃から前歯部の開咬に気づき、うまく咬めなくなり、矯正治療を開始したが改善が得られなかった。開咬を伴う骨格性下顎前突症と診断し、顎矯正手術を併用した外科的矯正治療を行う方針とした。同時期に心房粗動と左室機能低下の診断を受け、鎮静下で経皮的カテーテル心筋焼灼を行った。また、把握性筋緊張が顕著になり、遺伝子検索で筋緊張性ジストロフィーの診断に至った。手術は、主訴である開咬の改善を図ることを目的とし、時間の短縮と骨片の安定性を考慮して下顎単独のObwegeser-Dal Pont法による下顎枝矢状分割法(SSRO)を選択した。全身麻酔は、悪性高熱症を誘発する可能性のある吸入麻酔薬を避けプロポフォールとレミフェンタニルによる全静脈麻酔とし、筋弛緩薬は非脱分極性のロクロニウム臭化物を選択した。術後2年4ヵ月が経過した現在も経過観察中であるが、開咬と反対咬合は改善し、患者自身の満足も得られている。

DOI： 10.5794/jjoms.62.612

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54歳女。両側舌癌、両側頸部リンパ節転移に対する1回目手術後より鬱傾向のため緩和ケアチームが介入した。その後、痛みが増強し、気管切開術、舌亜全摘出術、両側頸部郭清術および左側大胸筋皮弁による再建術を施行した。その後、皮弁が壊死したことより術後40日目、両側胸三角筋部皮弁および大胸筋皮弁の遷延交差皮弁の形成と壊死組織除去術を施行した。術後56日目、舌欠損部閉鎖の必要性から大胸筋皮弁による舌口腔底再建術を施行した。第2回目の手術の麻酔経験から術中・術後の十分な鎮痛が必要と判断したためモルヒネ塩酸塩の量は維持し、必要に応じて昇圧剤・降圧剤を使用して循環動態を安定させた。術中、血圧低下低下は頻回に生じたが基本的にはモルヒネ塩酸塩の投与量は減量せず、フェニレフリン塩酸塩の使用とレミフェンタニル塩酸塩投与量の調節で対応した。覚醒は良好で、術後の疼痛と呼吸困難感を訴えることはなかった。

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三叉神経、特に下歯槽神経は、下顎管という硬組織に囲まれているため、外的刺激を直接受けにくいが、歯科治療、局所麻酔注射、インプラント、抜歯など口腔外科手術、外傷や炎症などによっては侵襲的刺激を受ける可能性があり、その結果、神経障害が生じたという報告は少なくない。三叉神経損傷の原因、症状の時間的変化、診断方法、治療、受傷後の過程における症状変化、神経損傷に対する初期対応について述べた。

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症例は81歳女性で、乳癌術後、子宮筋腫の既往があり、糖尿病、高血圧で内服加療中であった。下顎骨悪性腫瘍で下顎骨区域切除・プレートによる再建術・頸部郭清術を受け、手術終了後病棟へ帰室直後から過活動型の術後せん妄を認め、ミダゾラム持続投与で鎮静を行い、入眠してせん妄は消失した。今回、プレートの除去術と周囲の掻爬術が予定された。術後せん妄の可能性を考慮して抑肝散を術前4日間投与し、手術当日は休薬とした。ミダゾラム、フェンタニル、プロポフォールで鎮静を得て気管支ファイバー誘導下に気管挿管を行い、プロポフォール、ロクロニウム臭化物を静注し、胃管を挿入して空気、酸素、セボフルランおよびレミフェンタニル適宜投与で維持した。手術時間は4時間2分、麻酔時間は5時間19分であった。術後回復は良好で不快感なく退室した。病棟へ帰室後も平常通りで、過活動型のせん妄は認めなかった。

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(目的)新潟大学医歯学総合病院歯科麻酔科診療室における平成2年度と平成23年の患者内訳と診療詳細を比較・分析し、今後の当科の診療のあり方について検討を行った。(方法)平成23年1月から12月末までに新潟大学医歯学総合病院歯科麻酔科診療室を初診した患者の患者数や主訴などについて歯科麻酔科診療室の患者台帳と診療記録をもとに調査し、さらに平成2年から現在までの患者数に関しては医事課作成の外来患者数の資料をもとに調査し、検討を行った。(結果)平成23年の新患数は247人(平成2年の約2倍)であり、のべ診療数は2617回(5.4倍)にまで増加した。この中で歯科治療の全身管理を依頼して受診した患者は138名と最も多く全体の54%を、次いで痛み疾患と知覚障害を訴えて来院した患者は87名であり35%を占めていた。(結論)精神鎮静法を希望する患者および、他院では診断されなかったまたは治療されない不定愁訴を含む神経障害などを訴えて受診する患者が増加していた。高齢化社会と有病者の増加傾向を背景に、これらの充実化が当診療科へ求められていることであると考えられる。(著者抄録)

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新潟大学医歯学総合病院歯科外来診療棟では、患者の緊急の容態変化に対して、コードブルーとデンタルコールという2つの救急対応システムを稼動させている。意識喪失や心停止などの重篤な状態に対しては本学救急部で発足したコードブルー体制を機動することとしている。これに対して意識や反応はあるが不安定な状態であり、その対応に困る容態の変化に対しては、歯科麻酔科を中心に発足した歯科版院内救急対応システム、すなわち「デンタルコール」を行っている。また新潟大学医歯学総合病院は医科診療棟と歯科診療棟が離れているため、不必要なコードブルーの稼動は避けなければならない。今回は本学歯科外来診療棟において存在しているこの2つの救急対応体制を共存させている現況を分析し、デンタルコール体制発足後から現在までの5年間における救急症例について、当診療室における過去の救急症例の報告との比較検討を行った。2007年4月のデンタルコール体制発足後から2012年3月までの5年間で発生した偶発症例は29例で、そのうち当診療室が救急対応した症例は26例あった。歯科治療に関連した症例は22例で、その発生状況は歯科治療前が10例と最も多く、次いで治療中7例、治療後5例の順であった。発生時間帯は午前が若干多く午前・午後ともに治療開始の時間帯が最も多くみられた。年齢層は20歳代が7例、次いで50歳代5例と多くみられ、30歳未満の若年者では女性が多く、65歳以上の高齢者では男性が多い傾向がみられた。発生場所は総合診療部が6例と最も多くみられたが、受付や廊下などの診療室外での症例も11例と多くみられた。発生原因は疼痛性ショックが5例と最も多く、次いで過換気症候群、一過性脳虚血発作、てんかん発作がともに3例であった。偶発症の誘因としては、歯科治療中に発症した症例では局所麻酔に関連したものが最も多く、歯科治療以外の症例では全身的合併症の増悪によるものが多数を示した。デンタルコール体制による救急処置自体は全ての症例において比較的迅速かつ的確に行われており重篤な後遺症や死亡症例もなく、有用に機能したと考えられた。しかし依然として院内放送によるデンタルコール機動システムが十分に周知されていないこと、歯科医師の全身管理の知識・技術の未熟さを疑わせる症例があり、今後歯科における院内救急対応システムの改良と歯科医師の緊急に対する意識の向上が必要である。(著者抄録)

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：真興交易(株)医書出版部  

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

16歳男。小学生まで軽度の間欠型の喘息があったが、術前の各種検査で異常は認めず、全身麻酔下での上顎嚢胞摘出術が予定された。前投薬は行わず、フェンタニルクエン酸塩、プロポフォール、セボフルラン、ロクロニウム臭化物で全身麻酔導入し、1回換気量は550〜600ml、気道内圧は15〜20cmH2Oであったが、セフォチアムの点滴静注を開始した頃よりSpO2が低下して気道内圧が上昇し、両肺から著明な喘鳴を聴取するようになった。喘息発作を疑い治療を開始したところ、気道内圧は徐々に低下して喘鳴は消失し、気道内圧の上昇に前後して認められた体幹部の膨疹も消失した。本症例では血圧低下を認めず、血液検査のトリプターゼとヒスタミンは正常値であったが、皮膚症状出現からアナフィラキシー反応であった可能性が高く、原因物質としてセフォチアムが考えられた。

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

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Language：Japanese   Publisher：一般社団法人日本心身医学会  

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

20歳女。上顎嚢胞の診断で嚢胞摘出術、歯根端切除術が予定された。ターナー症候群、周期性ACTH-ADH放出症候群などの既往を有し、嘔吐発作の頻度は年1〜2回であったが、発作の誘発原因となりうる精神的な緊張を軽減する必要があると考え、術前にはジアゼパムの経口投与、母親同伴の手術室入室などを行い、患者のストレス緩和に努めた。術中の経過は安定しており、抜管後の回復は速やかで疼痛や不快感はなかったが、帰室後に悪心や嘔吐が出現した。その後時間の経過とともに周期性ACTH-ADH放出症候群によると思われる傾眠、鬱傾向を伴う嘔吐を認め、クロルプロマジン静注により悪心・嘔吐は落ち着いた。

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Language：Japanese   Publisher：医歯薬出版(株)  

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Language：Japanese   Publisher：Japanese Society of Psychosomatic Medicine  

Objectives: Recently, some psychosomatic approaches become required in the patients for dental treatments, meaning that psychosomatic factors should be evaluated at the first admission. This study aimed to evaluate the contributions of psychosomatic factors to chronic orofacial pain development and clarify the relationship between the psychological states and some questionnaire scores. Subjects: Among 1,878 outpatients, who visited the dental anesthesia clinic at Niigata University Medical and Dental Hospital, 318 subjects who agreed with the aim of this study were recruited. They consist of 195 patients with some chronic orofacial pain and 123 patients without either psychological problem or chronic orofacial pain who were scheduled for intravenous anesthesia during oral surgeries. Methods: Subjects were asked to complete psychological questionnaires before consultation of the first admission to the clinic. These questionnaires consisted of the Hospital Anxiety and Depression Scale (HADs), the State and Trait Anxiety Inventory (STAI), the Self Rating Questionnaire for Depression (SRQ-D) and the Somatosensory Amplification Scale (SSAS). Physical disorders were examined about the pain duration, painful area, visual analogue scale, cause, physical diagnosis of orofacial pain, and psychosomatic diagnosis. According to the scores of these questionnaires, patients were categorized according to the following groups; the Pm group who complained some psychosomatic claims but any physical causes for pain could not be detectable, the Pp group who had some psychosomatic symptoms and physical causes and the C group who did not have any pain or psychological problems. Results: Anxiety and depression scores of the HADs were significantly higher in the Pm and the Pp groups compared with the C group (Kruscal-wallis one-way ANOVA, and Mann-Whitney U-test with Bonferroni correction, p<0.017). The Pm group exhibit significantly higher scores than the C group in state and trait scores of the STAI (Kruscal-wallis one-way ANOVA, and Mann-Whitney U-test with Bonferroni correction, p<0.017) but the Pp group did not in either scores (p>0.017). There was a significant difference in the score of SRQ-D among these groups and the Pm group showed the highest score (Kruscal-wallis one-way ANOVA, and Mann-Whitney U-test with Bonferroni correction, p<0.017). SSAS showed a significant higher score in the Pm group compared with the other groups (Kruscal-wallis one-way ANOVA, and Mann-Whitney U-test with Bonferroni correction, p<0.017) but there was no significant difference between Pp and C groups (p>0.017). Conclusion: The patients with orofacial pain tend to exhibit high anxiety and depression state irrespective of whether or not physical causes exists and it is suggested that psychological states have some contributions to the development of pain symptom.

DOI： 10.15064/jjpm.50.12_1187

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

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Language：Japanese   Publisher：一般社団法人日本心身医学会  

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Language：Japanese   Publisher：医歯薬出版(株)  

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Language：Japanese   Publisher：医歯薬出版(株)  

歯科治療においては残根を抜歯して十分掻爬することで必要な治療が成されたと考え、その後の痛みは非定型顔面痛として放置したり、疼痛性障害と診断したりする。慢性炎症や抜歯などの外科処置が三叉神経の末梢枝損傷を与え、そこから神経腫が形成されて慢性痛の原因となることは稀ではないが、歯科領域ではあまり知られていない。この神経腫の発生、病態と神経腫による痛みへの対応について概説した。

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Language：Japanese   Publisher：(株)メディカルプレス  

1.顎顔面領域の痛覚は三叉神経によって支配されている。同神経の侵害情報は、延髄脊髄路核尾側亜核で二次ニューロンへ中継され、腹側三叉神経脊髄路を通って視床から辺縁皮質または第一次体性感覚野へ送られる。脊髄路核尾側亜核は脊髄後角と同様の層状構造を持ち、その第2層は痛覚伝達の変調に関与している。2.顔面領域の広範囲の知覚を支配する三叉神経は、中枢側での神経終末が脊髄路核内で二次ニューロンに収束する。また三叉神経節では細胞間で情報伝達が行われる。これらが上顎または下顎に生じた痛みの空間的弁別能や関連痛発生に関連すると考えられている。3.三叉神経終末に加えられた侵害刺激は反射性に咬筋、顎二腹筋、頸部筋群の収縮を引き起こし、さらに中枢の持続性興奮を誘発する。これは三叉神経領域の痛み発生のメカニズムにも関与している可能性がある。4.顎顔面領域の痛みは会話・摂食などの日常生活に影響を与え、精神・心理的要因がその発症または病状の進行にも大きく関わっている。(著者抄録)

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：ELSEVIER IRELAND LTD  

Web of Science

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Other Link： http://search.jamas.or.jp/link/ui/2004188715

Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

歯科領域の処置において浸潤麻酔,伝達麻酔を必要とする231例を対象に,NSY-101(N群)の臨床的有用性を,1:80000エピネフリン配合2%塩酸リドカイン製剤(L群)を対照薬とした二重盲検群間比較法により検討した.その結果,N群の有効率は L群と同等であり,麻酔効果持続時間はL群が有意に長かった.副作用は,L群に軽度の内出血を1例認めたのみであった.有効率,安全率に麻酔効果持続時間の印象を加味した有効率は,両群で同等であり,「きわめて有用」率ではN群が有意に優っていた.これらの結果,NSY-101は,対照薬であるエピネフリン配合の塩酸リドカイン製剤と同等の有効率を示すことが確認された.また,NSY-1の麻酔効果持続時間は対照薬よりも有意に短く,30分以内の歯科処置であれば,処置後の麻痺感から患者を早期に解放しうる点から,対照薬に比べて有用であると考えられた

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Language：Japanese   Publisher：日口蓋誌  

For cleft lip and/ or palate patients, effective treatment by a team approach performed by the medical specialist is indispensable. In 1991, a Cleft Palate Team was est ablished at Niigata University Dental Hospital, and since then,778 patients have been registered for management in a total care system by the Team, until December 31,2000.&lt;BR&gt;We have already reported a clinical and statistical evaluation of Cleft Palate Team activities regarding primary cases, in 1998.&lt;BR&gt;The purpose of this study was to conduct a clinical and statistical evaluation of Cleft Palate Team activities by analyzing 360,10-to-18-year-old patients, including not only primary cases but also secondary cases.&lt;BR&gt;The results were as follows:&lt;BR&gt;1. The percentage of primary cases was 64.2, and that of those who lived in Niigata prefecture was 88.6. The rate of the primary cases was more than that of secondary cases for patients under 16 years old.&lt;BR&gt;2. There were few o pportunities to consult operative dentistry and endodontics, fixed prosthodontic dentistry, and removable prosthdontic dentistry.&lt;BR&gt;3. Mean initial visits of secondary cases were at 6Y6M to oral-maxillofacial surgery, at 4Y1M to speech clinic, at 3Y5M to preventive dentistry, at 4Y2M to pediatric dentistry, and at 5Y6M to orthodontics.&lt;BR&gt;4. The management situation of patient was favorable, and it was suggested that effective treatment has been performed smoothly by the Cleft Palate Team approach.

DOI： 10.11224/cleftpalate1976.27.3_297

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Other Link： http://search.jamas.or.jp/link/ui/2002200311

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Language：Japanese   Publisher：(一社)日本歯科麻酔学会  

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ヘリカルCTを利用した顔面深部への神経ブロックは非常に有効な方法と考えられた

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Language：Japanese   Publisher：Niigata University  

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Other Link： http://search.jamas.or.jp/link/ui/2000246675

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Language：Japanese   Publisher：Niigata University  

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Other Link： http://search.jamas.or.jp/link/ui/2000053159

Language：Japanese   Publisher：(一社)日本口蓋裂学会  

1996年12月以前に生まれ,初回手術を当病院にて行った登録患者433名を対象とし,生年月,裂型,性別,現住所,各科における受診状況を集計した.対象患者は女207名,男226名であった.裂型は唇裂が26名,唇顎裂が70名,唇顎口蓋裂が199名,口蓋裂が138名であった.県内外から広く受診しており,特に県内で発生した口唇裂口蓋裂を有する人の殆どが受診していた.各科が管理している対象患者数は,各々口腔外科371名,言語治療室166名,予防歯科127名,小児歯科163名,矯正科174名,保存科2名,補綴科1名であった

DOI： 10.11224/cleftpalate1976.23.4_342

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Language：Japanese   Publisher：新潟医学会  

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Other Link： http://search.jamas.or.jp/link/ui/1999067528

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Other Link： http://search.jamas.or.jp/link/ui/1998144433

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We report a case in which transient sinus arrest was observed under general anesthesia. This was associated with opening the mouth and was thought to be caused by a trigeminovagal reflex. The reflex was interrupted by blocking bilaterally the third division of trigeminal nerve.

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Other Link： http://search.jamas.or.jp/link/ui/1989221917

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