T. Fujisawa

Hokkaido University, Sapporo, Hokkaido, Japan

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Publications (35)51.09 Total impact

  • No preview · Article · Sep 2015
  • T. Hojo · R. Iwamoto · T. Fujisawa
    [Show abstract] [Hide abstract] ABSTRACT: We encountered a case of suspected delayed-type allergy to lidocaine. The patient was a 60-year-old woman who had previously undergone dental treatments with methylparaben-free lidocaine at least twice without experiencing any allergy symptoms. However, the following year, significant swelling of the vulva was observed in the evening after the morning of the application of an antipruritic cream to that area. Three months later, significant swelling and redness of the lips and chin were also observed at least several hours after the use of a local anesthesia to treat left nasal bleeding. At that time, a lidocaine allergy was diagnosed by a dermatologist. We initially performed a patch test based on our suspicion that methylparaben constituted the antigen component of the delayed-type allergy. Test reagents were applied with a patch tester kit to the anterior region of the forearm, and the kit was removed after 48 h. The evaluation was performed according to the standards of the International Contact Dermatitis Research Group at 49 and 72 h after the application of the tester kit. Test numbers 1, 3, and 4 were all strongly positive (+ +), indicating the presence of erythema, infiltration, and papules containing vesicles, regardless of the inclusion of methylparaben. As a result, an allergy to lidocaine was strongly suspected, contrary to our expectations. We next performed a patch test using procaine and obtained negative reactions. The patient subsequently underwent further dental treatments using procaine without experiencing any allergic reactions. These findings indicate that a drug may become an allergen, even if it has low antigenicity and has been used safely in the past.
    No preview · Article · Jan 2015 · Journal of Japanese Dental Society of Anesthesiology
  • No preview · Article · Mar 2014 · Cancer Research
  • No preview · Article · Mar 2014 · Cancer Research
  • No preview · Conference Paper · Mar 2014
  • A. Nasu · N. Kamekura · S. Takuma · Y. Kimura · T. Fujisawa
    No preview · Article · Jan 2014 · Journal of Japanese Dental Society of Anesthesiology
  • Y. Kimura · T. Hiwatari · Y. Nitta · T. Fujiwara · T. Fujisawa
    No preview · Article · Jan 2014 · Journal of Japanese Dental Society of Anesthesiology
  • [Show abstract] [Hide abstract] ABSTRACT: Frontotemporal dementia (FTD) is a disease that presents localized cerebral degeneration and atrophy in the frontal and temporal lobes of the brain. A patient with FTD has a high chance of being indicated for intravenous sedation in dental treatment from a relatively early stage due to being easily distracted and communication difficulty (Table 1). However, there are no reports on intravenous sedation management or management with BIS monitor for patients with FTD, although there have been some reports on intravenous sedation using the BIS monitor for dementia patients. Recently, we experienced intravenous sedation management using the BIS monitor for a patient with moderate or severe-stage FTD. MRI and SPECT of this patient are shown in Fig. 1. The electrode of the BIS monitor (Fig. 2) was attached to the right side of the forehead where there was less atrophy and diminished cerebral blood flow. The target dental treatment was completed under conscious sedation level with propofol at a continuous infusion speed of 1.5-3.5 mg/kg/h. The control value of BIS Index showed a normal level of 97 and the values during sedation management were in the low 80s. As a result, all values of BIS Index were consistent with clinical findings from the beginning to the end. The electroencephalographic views vary with the type of dementia and its period. In general, normal brain waves or decreased alpha and beta activities are seen in the incipient period, and theta waves, which are a slow wave, are dominant in the middle period in Alzheimer's disease (AD). Meanwhile, normal brain waves are seen in the incipient and middle periods, and decreased alpha and beta activities are seen in the last period in FTD. Therefore, the BIS monitor appears to be useful for evaluating sedation level in patients with FTD till the middle period, unlike patients with AD.
    No preview · Article · Jan 2013
  • No preview · Article · Dec 2012 · Cancer Research
  • No preview · Article · Dec 2012 · Cancer Research
  • No preview · Article · Mar 2012 · European Journal of Cancer
  • Y. Hase · N. Kamekura · Y. Kimura · T. Fujisawa · K. Fukushima
    [Show abstract] [Hide abstract] ABSTRACT: Hypertrophic obstructive cardiomyopathy (HOCM) is a cardiovascular disease that affects the heart muscle, causing left ventricular diastolic dysfunction and left ventricular outflow obstruction. Special attention must be paid to the possibility of sudden cardiac death and heart failure during general anesthesia in patients with HOCM. We describe a case of an oral floor carcinoma with HOCM, who had several coexisting diseases and a risk of sudden cardiac death. The patient was a 75-year-old female, who needed resection of the carcinoma and rotation of the pedicled submandibular gland, and who had a history of HOCM (pressure gradient 55 mmHg), hypertension, atrial fibrillation (Af), mitral regurgitation (MR), chronic heart failure, esophageal perforation by transesophageal echocardiography, suspicion of a left atrial thrombus, left renal infarction, multiple cerebral infarctions, obstructive lung disease, suspicion of pulmonary adenocarcinoma, and so on. She was treated with an anticoagulant (warfarin). After placement of an arterial catheter in the right radial artery for continuous blood pressure monitoring, general anesthesia was induced using midazolam, fentanyl and sevoflurane, and maintained with sevoflurane. Although her blood pressure often decreased, the capacity load and administration of phenylephrine were effective. The operation and anesthesia were completed without serious problems and the postoperative course was uneventful. In this case, as the patient also had MR, chronic heart failure, and Af, the tolerance range of circulation control was narrow. In other words, since the treatment policies for each disease differed, we faced a dilemma in the treatment strategy. For example, capacity load is desirable for HOCM, Af and MR, but it becomes a disadvantage for chronic heart failure. Moreover, as bradycardia can worsen regurgitation, the heart rate should be kept normal or slightly fast for MR, though it is critically important to prevent tachycardia in patients with HOCM and Af, as it causes increased myocardial oxygen consumption and left ventricular outflow obstruction. Careful planning for the responses to hemodynamic change and the possibility of fatal complications such as arrhythmia was necessary during anesthesia in this case. The details are as follows : considering a potential emergency such as perioperative acute circulatory failure, we asked the Department of Medical Anesthesia, the Emergency Department and Circulation Department for backup in advance. Preoperatively, we discussed the risks accompanying this anesthesia with the patient's family and obtained informed consent, which was a precondition of this management.
    No preview · Article · Jan 2012 · Journal of Japanese Dental Society of Anesthesiology
  • A. Nasu · N. Kamekura · M. Shibuya · T. Fujisawa
    No preview · Article · Jan 2012 · Journal of Japanese Dental Society of Anesthesiology
  • Y. Nitta · M. Shibuya · N. Kamekura · T. Fujisawa · K. Fukushima
    [Show abstract] [Hide abstract] ABSTRACT: Physical restraint is often needed when a patient with autism spectrum disorder panics during induction of general anesthesia. Enforced anesthesia induction with physical restraint has many risks such as injury to the patient and staff, as well as emotional trauma for the patient We tried to avoid physical restraint at the induction of general anesthesia in a 32-year-old male patient with autism using a structured teaching method and behavior management Because the patient had refused dental treatment since turning 18, he required dental treatment under general anesthesia. For the first five visits, he underwent anesthesia without physical restraint, but on the 6th visit, he required strong restraint. To avoid enforced anesthesia induction with restraint in subsequent visits, we attempted to use a visual guide based on structured teaching. Structured teaching is described in TEACCH (Treatment and Education for Autistic and Communication in Handicapped Children), which is a wellknown program for autism spectrum disorder (Table 1). The visual guide consists of a series of pictures of the places, tools and the processes that the patient will see and experience during induction of anesthesia Each card contains a written description in two or three words (Fig. 1). At preoperative consultation, we showed the picture cards and practiced the induction of anesthesia using them. Tell-Show-Do and count methods were used at the same time. We lent his mother the picture cards and facemask and asked her to practice repeatedly with them at home. For all three subsequent visits, we planned to manage him in the same procedure and with the same staff, as patients with autism prefer routines and sameness over changes and novelty. As a result of using these devices and procedures, we were able to manage him without any restraint It appears that people with autistic spectrum disorders are affected with panic because they cannot understand how to perform and cannot readily adapt to new changes or situations (Fig. 2). To avoid inducing panic, a structured teaching method with behavior management is effective for patients with autism spectrum disorders, even if they had previously experienced physical restraint for the induction of general anesthesia in the past.
    No preview · Article · Jan 2009
  • Y. Ofune · N. Kamekura · T. Fujisawa · K. Fukushima
    No preview · Article · Jan 2009
  • M. Shibuya · T. Fujisawa · Y. Kimura · N. Kamekura · K. Fukushima
    [Show abstract] [Hide abstract] ABSTRACT: Freeman-Sheldon Syndrome (FSS) is a congenital disorder defined by multiple abnormalities of the head, face, and skeleton. It is also called "whistling face syndrome" because of the characteristic appearance of the patient who has a small mouth and long philtrum. We performed general anesthesia for a patient with FSS. A 2-year-old male was scheduled to undergo palatoplasty. He had micrognathia, a short neck, ventricular septal defect, a past history of aspiration pneumonia and mental retardation (Fig. 1). Because he had fever and wheezing on the day of admission to our hospital, the operation was postponed. Two months later when he had no symptoms of a common cold, we conducted anesthesia. No premedication was done. Anesthesia was gradually induced with nitrous oxide, oxygen and sevoflurane. Because of thick subcutaneous tissue, it was difficult to establish a venous route which took a long time. After the establishment of the venous route, 0.1 mg/kg vecuronium bromide was given. Mask ventilation was possible when his face was turned sideways. The Cormack sign was grade III on laryngoscopy at first. With external cricoid pressure, the bottom of the vocal cord could be seen, and intubation with a 4.5 tracheal tube size could be done on the first attempt. Since a micro-defect of the interventricular septum could be suspected, prophylactic ampicillin was administered 30 minutes before the operation. His temperature rose to 38.2°C during anesthesia, but there were no other symptoms of malignant hyperthermia such as abnormal tachycardia, arrhythmia, muscle rigidity, elevation of EtCO2 or portwine-colored urine. After rectal acetaminophen administration, the temperature went down. As we judged that the airway could be sufficiently maintained after extubation and reintubation could be done, the endotracheal tube was removed in the operating room. There was no obstruction of the upper airway after the extubation. After he was moved back to his room, his respiratory condition was good until the 3 rd postoperative day. However, on the 4 th day, his temperature rose to 39.2°C and upper respiratory inflammation was diagnosed. Patients with FSS have various abnormalities as shown in Table 1. Table 2 shows the problems of general anesthesia in patients with FSS. Patients with FSS who undergo palatoplasty need careful care and attention because the operating area overlaps the airway and the operation may adversely affect postoperative airway management.
    No preview · Article · Jan 2008 · Journal of Japanese Dental Society of Anesthesiology
  • S. Homma · T. Fujisawa · S. Takuma · M. Shibuya · K. Fukushima
    No preview · Article · Jan 2008
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    T Fujisawa · S Takuma · H Koseki · K Kimura · K Fukushima
    [Show abstract] [Hide abstract] ABSTRACT: Dynamic balance involving movement of the centre of gravity is important for the evaluation of street fitness after sedation. The purpose of this study was to compare the recovery of dynamic balance after intravenous sedation with propofol or midazolam, and to investigate the usefulness of simple dynamic balance tests in evaluating the recovery. Fourteen young male volunteers underwent intravenous sedation with propofol and midazolam for 1 h each at an interval of more than 1 week. Computerized dynamic posturography using a multi-axial tilting platform, the 10-m maximum-speed walking test and the timed 'up & go' test (subjects stand up from a chair, walk 5 m and back with maximum speed and sit down again) were performed before and after sedation. The increase in each variable of the tests described above represents a reduction of function. The score of the computerized dynamic posturography was significantly lower in propofol sedation than that in midazolam sedation until 40 min after the end of sedation (P = 0.006). The scores of maximum-speed walking test and timed 'up & go' test were significantly lower in propofol sedation than those in midazolam sedation till 60 min after the end of sedation, respectively (P = 0.035 and 0.042). The timed 'up & go' and maximum-speed walking tests were well and significantly correlated with computerized dynamic posturography in midazolam sedation (timed 'up & go' test vs. computerized dynamic posturography: r = 0.66, P < 0.01; and maximum-speed walking test vs. computerized dynamic posturography: r = 0.53, P < 0.01). The timed 'up & go' and maximum-speed walking tests are useful simple dynamic balance tests well correlated with precise computerized dynamic posturography for the evaluation of the recovery of dynamic balance from midazolam sedation in younger adults.
    Full-text · Article · May 2007 · European Journal of Anaesthesiology
  • [Show abstract] [Hide abstract] ABSTRACT: We analyzed and investigated the management of thirty patients (9 male, 21 female) with panic disorder (PD) during dental treatment. There were more than twice as many female patients as male patients, and the patients were mostly in their thirties. At the time of their first visit to the outpatient clinic of the Department of Dental Anesthesiology of Hokkaido University Hospital, one third of the patients had been suffering from PD for 1 to 5 years, ten had PD for more than 10 years. Most of them were assessed as having exhibiting a relatively mild form of PD. Patients with PD sometimes have other complications such as other mental or physical diseases, and therefore we needed to consider these. In addition, some patients are taking medications which necessitate caution when considering administering epinephrine, (e. g., Serotonin-dopamine antagonist, tricyclic antidepressant, or phenothiazines), so it is necessary to be careful about the choice and dose of the local anesthetic during dental treatment. Moreover, many patients with PD have dental phobia and some of them have gagging reflex, so decisions regarding their management must be made carefully. Finally, we have to note the increased dosage of sedative drugs and their influence on the respiratory and circulatory system. The analysis showed that management of patients with PD was completed without complications in most of the cases. In particular, intravenous sedation (IVS) treatment appeared to be effective because once the patients were sedated, panic attacks did not occur. However, the study showed that there were 6 cases in which the management did not proceed as smoothly compared to the other cases. From these six cases, we observed the following : IVS was more suitable management method for the patients with PD than monitoring care alone. Preoperative care is very important, in addition to care during the operation. Pain control was indispensable throughout the managements. Pre- and postoperative sedation may be necessary, as well as prevention of postoperative nausea and vomiting. In order to smoothly perform dental treatments on patients with PD and prevent the occurrence of panic attacks, it is important to thoroughly inform the patients about the medication and the means of the management. It is strongly suggested to work with the patients' psychiatrist to assess the past medical history, severity of PD, general condition, and the medication they are taking.
    No preview · Article · Jan 2007 · Journal of Japanese Dental Society of Anesthesiology
  • A. Kurozumi · K. Kimura · N. Kamekura · T. Fujisawa · K. Fukushima
    [Show abstract] [Hide abstract] ABSTRACT: Intravenous sedation is widely used by dental anesthesiologists for dental treatment. However, there is no clear policy whether fasting should be practiced before the procedure to reduce the risk of pulmonary aspiration. We therefore sent a questionnaire to the department of dental anesthesiology of all 29 dental school hospitals in Japan. Twenty-three of the hospitals (79.3%) responded to the survey. We found that Japanese dental anesthesiologists have been practicing intravenous sedation in various ways: 21 hospitals followed a protocol; of these, 13 hospitals required fasting routinely, 8 hospitals required fasting when using certain drugs or to certain patients. On the other hand, 2 hospitals allowed the patients to eat and drink before the procedure (Fig. 2). The average time of 13 hospitals that required fasting in all patients was 5.3± 1.7 and 3.4±1.6 hours for food and fluids, respectively (Fig. 3). The average time of fasting was similar to those for general anesthesia. However, no dental anesthesiologist could clearly explain the rationale of why fasting was recommended. Only one hospital experienced pulmonary aspiration associated with sedation. Many respondents replied that they experienced unexpected changes from "conscious sedation" to "deep sedation" (Fig. 7). The available literature does not appear to provide sufficient evidence to conclude that fasting results in a decreased incidence of aspiration in patients undergoing sedation. However, deep sedation may compromise the protective reflexes and increase the risk of aspiration. Furthermore, the operative field of dental treatment, which is connected with the airway could further increase the risk of aspiration. Pulmonary aspiration during dental intravenous sedation appears to be rare. However, when it occurs, it is a morbid complication. Therefore, guidelines including preprocedure fasting before dental intravenous sedation may be required.
    No preview · Article · Jan 2006