Toshiaki Fujisawa

Hokkaido University, Sapporo, Hokkaido, Japan

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Publications (31)26.9 Total impact

  • Yukie Nitta · Nobuhito Kamekura · Shigeru Takuma · Toshiaki Fujisawa
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    ABSTRACT: Abstract Acute angle-closure glaucoma (AACG) is a rare complication of general anesthesia. The coexistence of individual risk factors for postoperative AACG and factors associated with intraocular hypertension are considered to be required for postoperative AACG to develop. We present a case of AACG after general anesthesia for oral bone grafting in a patient with no preoperative eye symptoms. In this case, several factors such as postoperative care in a darkened room, psychological stress, and postoperative hypertension may have precipitated the event in this patient, who may have had preexisting undiagnosed elevated intraocular pressure. The interval between the earliest appearance of symptoms at 9 hours and the ultimate diagnosis was 36 hours. In the postoperative period following general anesthesia, any patient is at risk for AACG. It is important that a postoperative diagnosis of AACG should be considered and a timely consultation with an ophthalmologist be considered if a postoperative patient complains of red eyes, visual disorder, eye pain, headache, and nausea.
    No preview · Article · Dec 2014 · Anesthesia Progress
  • Yuri Hase · Nobuhito Kamekura · Toshiaki Fujisawa · Kazuaki Fukushima
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    ABSTRACT: Abstract Klippel-Feil syndrome (KFS) is a rare disease characterized by a classic triad comprising a short neck, a low posterior hairline, and restricted motion of the neck due to fused cervical vertebrae. We report repeated anesthetic management for orthognathic surgeries for a KFS patient with micrognathia. Because KFS can be associated with a number of other anomalies, we therefore performed a careful preoperative evaluation to exclude them. The patient had an extremely small mandible, significant retrognathia, and severe limitation of cervical mobility due to cervical vertebral fusion. As difficult intubation was predicted, awake nasal endotracheal intubation with a fiberoptic bronchoscope was our first choice for gaining control of the patient's airway. Moreover, the possibility of respiratory distress due to postoperative laryngeal edema was considered because of the surgeries on the mandible. In the operating room, tracheotomy equipment was always kept ready if a perioperative surgical airway control was required. Three orthognathic surgeries and their associated anesthetics were completed without a fatal outcome, although once the patient was transferred to the intensive care unit for precautionary postoperative airway management and observation. Careful preoperative examination and preparation for difficult airway management are important for KFS patients with micrognathia.
    No preview · Article · Sep 2014 · Anesthesia Progress
  • A. Nasu · N. Kamekura · S. Takuma · Y. Kimura · T. Fujisawa

    No preview · Article · Jan 2014 · Journal of Japanese Dental Society of Anesthesiology
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    ABSTRACT: The neuropeptide Y (NPY) system is known as one of the major neural signaling pathways. NPY, produced by peripheral tissues including osteoblasts, is known to bind to the Y1 receptor. Recently, osteoblast-specific Y1 receptor knockout mice were developed and were found to have a high bone mass phenotype, indicating a role for the NPY-Y1 receptor axis as a regulator of bone homeostasis. However, regulation of Y1 receptor expression during osteoblastic differentiation remains unexplored. In the present study, we examined the role of bone morphogenetic protein (BMP) 2 signaling in regulating Y1 receptor expression. In C2C12 cells, expression of Y1 receptor mRNA was induced by BMP2. This induction was also observed after co-transfection with Smad1 and Smad4, the intracellular signaling molecules of the BMP2 signaling pathway. In a transfection assay, Smad1/4 up-regulated transcriptional activity through interaction with the Y1 receptor gene promoter. Following transfection of MC3T3-E1 cells with siRNA for the Y1 receptor, the expression of ALP, osteocalcin, Runx2 and osterix were increased. These results show that BMP2 signaling regulates Y1 receptor gene expression, and raises the possibility that NPY acts in osteoblasts via an autocrine mechanism.
    Preview · Article · Sep 2013 · Biochemical and Biophysical Research Communications
  • Y. Hase · N. Kamekura · Y. Kimura · T. Fujisawa · K. Fukushima
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    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
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    ABSTRACT: Recovery of dynamic balance, involving adjustment of the center of gravity, is essential for safe discharge on foot after ambulatory anesthesia. The purpose of this study was to assess the recovery of dynamic balance after general anesthesia with sevoflurane, using two computerized dynamic posturographies. Nine hospitalized patients undergoing oral surgery of less than 2 h duration under general anesthesia (air-oxygensevoflurane) were studied. A dynamic balance test, assessing the ability of postural control against unpredictable perturbation stimuli (Stability System; Biodex Medical), a walking analysis test using sheets with foot pressure sensors (Walk Way-MG1000; Anima), and two simple psychomotor function tests were performed before anesthesia (baseline), and 150 and 210 min after the emergence from anesthesia. Only the double-stance phase in the walking analysis test showed a significant difference between baseline and results at 150 min. None of the other variables showed any differences among results at baseline and at 150 and 210 min. The recovery times for dynamic balance and psychomotor function seem to be within 150 min after emergence from general anesthesia with sevoflurane in patients undergoing oral surgery of less than 2-h duration.
    No preview · Article · Feb 2009 · Journal of Anesthesia
  • Y. Ofune · N. Kamekura · T. Fujisawa · K. Fukushima

    No preview · Article · Jan 2009
  • M. Shibuya · T. Fujisawa · Y. Kimura · N. Kamekura · K. Fukushima
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    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
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    ABSTRACT: Complete dentures were constructed after tooth extraction for a 71-year-old uncommunicative patient with Alzheimer's disease. Although she had never previously used them, her husband requested the fitting of complete maxillary and mandibular dentures. Thirteen teeth were extracted under local anesthesia and intravenous sedation (IVS), followed by impression-making under IVS. Denture fabrication and adjustment were carried out under mild physical restraint. A tissue conditioner was applied to the fitting surface of the denture base followed by regular denture adjustments. The time required for the patient to eat a meal decreased from 90 minutes without dentures to 30 minutes with dentures due to an improvement in swallowing. Important factors in the successful fitting and use of dentures in this patient were the use of IVS to control behavior during treatment, the treatment plan focused on painless denture use, and oral care by the patient's husband.
    No preview · Article · Sep 2007 · Special Care in Dentistry
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    ABSTRACT: Assessing the recovery of dynamic balance after intravenous sedation in the elderly is important for ensuring their safe discharge, especially when they are walking. A reliable, simple dynamic balance test would be useful in daily clinical practice. We observed the recovery of balance after intravenous sedation with midazolam, using computerized dynamic posturography (CDP), and we evaluated the correlation between the CDP result and the results of simple dynamic balance tests. Midazolam was administered in divided doses, until the Wilson sedation score reached 3, in 18 elderly male volunteers. The dynamic balance test using CDP with perturbation stimuli was performed before and after sedation. As simple dynamic balance tests, the usual-speed walking (USW) and maximum-speed walking (MSW) tests and a modified timed "up and go" (TUG) test (subjects stand up from a chair, walk 5 m forward and return to the chair with MSW, and sit down again) were performed. The recovery times (defined as the time until the significant difference between the value at each time point and the baseline value disappeared) in the dynamic balance test (CDP), USW test, MSW test, and TUG test, were 80, 40, 80, 80 min, respectively. There was a significant, strong positive correlation between the result of the dynamic balance test (CDP) and the TUG test (P < 0.01; r = 0.70). The TUG test is a useful simple dynamic balance/motor test that can be used in daily clinical practice in the elderly.
    Full-text · Article · May 2007 · Journal of Anesthesia
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    ABSTRACT: We have previously reported that a dynamic balance test with perturbation stimuli and computerised dynamic posturography sensitively reflected the inhibitory effect on balance of intravenous midazolam sedation given intravenously as a single dose, and recovery time was within 80 min. The purpose of this study was to investigate the recovery of dynamic balance after additional doses of midazolam. Eighteen young adult male volunteers were sedated with midazolam given intravenously. The initial dose was given until the Wilson sedation score reached 3, and an additional dose was given until the same score was obtained 40 min later. They were tested with perturbation stimuli 40, 80, 100, and 120 min after the additional doses had been given. Their recovery time was recorded. The mean (S.D.) initial dose of midazolam was 0.07 (0.005) mg kg(-1), and additional doses were 41 (7)% of the initial dose. The serial changes in bispectral index after initial and additional doses were similar. The recovery time for the dynamic balance test (within 80 min) was the same as that recorded in the previous single-dose study. The recovery time of the psychomotor function test was within 75 min. Additional doses of midazolam aiming for a Wilson sedation score of 3 at a dose about 40% of the initial dose and given 40 min after the initial dose are valid in terms of the maintenance of sedation and recovery of dynamic balance. Complete recovery time, including psychomotor function, was within 80 min of the additional dose of the drug.
    Full-text · Article · May 2007 · British Journal of Oral and Maxillofacial Surgery
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    T Fujisawa · S Takuma · H Koseki · K Kimura · K Fukushima
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    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
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    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
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    ABSTRACT: Background and objective: Computerized dynamic posturography using an intentional postural sway task can be used to assess body-leaning ability and postural control ability to prevent falls. Falls are the leading cause of morbidity and mortality for the elderly. The purpose of the present study was to evaluate the recovery of intentional dynamic balance function after intravenous sedation with midazolam in elderly subjects in comparison with that in young subjects. Methods: Midazolam was administered in small, divided doses over 4 to 5 minutes until the Wilson sedation score reached 3 in 20 young and 18 elderly male volunteers. A dynamic limits of stability test, in which subjects leaned their body intentionally as indicated by a cursor moving on a computer screen, was performed before (baseline) and 50, 70, 90, 110, and 130 minutes after administration of midazolam. Results: The changes from baseline values of path sway and movement time 50 minutes after the administration of midazolam in elderly subjects (106.8101.0 %, 4.63.0 seconds; meanSD) were significantly greater than those (32.987.2%, 1.92.8 seconds) in young subjects (p=0.024, p=0.008), respectively. Conclusions: The elderly show slower recovery of the intentional dynamic balance function than do young adults after intravenous sedation with midazolam.
    Full-text · Article · Jun 2006 · European Journal of Anaesthesiology
  • A. Kurozumi · K. Kimura · N. Kamekura · T. Fujisawa · K. Fukushima
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    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
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    ABSTRACT: To assess street fitness after sedation, computerized dynamic posturography (CDP) involving movement of the center of gravity may be more accurate than the conventional computerized static posturography (CSP). The purpose of this study was to evaluate the recovery of dynamic balance function after intravenous sedation by CDP in comparison with CSP, and to find a simple dynamic balance test that is well correlated with CDP. The subjects were 20 male volunteers aged 20-27 years. After intravenous injection of midazolam (0.07 mg . kg(-1)), four balance tests were performed. The recovery time and the percentage of subjects showing recovery (difference from the baseline value < or =10%) were compared. As CDP, a test in which unexpected perturbation stimuli are given using an unstable platform was performed. As CSP, standing sway tests were performed. Maximum speed walking (MSW) and usual speed walking (USW) tests were performed as simple balance tests. The recovery time in CDP (80 min) was longer than that in CSP (40-60 min). The percentage of subjects showing recovery in CDP (20%) was significantly lower than that in CSP (55%-70%) 60 min after the administration of midazolam. There was a significant positive correlation between the CDP test and the MSW test (r = 0.67). CDP with perturbation stimuli detects the balance inhibitory effects of midazolam with greater sensitivity than CSP. The MSW test is well correlated with CDP with perturbation stimuli.
    No preview · Article · Feb 2005 · Journal of Anesthesia
  • S. Takuma · T. Fujisawa · H. Koseki · K. Kimura · K. Fukushima
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    ABSTRACT: The purpose of this study was to investigate the usefulness of a modified propofol intravenous sedation method with a target controlled infusion (TCI) pump and evaluate the level of sedation with constant verbal stimulation in volunteers. Methods: Fourteen healthy male volunteers were sedated with intravenous propofol. The sedation level aimed for was a state in which the patient's eyes were closed but they responded to mild verbal commands. The TCI was started after the initial target blood concentration had been set at 2.2 μg/ml (Fig. 1). Immediately after the aimed sedation level was recognized during induction, the target blood concentration was manually reset to the same value as the calculated brain (effect-site) concentration displayed at that time (A value). Then the infusion rate was automatically regulated to let the calculated blood concentration follow the target blood concentration. The target blood concentration was manually regulated to maintain sedation level described above during the experiment. The main parameters were 1) the calculated brain concentration of propofol at the time when the sedation level aimed for appeared during induction, 2) the maximum discrepancy between the calculated brain concentration at the sedation level aimed for during induction and the calculated blood concentration during the experiment, and 3) Bispectral index (BIS) value from the beginning of infusion to the end of infusion. Results: The calculated brain concentration at the sedation level aimed for during induction was 1.69±0.08 μg/ml (mean±SD) and the distribution range was wide, from 1.0 to 2.2 μg/ml (Fig. 2). A maximum discrepancy of less than 0.2 μg/ml occurred in 71% (10/14) of the volunteers (Fig. 3). The range of BIS was from 70 to 83 (77.1±3.2) between 5 minutes after the beginning of infusion and the end of infusion. Conclusion: This method has shown to predict the optimal blood concentration within a small error range, using the calculated brain concentration at the optimal sedation level obtained during induction. Moreover, the maintenance of the calculated blood concentration was easy and reliable because the infusion rate was changed automatically according to a validated pharmacokinetic model. Therefore, this TCI pump method is useful.
    No preview · Article · Jan 2005 · Journal of Japanese Dental Society of Anesthesiology
  • K. Kimura · T. Fujisawa · S. Takuma · H. Koseki · K. Fukushima
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    ABSTRACT: It is important that during conscious sedation in patients undergoing dental treatment, the capability of maintaining certain reflexes are not lost. We considered that the risk of mis-swallowing is low if the patient is capable of holding or containing water in the oral cavity, during dental treatment, so that aspiration is avoided. Using the modified Gargle test, we investigated whether there were any differences in maintaining the ability of holding water in the oral cavity between sedation with intravenous propofol or midazolam. Fourteen healthy male volunteers enrolled in this study. The mean age was 23.9±1.7 years old (mean±SD). The sedation level aimed for was the Wilson's sedation score 3 (eyes closed but arousable to command). Drug administration was titrated by observing the clinical signs and bispectral index (BIS) monitor to achieve the adequate sedation level. The modified Gargle tests, consisting of three tests were carried out as follows: a) Before (control) and after the drugs were administered for 30 minutes, 20 ml of water was introduced into the oral cavity, and it was observed whether the subject could hold or contain the water for 1 minute. After the test was completed, the residual amount of water was measured (the water containment test); b)Thereafter, 5 ml of water was introduced into the oral cavity, and the subject was asked to swallow the water while the mouth was opened (the drinking test); c) Lastly, the subject was instructed to gargle for 10 seconds after 10 ml of water was introduced into the oral cavity. At the end of the test, the residual quantity of water was measured (the gargling test). All of the above tests were performed in the supine position. The BIS values immediately before the test were 78.9±8.6 in the propofol group (group P) and 81.9±4.2 in the midazolam group (group M). There were no significant differences between the two groups (Fig. 1). Twelve subjects achieved the water containment test in both groups. Fourteen subjects achieved the drinking test in group P as compared to 13 in group M. Thirteen subjects achieved the gargling test in each of the groups. Most volunteers achieved the goals in the tests as described above (Fig. 2). We also investigated the rate of reduction of sterilized water in the water containment test and the gargling test for test achievers. In the water containment test, the reduction rates (%) were 17.5±20.9 and 26±23.9 in group P and group M, respectively (Fig. 3). In the gargling test, the reduction rates (%) were 5.3±10.4 and 15.8±17.4 in group P and group M, respectively (Fig. 4). There were no significant differences between the two groups. In conclusion, the present study showed that the ability for water containment in the mouth was similarly achieved under conscious sedation with either propofol or midazolam in healthy young volunteers.
    No preview · Article · Jan 2004 · Journal of Japanese Dental Society of Anesthesiology
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    ABSTRACT: This retrospective study analyzed the management of 25 patients with hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), or dilated phase of hypertrophic cardiomyopathy (dHCM) treated in the outpatient clinic of the Department of Dental Anesthesiology at Hokkaido University. A total of 87 dental treatment sessions were completed. Intravenous sedation was used significantly more often for patients with HCM than those who had DCM. This seemed to be because dental anesthesiologists expected sedative drugs to suppress hyperdynamic circulatory changes caused by mental stress. Intraoperative complications occurred during 19 treatments. The incidence of circulatory complications increased when participants with DCM also reported dental fear. For participants with HCM who reported dental fear, circulatory complications occurred only when sedation was not used. It is not clear whether complications were related to cardiac function or dental treatment. Therefore, it is important to continually monitor patients with these conditions and to be prepared to handle complications that may arise during dental treatment.
    No preview · Article · Nov 2003 · Special Care in Dentistry