Mika Seto

The success rate of nasotracheal intubation using lightwand does not depend on the laryngoscopic view.

PurposeThe purpose of this study was to evaluate the usefulness of Trachlight (TL) for nasotracheal intubation and to determine the relationship between the grade of laryngeal view and the subsequent ease of nasotracheal intubation using TL.MethodsPatients requiring nasotracheal intubation were enrolled in this study. Laryngoscopy was performed in all patients under topical anesthesia, with 8% lidocaine spray applied to the supraglottic region and the vocal cords. Glottic visualization during laryngoscopy was assessed using the Cormack and Lehane classification. Patients were allocated to four groups according to this classification. If the TL intubation was unsuccessful after three attempts, intubation was carried out using direct laryngoscopy. Intubation difficulty was assessed by the original 6-point scale and the total intubation time was also recorded.ResultsTrachlight intubation was successful in 89.1% of the 110 patients enrolled in the study. There was no observed correlation between the original 6-point scale and glottic visualization. The total intubation time and the ratio of “unsuccessful” cases were not significantly different among the four groups.ConclusionNo relationship was found between the ease of nasotracheal intubation using TL and glottic visualization.

Oral surgery under local anesthesia with dexmedetomidine sedation in a morbidly obese patient with aortic dissection

We report a case of a morbidly obese man with an aortic aneurysm, in whom dental surgery was performed before elective cardiac surgery. His aortic aneurysm required emergency surgery. However, because of his morbid obesity, elective cardiac surgery was planned. Considering the high risk of infective endocarditis, dental surgery was required. Our patient was at a high risk of aortic rupture caused by hypertension and breathing difficulty in the supine position. Dexmedetomidine (DEX) is an anti-anxiety, sedative, and analgesic medicine that can stabilize circulatory dynamics and minimize blood pressure fluctuations. We administered intravenous DEX for sedation of the patient in Fowlers position. In conclusion, our understanding of the risk factors of DEX enabled us to perform safe invasive oral treatment.

QT-interval prolongation due to medication found in the preoperative evaluation

QT prolongation is an electrocardiographic change that can lead to lethal arrhythmia. Acquired QT prolongation is known to be caused by drugs and electrolyte abnormalities. We report three cases in which the prolonged QT interval was improved at the time of operation by briefly discontinuing the drugs suspected to have caused the QT prolongation observed on preoperative electrocardiography. The QTc of cases 1, 2, and 3 improved from 518 to 429 ms, 463 to 441 ms, and 473 to 443 ms on discontinuing the use of a gastrointestinal prokinetic agent, a proton pump inhibitor, and a molecular targeted drug, respectively. These cases were considered to have drug-induced QT prolongation. We reaffirmed that even drugs administered for conditions unrelated to cardiac diseases can have adverse side effect of QT prolongation. In conclusion, our cases indicate that dental surgeons should be aware of the dangerous and even potentially lethal side effects of QT prolongation. For safe oral and maxillofacial surgery, cooperation with medical departments in various fields is important.

Anxiety before dental surgery under local anesthesia: reducing the items on state anxiety in the State-Trait Anxiety Inventory-form X

Background It is important to evaluate preoperative anxiety and prepare sedation when performing dental surgery under local anesthesia. Spielbergers State-Trait Anxiety Inventory (STAI) is useful for predicting preoperative anxiety. State anxiety is defined as a subjective feeling of nervousness. Reduction in the number of the state anxiety items (questions) will be clinically important in allowing us to predict anxiety more easily. Methods We analyzed the STAI responses from 1,252 patients who visited our institution to undergo dental surgery under local anesthesia. Multiple linear regression analysis was conducted for 9 groups comprising anxiety level determinations using the STAI; we then developed a coefficient of determination and a regression formula. We searched for a group satisfying the largest number of requirements for regression expression while setting any necessary conditions for accurately predicting anxiety before dental surgery under local anesthesia. Results The regression expression from the group determined as normal for preoperative state anxiety was deemed the most suitable for predicting preoperative anxiety. Conclusions It was possible to reduce the number of items in the STAI by focusing on “Preoperative anxiety before dental surgery.”

Appropriate Head Position for Nasotracheal Intubation by Using Lightwand Device

Background: The purpose of this study was to determine the relationship between the head position and the subsequent ease of nasotracheal intubation by using lightwand device TrachlightTM (TL). Methods: Patients requiring nasotracheal intubation were subdivided into three groups according to the intubated head position (Group S: sniffing position, Group E: extension position, Group N: neutral position). The number of attempts, the total intubation time, and the failures of the TL intubation were recorded. Intubation difficulty by means of TL was assessed by the original 6-point scale. Results: Of total 300 patients enrolled in the study, TL intubation was successful in the patients of 91.3%. No correlation between the original scale and the head position was observed. Conclusion: TL is an effective alternative for patients who require nasotracheal intubation. We could not find the favorable head position for nasotracheal intubation with TL, so we recommend that the nasotracheal intubation with TL should be started with neutral position and have to find the appropriate head position individually.

Radicular cyst in a patient with untreated Wiskott–Aldrich syndrome: A case report

Abstract Wiskott–Aldrich syndrome (WAS) is a condition with variable expression, which causes persistent thrombocytopenia and, in its complete form, also causes small platelets and humoral immunodeficiency. A 14-year-old boy, diagnosed with WAS but never treated, presented with symptoms of heart and renal failure. His right buccal region was swollen and his right first molar showed a cyst-like image on dental X-ray films. The boys symptoms were attributed to an infected cyst, greatly aggravated by WAS-related immunodeficiency. The boy was sedated and the affected tooth and cyst were enucleated. Invasive treatment was safely achieved by paying close attention to whole-body management.

Wisdom teeth extraction in a patient with moyamoya disease

Moyamoya disease is a rare neurovascular disorder that involves constriction of certain arteries in the brain. In patients with moyamoya disease, it is very important to prevent cerebral ischemic attacks and intracerebral bleeding caused by fluctuating blood pressure and increased respiration. A 40-year-old woman with moyamoya disease was scheduled for extraction of her right upper and lower impacted wisdom teeth. Her lower impacted wisdom tooth was situated close to the inferior alveolar nerve. We decided to continue her oral antiplatelet therapy and planned intravenous sedation with analgesic agents administered approximately five minutes prior to extraction of the root of the mandibular wisdom tooth. Oral analgesic medications were regularly administered postoperatively to alleviate pain and anxiety. During the perioperative period, no cerebrovascular event occurred, and the wisdom teeth were successfully extracted as per the planned procedure. It is thought that the perioperative risks of wisdom tooth extraction in patients with moyamoya disease can be minimized with the use of our protocols.

Gabapentin therapy in patients with orofacial neuropathic pain: Report of 12 cases

Abstract Objective There are several types of orofacial neuropathic pain and some of these types are often refractory to treatment. Gabapentin is an oral antiepileptic agent with a proven analgesic effect in various traumatic neuropathic pain syndromes. We retrospectively examined the analgesic effect of gabapentin on non-dental and non-traumatic orofacial neuropathic pain. Subjects and methods This study included 12 patients. All patients showed an excessive response to noxious (hyperalgesia) and/or innocuous (allodynia) stimuli in the affected region. Gabapentin therapy was initiated with a dosage of 200–600mg/day. Pain intensity was assessed using a modified numerical rating scale (m-NRS) (0, no pain; 10, pain equal to that experienced on the day gabapentin therapy was initiated). In addition, the side effects were also recorded. Results All the patients had received medications for their pain prior to referral, but the drugs failed to provide adequate relief from their neuropathic pain. The m-NRS scores for all patients started decreasing within 7 days after internal use was initiated. The average time taken for the m-NRS score to decrease to half was 3.3 (1.7) days. Side effects were observed in 2 patients. Conclusion We concluded that gabapentin therapy is efficacious for the treatment of orofacial neuropathic pain in selected patients.