Shigeharu Jinno

Postoperative hyperthermia of unknown origin treated with dantrolene sodium.

An 11-year-old girl was scheduled for alveolar cleft bone grafting with an iliac bone under general anesthesia. Anesthesia was performed with 70% nitrous oxide, 30% oxygen, and propofol. On the first and second postoperative day, persistent hyperthermia was observed. Because the administration of diclofenac sodium had not been effective for the hyperthermia, dantrolene sodium was given. Her body temperature gradually dropped and returned to normal level on the fifth postoperative day. The hyperthermia in the present case might have been caused by a rapidly elevated muscle metabolism in response to pain and stress after the propofol anesthesia. The oral administration of dantrolene sodium successfully lowered the patients high body temperature.

Sensory changes after tongue reduction for macroglossia

We report sensory changes after tongue reduction by the Harada-Enomoto method for macroglossia in a 20-year-old woman with Beckwith-Wiedemann syndrome. Sensory tests were performed before surgery and 1 week and 2 months after surgery. We assessed the static tactile threshold, vibration sense, static 2-point discrimination, pain threshold, and taste. No sensory loss of any category tested was observed after tongue reduction.

Accuracy and reliability of thermal threshold measurement in the chin using heat flux technique

BACKGROUND Neurosensory disturbance (NSD) occasionally develops in the chin following dental treatments, and evaluation of the involved nerve damage is important for treatment. The thermal-threshold test is a method of evaluating nerve sensations, but it is not widely used because its accuracy and reliability have not yet been determined. PURPOSE This study aimed to determine the accuracy and reliability of thermal-threshold measurement of the chin by using the heat-flux technique. MATERIALS AND METHODS The subjects were 19 healthy volunteers (7 women, 12 men), aged 21 to 36 years (mean age +/- SD, 27.2 +/- 4.5 years). The thermal thresholds, including the warm and cold heat-flux thresholds (WHF and CHF, respectively) were measured on the chin, forehead, and neck by using a thermostimulator. To evaluate test-retest reliability, we measured the thermal thresholds on 3 different days (days 1, 3, and 7). RESULTS The WHF and CHF of the right chin were 460 +/- 165 W/m(2) (mean +/- SD W/m(2)) and 589 +/- 133 W/m(2), respectively, and those of the left chin were 446 +/- 112 W/m(2) and 576 +/- 147 W/m(2), respectively. The thermal thresholds of the right and left chin were significantly correlated (R = 0.89, P < .001). Thermal-threshold measurement was more accurate in the case of the chin than in the case of the neck. The thermal thresholds measured over the 3 days varied very little (intraclass correlation coefficient, 0.80-0.81), indicating high test-retest reliability. CONCLUSION The heat-flux technique is accurate and highly reliable. Therefore, it may be a useful method for determining the thermal threshold of the chin.

Risk Factors With Intravenous Sedation for Patients With Disabilities

The purpose of this study was to identify the risk factors associated with low peripheral oxygen saturation (SpO2) and delayed recovery of dental patients with disabilities after intravenous sedation. A total of 1213 patients with disabilities were retrospectively investigated with respect to demographic parameters and sedation conditions. Multivariate logistic analyses were conducted for patients with an SpO2 <90% and a recovery period of >60 minutes to identify the risk factors for poor sedation conditions. A significant odds ratio related to decreased SpO2 was observed for age, sex, midazolam and propofol levels, concurrent use of nitrous oxide, cerebral palsy, Down syndrome, and mental retardation. The most problematic patients were those diagnosed with Down syndrome (odds ratio, 3.003-7.978; 95% confidence interval; P < .001). Decision tree analysis showed an increased risk of decreased SpO2 in males with Down syndrome or after administration of >0.493 mg/kg propofol in combination with midazolam. An increased risk of delayed awakening was seen in patients aged less than 21 years and in males administered >0.032 mg/kg of midazolam. Intravenous sedation for dental patients with disabilities, particularly those with cerebral palsy, Down syndrome, or mental retardation, increases the risk of decreased SpO2. In addition, delayed recovery is expected after midazolam administration.

Analysis of clinical usefulness of the heat flux technique: predictability of the recovery from neurosensory disturbances in the chin undergoing mandibular sagittal split ramus osteotomy

OBJECTIVE To examine the prognosis of the neurosensory disturbance (NSD) in the chin after bilateral sagittal split ramus osteotomy (BSSRO), using the heat flux technique. STUDY DESIGN Twenty-nine patients (total 58 sides) undergoing BSSRO were examined. The warm sensory threshold (WHF) and cold sensory threshold (CHF) in the chins of these patients were measured by the heat flux technique. Touch sensory threshold (TS) was measured by an Semmes-Weinstein esthesiometer. Touch sensory disturbance was subjectively evaluated by visual analog scale. RESULTS At all of the postoperative time points, there were no significant differences in the incidence rate among all tests (chi-squared test; P > .05). WHF, CHF, and TS were significantly correlated with the subjective evaluation. Recovery from NSD was delayed in cases that the postoperative variation of 2 weeks was >400 W/m(2) in WHF and CHF and the filament marking at 2 weeks after surgery was >3.5 in TS. CONCLUSION The heat flux technique appears to be a useful method for the prediction of the recovery from NSD in the chin.

Delirium during intravenous sedation with midazolam alone and with propofol in dental treatment.

A 62-year-old man visited our clinic for dental implantation under intravenous sedation. He demonstrated increased psychomotor activity and incomprehensible verbal contact during intravenous sedation. Although delirium caused by midazolam or propofol in different patients has been reported, the present case represents a delirium that developed from both drugs in the same patient, possibly because of the patients smaller tolerance to midazolam and propofol.

Difference of Recovery of Neuromuscular Function in Adductor Pollicis and Flexor Hallucis Brevis Following Muscle Relaxation with Vecuronium

In general anesthesia, neuromuscular function should be monitored to detect the degree of recovery from muscle relaxation for safety use of neuromuscular blocking agent. The method of the detection involves measuring the force of the muscle contraction induced by electrical stimulation of the peripheral nerve innervating of a muscle. Ulner nerve and Adductor Pollicis muscle are usually evaluated for this purposed. However these cannot be used, for example, in the case of burn or trauma in the hands, forearm surgery, or head and neck surgery. In these cases, Tibial nerve and Flexor Hallucis Brevis muscle may be substituted.